SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: April 7, 2004.
Purpose: Chapter 388-475 WAC, SSI-Related Medical--Part 2 of 4, SSI-related medical eligibility rules are being combined into one Washington Administrative Code (WAC) chapter, chapter 388-475 WAC, for easier reference. In some instances, the rules have been rewritten according to the clear writing standards of the Governor's Executive Order 97-02.
New sections WAC 388-475-0350 Property and contracts, 388-475-0400 Vehicles excluded as resources, 388-475-0450 Life insurance excluded as a resource, and 388-475-0500 Burial funds, contracts, and spaces excluded as resources. Repealing WAC 388-470-0040 Additional excluded resources for SSI-related medical assistance.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-470-0040.
Statutory Authority for Adoption: RCW 74.04.050, 74.08.090.
Adopted under notice filed as WSR 03-20-077 on September 29, 2003.
Changes Other than Editing from Proposed to Adopted Version:
|•||WAC 388-475-0350 (6), (7): Dates changed from "2003" to "2004" to reflect date of WAC implementation.|
|•||WAC 388-475-0450 (3) and (4): Wording changed to clarify meaning of life insurance policies with potential to have cash surrender value. The subsections now read: "(3) If the total face value of all policies with a CSV potential that a person owns on the same insured is equal to or less than fifteen hundred dollars, the resource is excluded. (4) If the total face value of all policies with a CSV potential that a person owns on the same insured is more than fifteen hundred dollars, the total CSV of the policies is counted toward the resource limit, unless the client designates such policies as burial funds. If they are designated as burial funds, they must be evaluated under the burial fund exclusion described in WAC 388-475-0500."|
|•||WAC 388-475-0500 (4) and (8): Subsection (4) wording "(a) and (b)" was removed after "described in subsection (2)" to clarify that this subsection applies to all of subsection (2) of this WAC; subsection (8)(c): Two subsections (iii) and (iv) were erroneously deleted from the proposed rule sent to public hearing from previous drafts, listing burial related resource exclusions. These are added back in, and read: "(iii) Arrangements for the opening and closing of the gravesite; and (iv) Contracts for care and maintenance of the gravesite."|
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 4, Amended 0, Repealed 1.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: June 1, 2004.
April 7, 2004
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3306.5
(a) A client's household goods and personal effects;
(b) One home (which can be any shelter), including the land on which the dwelling is located and all contiguous property and related out-buildings in which the client has ownership interest, when:
(i) The client uses the home as his or her primary residence; or
(ii) The client's spouse lives in the home; or
(iii) The client does not currently live in the home but the client or his/her representative has stated the client intends to return to the home; or
(iv) A relative, who is financially or medically dependent on the client, lives in the home and the client, client's representative, or dependent relative has provided a written statement to that effect.
(c) The value of ownership interest in jointly owned real property is an excluded resource for as long as sale of the property would cause undue hardship to a co-owner due to loss of housing. Undue hardship would result if the co-owner:
(i) Uses the property as his or her principal place of residence;
(ii) Would have to move if the property were sold; and
(iii) Has no other readily available housing.
(2) Cash proceeds from the sale of the home described in subsection (1)(b) above are not considered if the client uses them to purchase another home by the end of the third month after receiving the proceeds from the sale.
(3) An installment contract from the sale of the home described in subsection (1)(b) above is not a resource as long as the person plans to use the entire down payment and the entire principal portion of a given installment payment to buy another excluded home, and does so within three full calendar months after the month of receiving such down payment or installment payment.
(4) The value of sales contracts is excluded when the:
(a) Current market value of the contract is zero,
(b) Contract cannot be sold, or
(c) Current market value of the sales contract combined with other resources does not exceed the resource limits.
(5) Sales contracts executed before December 1, 1993, are exempt resources as long as they are not transferred to someone other than a spouse.
(6) A sales contract for the sale of the client's principal place of residence executed between December 1, 1993 and May 31. 2004 is considered an exempt resource unless it has been transferred to someone other than a spouse and it:
(a) Provides interest income within the prevailing interest rate at the time of the sale;
(b) Requires the repayment of a principal amount equal to the fair market value of the property; and
(c) The term of the contract does not exceed thirty years.
(7) A sales contract executed on or after June 1, 2004 on a home that was the principal place of residence for the client at the time of institutionalization is considered exempt as long as it is not transferred to someone other than a spouse and it:
(a) Provides interest income within the prevailing interest rate at the time of the sale;
(b) Requires the repayment of a principal amount equal to the fair market value of the property within the anticipated life expectancy of the client; and
(c) The term of the contract does not exceed thirty years.
(8) Payments received on sales contracts of the home described in subsection (1)(b) above are treated as follows:
(a) The interest portion of the payment is treated as unearned income in the month of receipt of the payment;
(b) The principal portion of the payment is treated as an excluded resource if reinvested in the purchase of a new home within three months after the month of receipt;
(c) If the principal portion of the payment is not reinvested in the purchase of a new home within three months after the month of receipt, that portion of the payment is considered a liquid resource as of the date of receipt.
(9) Payments received on sales contracts described in subsection (4) are treated as follows:
(a) The principal portion of the payment on the contract is treated as a resource and counted toward the resource limit to the extent retained at the first moment of the month following the month of receipt of the payment; and
(b) The interest portion is treated as unearned income the month of receipt of the payment.
(10) For sales contracts that meet the criteria in subsections (5), (6), or (7) but do not meet the criteria in subsections (3) or (4), both the principal and interest portions of the payment are treated as unearned income in the month of receipt.
(11) Property essential to self-support is not considered a resource within certain limits. The department places property essential to self-support in several categories:
(a) Real and personal property used in a trade or business (income-producing property), such as:
(v) Motor vehicles, and
(b) Nonbusiness income-producing property, such as:
(i) Houses or apartments for rent, or
(ii) Land, other than home property.
(c) Property used to produce goods or services essential to an individual's daily activities, such as land used to produce vegetables or livestock, which is only used for personal consumption in the individual's household. This includes personal property necessary to perform daily functions including vehicles such as boats for subsistence fishing and garden tractors for subsistence farming, but does not include other vehicles such as those that qualify as automobiles (cars, trucks).
(12) The department will exclude an individual's equity in real and personal property used in a trade or business (income producing property listed in subsection (11)(a) above) regardless of value as long as it is currently in use in the trade or business and remains used in the trade or business.
(13) The department excludes up to six thousand dollars of an individual's equity in nonbusiness income-producing property listed in subsection (11)(b) above, if it produces a net annual income to the individual of at least six percent of the excluded equity.
(a) If a person's equity in the property is over six thousand dollars, only the amount over six thousand dollars is counted toward the resource limit, as long as the net annual income requirement of six percent is met on the excluded equity.
(b) If the six percent requirement is not met due to circumstances beyond the person's control, and there is a reasonable expectation that the activities will again meet the six percent rule, the same exclusions as in subsection (13)(a) above apply.
(c) If a person has more than one piece of property in this category, each is looked at to see if it meets the six percent return and the total equities of all those properties are added to see if the total is over six thousand dollars. If the total is over the six thousand dollars limit, the amount exceeding the limit is counted toward the resource limit.
(d) The equity in each property that does not meet the six percent annual net income limit is counted toward the resource limit, with the exception of property that represents the authority granted by a governmental agency to engage in an income-producing activity if it is:
(i) Used in a trade or business or nonbusiness income-producing activity; or
(ii) Not used due to circumstances beyond the individual's control, e.g., illness, and there is a reasonable expectation that the use will resume.
(14) Property used to produce goods or services essential to an individual's daily activities is excluded if the individual's equity in the property does not exceed six thousand dollars.
(15) Personal property used by an individual for work is not counted, regardless of value, while in current use, or if the required use for work is reasonably expected to resume.
(16) Interests in trust or in restricted Indian land owned by an individual who is of Indian descent from a federally recognized Indian tribe or held by the spouse or widow/er of that individual, is not counted if permission of the other individuals, the tribe, or an agency of the federal government must be received in order to dispose of the land.
(2) One vehicle is excluded regardless of its value, if it is used to provide transportation for the individual or a member of the individual's household:
(a) For employment;
(b) For the treatment of a specific or regular medical problem;
(c) For transportation of or modified for operation by a handicapped person; or
(d) Because of climate, terrain, distance, or similar factors to perform essential daily activities.
(3) If no vehicle is excluded under subsection (2), the department excludes up to five thousand dollars of the current fair market value of one vehicle as a resource. If the current fair market value of the vehicle exceeds five thousand dollars, the excess is counted toward the resource limit.
(4) A vehicle used as the client's primary residence is excluded as the home, and does not count as the one excluded vehicle.
(5) All other vehicles, except those excluded under WAC 388-475-0350 (11) through (14), are treated as nonliquid resources and the equity value is counted toward the resource limit.
(2) Policies owned by each spouse are evaluated and counted separately.
(3) If the total face value of all policies with a CSV potential that a person owns on the same insured is equal to or less than fifteen hundred dollars, the resource is excluded.
(4) If the total face value of all policies with a CSV potential that a person owns on the same insured is more than fifteen hundred dollars, the total CSV of the policies is counted toward the resource limit, unless the client designates such policies as burial funds. If they are designated as burial funds, they must be evaluated under the burial fund exclusion described in WAC 388-475-0500.
(a) Revocable burial contracts;
(b) Revocable burial trusts;
(c) Installment contracts for purchase of a burial space on which payments are still owing;
(d) Other revocable burial arrangements. The designation is effective the first day of the month in which the person intended the funds to be set aside for burial.
(2) The following burial funds are excluded as resources for the client and spouse up to fifteen hundred dollars each when set aside solely for the expenses of burial or cremation and expenses related to the burial or cremation, and the funds are either:
(a) An installment contract for purchase of a burial space that is not yet paid in full; or
(b) In a revocable burial contract, burial trust, cash accounts, or other financial instrument with a definite cash value.
(3) Interest earned in burial funds and appreciation in the value of excluded burial arrangements in subsection (2)(a) and (b) above are excluded from resources and are not counted as income if left to accumulate and become part of the separate burial fund.
(4) The fifteen hundred dollar exclusion for burial funds described in subsection (2) above is reduced by:
(a) The face value of life insurance with CSV excluded in WAC 388-475-0450; and
(b) Amounts in an irrevocable burial trust, or other irrevocable arrangement available to meet burial expenses, or burial space purchase agreement installment contracts on which money is still owing. If these reductions bring the balance of the available exclusion to zero, no additional funds can be excluded as burial funds.
(5) An irrevocable burial account, burial trust, or other irrevocable burial arrangement, set aside solely for burial and related expenses is not considered a resource. The amount set aside must be reasonably related to the anticipated death-related expenses in order to be excluded.
(6) A client's burial funds are no longer excluded when they are mixed with other resources that are not related to burial.
(7) When excluded burial funds are spent for other purposes, the spent amount is added to other countable resources and any amount exceeding the resource limit is considered available income on the first of the month it is used. The amount remaining in the burial fund remains excluded.
(8) Burial space and accessories for the client and any member of the client's immediate family described in subsection (9) of this section are excluded. Burial space and accessories include:
(a) Conventional gravesites;
(b) Crypts, niches, and Mausoleums;
(c) Urns, caskets and other repositories customarily used for the remains of deceased persons;
(d) Necessary and reasonable improvements to the burial space including, but not limited to:
(i) Vaults and burial containers;
(ii) Headstones, markers and plaques;
(iii) Arrangements for the opening and closing of the gravesite; and
(iv) Contracts for care and maintenance of the gravesite.
(e) A burial space purchase agreement that is currently paid for and owned by the client is also defined as a burial space. The entire value of the purchase agreement is excluded; as well as any interest accrued, which is left to accumulate as part of the value of the agreement. The value of this agreement does not reduce the amount of burial fund exclusion available to the client.
(9) Immediate family, for the purposes of subsection (8) of this section includes the client's:
(b) Parents and adoptive parents;
(c) Minor and adult children, including adoptive and stepchildren;
(d) Siblings (brothers and sisters), including adoptive and stepsiblings;
(e) Spouses of any of the above.
None of the family members listed above, need to be dependent on or living with the client, to be considered immediate family members.
The following section of the Washington Administrative Code is repealed:
|WAC 388-470-0040||Additional excluded resources for SSI-related medical assistance.|