SOCIAL AND HEALTH SERVICES
[Filed December 20, 1996, 3:43 p.m.]
Preproposal statement of inquiry was filed as WSR 96-19-039.
Title of Rule: WAC 388-506-0630, 388-511-1130, 388-511-1140, and 388-513-1330.
Purpose: Clarification concerning COLA exemption process, deeming, and self-employment income deductions. Implement change in garnished income.
Statutory Authority for Adoption: RCW 74.08.090 and 74.05.040.
Statute Being Implemented: 20 CFR 416.1110-1112 and 1160.
Summary: See Purpose above.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, 617 8th S.E., Olympia, WA, (360) 753-0529.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is necessary because of federal law, 20 CFR 416.1110-1112 and 1160.
Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.
Proposal Changes the Following Existing Rules: See Purpose above.
No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not have an economic impact on small businesses. It concerns eligibility policy and affects only clients and staff.
Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. This section does not pertain to the Department of Social and Health Services.
Hearing Location: Lacey Government Center (behind Tokyo Bento restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on February 4, 1997, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Merry Kogut, Manager, by January 14, 1997, TTY (360) 902-8324, Voice (360) 902-8317.
Submit Written Comments to: Leslie Baldwin, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by February 4, 1997.
Date of Intended Adoption: February 5, 1997.
December 20, 1996
Merry A. Kogut, Manager
Rules and Policies Assistance Unit
AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)
WAC 388-506-0630 SSI-related income deeming. (1) At the client's option, the department shall consider an SSI-related person, living with a spouse or parent who is ineligible for SSI, as a separate MAU. The department shall deem income from a financially responsible spouse or parent to the SSI-related person, who lives in the same household, as follows when determining:
(a) Categorically needy or medically needy eligibility for an SSI-related child. The department shall consider the income of the parents available to the SSI-related child except for:
(i) Income exemptions under WAC 388-511-1140, including the twenty dollar deduction and the sixty-five dollars plus one-half of the balance earned income deduction; and
(ii) A child's allowance for each SSI-ineligible child equal to one-half of the Federal Benefit Rate (FBR) minus any income of that child; and
(iii) A parent's allowance equal to:
(A) One-person FBR for a single parent; or
(B) Two-person FBR for two parents.
(b) Categorically needy Medicaid for an SSI-related spouse. The department shall:
(i) Allow the financially responsible spouse the income exemptions under WAC 388-511-1140 except the:
(A) Twenty dollars deduction; and
(B) Sixty-five dollars plus one-half earned income deduction.
(ii) Deduct from the financially responsible spouse's income, a child's allowance for each SSI ineligible child equal to one-half of the FBR minus any income of that child;
(iii) Deem from the financially responsible spouse:
(A) Zero income when the financially responsible spouse's income equals or is less than one-half of the FBR after allowing the income deductions in (b)(i) and (ii) of this subsection; or
(B) All the financially responsible spouse's income when the income exceeds one-half of the FBR after allowing the income deductions in (b)(i) and (ii) of this subsection.
(c) Medically needy Medicaid for an SSI-related spouse. The department shall:
(i) Allow the financially responsible spouse the income deductions in (b)(i) and (ii) of this subsection;
(ii) Deem from the financially responsible spouse:
(A) Zero income when the financially responsible spouse's income equals or is less than the one-person medically needy income level (MNIL) after allowing the income deductions in (b)(i) and (ii) of this subsection;
(B) The financially responsible spouse's income above the MNIL after allowing the income deductions in (b)(i) and (ii) of this subsection;
(iii) From the SSI-related spouse's income, allow an amount needed to bring the financially responsible spouse's income up to the MNIL.
(2) The department shall consider a person eligible for Medicaid
when the person is ineligible for SSI cash assistance because of income
or resources deemed available from an alien sponsor.
[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-506-0630, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-92-027
AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)
WAC 388-511-1130 SSI-related income availability. The department shall:
(1) Consider client checks received in advance of the month the checks are normally received as income in the month of normal receipt;
(2) Consider electronically transferred client funds available as income in the month of normal receipt, regardless of whether the banking institution posted the funds to the client's bank account before or after the month the funds are payable;
(3) Include as ((
earned)) countable income the earned or unearned
income amounts withheld due to garnishment under a court, administrative
or agency order. See WAC (( 388-511-1140(4))) 388-513-1380(4) for
garnishment (( of unearned income)) affecting an institutionalized client;
(4) As a condition of eligibility, require a client to take all
necessary steps to obtain any annuities, pensions, retirement, and
disability benefits to which the client is entitled, unless the client
can show good cause for not doing so. Annuities, pensions, retirement,
and disability benefits include, but are not limited to, veteran's
compensation and pensions, OASDI benefits, railroad retirement benefits,
and unemployment compensation.
[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-511-1130, filed 5/3/94, effective 6/3/94. Formerly WAC 388-92-034 (part).]
AMENDATORY SECTION (Amending Order 3943, filed 2/9/96, effective 3/11/96)
WAC 388-511-1140 SSI-related income exemptions. (1) The department shall exempt:
(a) Any public agency's refund of taxes paid on real property or on food;
(b) State public assistance and supplemental security income (SSI) based on financial need;
(c) Any portion of a grant, scholarship, or fellowship used to pay tuition, fees, or other necessary educational expense at an educational institution;
(d) Income that a client does not reasonably anticipate, or receives infrequently or irregularly, when such income does not exceed twenty dollars per month if unearned, or ten dollars per month if earned;
(e) Any amount a client receives for the foster care of a child who lives in the same household, if the child is not SSI-eligible and was placed in such home by a public or nonprofit child placement or child care agency;
(f) One-third of any payment for child support a parent receives from an absent parent for a minor child who is not institutionalized;
(g) The first twenty dollars per month of earned or unearned income, not otherwise excluded in subsection (1)(a) through (f) of this section, for a client at home. The department shall consider the exemption only once for a husband and wife. The department shall not apply such exemption on income paid on the basis of an eligible person's needs, which is totally or partially funded by the federal government or a private agency;
(h) Tax exempt payments Alaska natives receive under the Alaska Native Claims Settlement Act;
(i) Tax rebates or special payments exempted under other statutes;
(j) Compensation provided to volunteers in ACTION programs established by P.L. 93-113, the Domestic Volunteer Service Act of 1973;
(k) From the income of a single SSI-related parent or a married SSI-related parent whose spouse does not have income, an amount to meet the needs of an ineligible minor child living in the household of SSI-related parent. See WAC 388-506-0630 when the SSI-related client has a spouse with income. The exemption is one-half of the one-person Federal Benefit Rate (FBR) less any income of the child;
(l) Veteran's benefits designated for the veteran's:
(i) Dependent; or
(ii) Aid and attendance/housebound allowance and unusual medical expense allowance (UME). For an institutionalized client, see WAC 388-513-1345;
(m) COLA increases in Title II Social Security Administration
. The department shall)) for a noninstitutionalized client:
Determine current client eligibility for categorically needy
medical assistance under WAC 388-503-0310(4), including all Title II
cost-of-living adjustment (COLA) benefit increases)) Received by the(( :
(A))) client since the client's termination from SSI/SSP; or
(B))) (ii) Received by the client's spouse (( and/))or other
financially responsible (( family member)) person living in the (( same))
household during the time period (( under (m)(i) of this subsection))
since the SSI/SSP termination.
(ii) Consider the total of the COLA benefit increases and the
Title II Social Security Administration benefits in computing the
client's participation in the cost of the institutionalized client's
(n) A fee a guardian or representative payee charges as reimbursement for providing services, when such services are a requirement for the client to receive payment of the income;
(o) Income an ineligible or nonapplying spouse receives from a governmental agency for services provided to an eligible client such as chore services;
(p) Certain cash payments a client receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;
(q) Restitution payment and any interest earned from such payment to a person of Japanese or Aleut ancestry under P.L. 100-383;
(r) The amount of the expenses directly related to a client's impairment that allows the permanently and totally disabled client to continue to work;
(s) The amount of the blindness-related work expenses of a blind client;
(t) Interest earned on excluded burial funds and any appreciation in the value of an excluded burial arrangement which are left to accumulate and become part of the separately identified burial funds set aside on or after November 1, 1982;
(u) Earned income tax credit (EITC);
(v) Crime victim's compensation funds;
(w) Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims under P.L. 101-201;
(x) Payments to certain survivors of the Holocaust under the Federal Republic of Germany's Law for Compensation of National Socialist Persecution or German Restitution Act. Interest earned on this income is not exempt;
(y) Payments to the injured person, the surviving spouse, children, grandchildren, or grandparents under the Radiation Exposure Compensation Act; and
(z) Payments under section 500 through 506 of the Austrian General Social Insurance Act. The department shall consider the earned interest from such payments as countable income;
(aa) Payments from the Dutch government, under the Netherlands' Act on Benefits for Victims of Persecution (WUV). The department shall consider interest earned on such payments as countable income; and
(bb) Up to two thousand dollars per year derived from an individual interest in Indian trust or restricted land.
(2) Unless income is contributed to the client, the department shall exempt all earned income of an ineligible or nonapplying person twenty years of age and under who is a student regularly attending a school, college, university, or pursuing a vocational or technical training designed to prepare the student for gainful employment.
(3) For the SSI-related client, the department shall exempt the first sixty-five dollars per month of earned income not excluded according to subsection (1) of this section, plus one-half of the remainder.
The department shall exempt as income the unearned income
amounts withheld due to garnishment under a court, administrative, or
(5))) The department shall exempt as income the unearned income
amounts which represent an essential expense incurred in receiving the
(6))) (5) Effective November 1, 1995, the department shall exempt
income which causes the client to lose SSI eligibility due solely to the
reduction in state supplement payment (SSP).
(6) The department shall exempt any portion of self-employment
income normally allowed as an income deduction by the Internal Revenue
[Statutory Authority: RCW 74.08.090 and State Plan Amendment Sup. 8a to
Article 2.6-A page 6. 96-05-010 (Order 3943, #100295), 388-511-1140,
filed 2/9/96, effective 3/11/96. Statutory Authority: RCW 74.08.090,
P.L. 100-383, AFDC Transmittal Memo, POMS 830.100, 830.115, 830.725 and
1130.605. 95-08-070 (Order 3845), 388-511-1140, filed 4/5/95,
effective 5/6/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order
3732), 388-511-1140, filed 5/3/94, effective 6/3/94. Formerly parts
of WAC 388-92-034 and 388-92-036.]
AMENDATORY SECTION (Amending Order 3819, filed 12/28/94, effective
WAC 388-513-1330 Institutional--Available income. (1) Income is defined under chapter 388-511 WAC for a SSI-related client and under WAC 388-22-030 for an AFDC-related client.
(2) The methodology and standards for determining and evaluating
income are defined under chapter 388-513 WAC ((
388-513-1315 and 388-513-1375)).
(3) The department shall consider the following income available to an institutionalized person when determining income eligibility unless the criteria in subsection (4) of this section is met:
(a) Income the institutionalized spouse receives in the institutionalized spouse's name;
(b) Income paid on the behalf of the institutionalized spouse, but received in the name of the institutionalized spouse's representative;
(c) One-half of the income the community and institutionalized spouses receive in both names; and
(d) Income from a trust as provided by the trust.
(4) The department shall consider income as available to an institutionalized person when:
(a) Both spouses are institutionalized; or
(b) An institutionalized person has a community spouse and income in excess of three hundred percent of the SSI federal benefit rate (FBR). For the determination of eligibility only:
(i) Use community property law in determining ownership of income for purposes of Medicaid eligibility;
(ii) Presume all income received after marriage by husband or wife to be community income;
(iii) Divide the total of the community income, by two assigning one-half of the total to each person; and
(iv) Consider if the community income received in the name of the nonapplying spouse exceeds the community income received in the name of the applying spouse, the applicant's interest in that excess shall be unavailable to the applicant.
(5) The department shall consider income the community spouse receives in the community spouse's name as unavailable to the institutionalized spouse.
(6) The department shall consider an agreement between spouses transferring or assigning rights to future income from one spouse to the other as invalid in determining eligibility for medical assistance or the limited casualty program for the medically needy.
(7) The department shall consider income produced by transferred or assigned resources as separate income.
(8) When an institutionalized spouse establishes the unavailability of income by a preponderance of evidence through a fair hearing, subsection (3) of this section shall not apply.
(9) See WAC 388-511-1130 for treatment of advance dated checks, and
electronically transferred funds((
, and garnished income)).
[Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter #94-33. 95-02-028 (Order 3819), 388-513-1330, filed 12/28/94, effective 1/28/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-513-1330, filed 5/3/94, effective 6/3/94.]