Original Notice.

     Preproposal statement of inquiry was filed as WSR 10-23-122.

     Title of Rule and Other Identifying Information: WAC 388-475-0820 SSI-related medical -- Child-related income exclusions, 388-475-0840 SSI-related medical -- Work- and agency-related income exclusions, 388-475-0900 SSI-related medical -- Allocating income, 388-475-0920 SSI-related medical -- Deeming/allocation of income from nonapplying spouse (new), 388-475-0940 SSI-related medical -- Deeming income from an ineligible parent(s) to a child applying for SSI-related medical (new), 388-475-0960 SSI-related medical -- Allocating income -- How the department considers income and resources when determining eligibility for an individual applying for noninstitutional medicaid when another household member is receiving institutional medicaid (new), and 388-506-0620 SSI-related medical clients (repeal).

     Hearing Location(s): Office Building 2, Auditorium, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html or by calling (360) 664-6094), on July 5, 2011, at 10:00 a.m.

     Date of Intended Adoption: Not sooner than July 6, 2011.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 1115 Washington Street S.E., Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on July 5, 2011.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by June 21, 2011, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at jennisha.johnson@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules:

•	DSHS is updating WAC to change the deeming and allocation rules for SSI-related medical programs so they mirror the federal rules. The department is creating new WAC to further clarify deeming rules relating to deeming from ineligible parents to applicant children; deeming between an applicant spouse and a nonapplying spouse; and deeming between spouses when one spouse is institutionalized.
•	DSHS is adding new language in WAC 388-475-0840 to support the student earned income exclusion and adding language in WAC 388-475-0820 to define a student for SSI-related medical.
•	DSHS is repealing WAC 388-506-0620 and incorporating the language to a new rule in chapter 388-475 WAC series.

     Reasons Supporting Proposal: See Purpose statement above.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500.

     Statute Being Implemented: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Catherine Fisher, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1357.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule does not impact small businesses.

     A cost-benefit analysis is not required under RCW 34.05.328. Client eligibility rules for medical assistance are exempt from the cost-benefit analysis requirement per RCW 34.05.328 (5)(b)(vii).

May 13, 2011

Katherine I. Vasquez

Rules Coordinator

     (a) ((The minor child lives with an SSI-related parent)) Unmarried; ((and))

     (b) ((The minor child is not receiving a needs-based cash payment such as TANF or SSI)) Living in the household of the SSI-related applicant; ((and))

     (c) ((The SSI-related parent is single)) The natural, adopted or stepchild of the SSI-related applicant or the applicant's spouse; ((or))

     (d) ((The SSI-related parent lives with a spouse who has no income; and)) Not receiving a needs-based cash payment such as TANF or SSI; and

     (e) ((The individual applying for or receiving SSI-related medical benefits is the adult parent. The maximum allowance is one-half the Federal Benefit Rate (FBR) for each child.)) Is either:

     (i) Age seventeen or younger; or

     (ii) Age twenty-one or younger and meets the SSI-related definition of a student described in subsection (6) of this section.

     (2) The department allows an allocation for the support of a child when determining the countable income of an SSI-related applicant. The allocation is calculated as follows:

     (a) For categorically needy (CN) medical coverage, the allocation is deducted from the countable income of a nonapplying spouse before determining the amount of the nonapplying spouse's income to be deemed to the SSI-related applicant. Allocations to children are not deducted from the income of an unmarried SSI-related applicant.

     (b) For medically needy (MN) medical coverage, the allocation is first deducted from the income of the nonapplying spouse as described in subsection (2)(a) of this section when the SSI-related applicant is married, and from the income of the applicant when the applicant is not married.

     (3) The child's countable income, if any, is subtracted from the maximum child's allowance before determining ((this allowance)) the amount of allocation.

     (((2))) (4) Foster care payments received for a child who is not SSI-eligible and who is living in the household, placed there by a licensed, nonprofit or public child placement or childcare agency are excluded from income regardless of whether the person requesting or receiving SSI-related medical is the adult foster parent or the child who was placed.

     (((3))) (5) Adoption support payments, received by an adult for a child in the household that are designated for the child's needs, are excluded as income. Adoption support payments that are not specifically designated for the child's needs are not excluded and are considered unearned income to the adult.

     (((4))) (6) The department excludes the earned income of a person ((under age twenty-two is excluded)) age twenty-one or younger if that person is a student. A student must meet one of the following criteria in order to allow the student earned income exclusion:

     (a) Attend a school, college, or university a minimum of eight hours a week; or

     (b) Pursue a vocational or technical training program designed to prepare the student for gainful employment a minimum of twelve hours per week; or

     (c) Attend school or be home schooled in grades seven through twelve at least twelve hours per week.

     (((5) Child support payments received from an absent parent for a child living in the home are considered the income of the child.

     (6))) (7) Any portion of a grant, scholarship, fellowship, or gift used for tuition, fees and/or other necessary educational expenses at any educational institution is excluded from income and not counted as a resource for nine months after the month of receipt.

     (8) One-third of child support payments received for a child ((are)) who is an applicant for SSI-related medical is excluded from the child's income. Child support payments that are subject to the one-third deduction may be voluntary or court-ordered payments for current support or arrears.

     (((7) Any portion of a grant, scholarship, fellowship, or gift used for tuition, fees and/or other necessary educational expenses at any educational institution is excluded from income for nine months after the month of receipt.

     (8))) (9) The one-third deduction described in subsection (8) of this section does not apply to child support payments received from an absent parent for a child living in the home when the parent(s) or their spouse is the applicant for SSI-related medical. Voluntary or court-ordered payments for current support or arrears are always considered the income of the child for whom they are intended and not income to the parent(s).

     (10) Gifts to, or for the benefit of, a person under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that code, is excluded as follows:

     (a) In-kind gifts that are not converted to cash; or

     (b) Cash gifts up to a total of two thousand dollars in a calendar year.

     (((9))) (11) Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children are excluded from income. Any portion of a veteran's payment that is designed as the dependent's income is countable income to the dependent and not the applicant (assuming the applicant is not the dependent).

     (((10) Unless it is specifically contributed to the client, all earned income of an ineligible or nonapplying person under the age of twenty-one who is a student:

     (a) Attending a school, college, or university; or

     (b) Pursuing a vocational or technical training program designed to prepare the student for gainful employment.))

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500, and Social Security Act as amended by P.L. 108-203. 06-04-046, § 388-475-0820, filed 1/26/06, effective 2/26/06. Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-005, § 388-475-0820, filed 4/7/04, effective 6/1/04.]

     (1) Work related expenses:

     (a) ((Including child care,)) That enable an SSI-related client to work;

     (b) That allows a blind or disabled client to work and that are directly related to the person's impairment.

     (2) First sixty-five dollars plus one-half of the remainder of earned income. This is considered a work allowance/incentive. This deduction does not apply to income already excluded.

     (3) Any portion of self-employment income normally allowed as an income deduction by the Internal Revenue Service (IRS).

     (4) Earned income of a person age twenty-one or younger if that person meets the definition of a student as defined in WAC 388-475-0820.

     (5) Veteran's Aid and Attendance, housebound allowance, unusual/unreimbursed medical expenses (UME) paid by the VA to some disabled veterans, their spouses, widows or parents. For people receiving long-term care services, see chapter 388-513 WAC.

     (((5))) (6) Department of Veterans Affairs benefits designated for the veteran's dependent as long as the SSI-related applicant is not the dependent receiving the income. If an SSI-related applicant receives a dependent allowance based on the veteran's or veteran's survivor claim, the income is countable as long as it is not paid due to unusual medical expenses (UME).

     (7) Payments provided in cash or in-kind, to an ineligible or nonapplying spouse, under any government program that provides social services provided to the client, such as chore services or attendant care.

     (((6))) (8) SSA refunds for medicare buy-in premiums paid by the client when the state also paid the premiums.

     (((7))) (9) Income that causes a client to lose SSI eligibility, due solely to reduction in the SSP.

     (((8) Department of Veteran's Affairs benefits designated for the veteran's dependent. It is considered income of that dependent.

     (9))) (10) Tax rebates or special payments excluded under other statutes.

     (((10))) (11) Any public agency refund of taxes paid on real property or on food.

[Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-005, § 388-475-0840, filed 4/7/04, effective 6/1/04.]

     (1) ((When income is allocated from an SSI-related person to other household members, that income is considered as the other members' income.

     (2) A portion of the income of a spouse or parent is allocated to the needs of an SSI-related applicant when the spouse or parent is:

     (a) Financially responsible for the SSI-related person as described in WAC 388-408-0055 and 388-506-0620. For long-term care programs, see WAC 388-513-1315, 388-513-1330, 388-513-1350; for waiver programs see WAC 388-515-1505 through 388-515-1530;

     (b) Living in the same household;

     (c) Not receiving SSI; and

     (d) Either not related to SSI or is not applying for medical assistance.

     (3) Allocations to children are deducted from the nonapplying spouse's unearned income, then from their earned income, before they are deducted from the applicant's income. See WAC 388-475-0820.

     (4) If the conditions in subsection (2) are met, the income to be allocated from a parent to an SSI-related minor child applying for medical benefits is the amount remaining after deducting:

     (a) All allowable income exclusions and disregards as described in WAC 388-475-750 through 388-475-880;

     (b) One-half of the federal benefit rate (FBR) for each SSI ineligible sibling of the SSI related child living in the household, minus any countable income of that child. See WAC 388-478-0055 for FBR amount;

     (c) The parent's allowance, either the one person FBR for a single parent or two person FBR for a two-parent household.

     (5) A portion of the countable income of a nonapplying spouse remaining after the deductions in subsection (4) may be allocated to the SSI-related spouse as follows for CN medical determinations:

     (a) If the income is less than or equal to one-half of the FBR after allowing the income exclusions in subsection (4) of this section, no income is allocated to the client.

     (b) If the income is equal to or more than one-half of the FBR after allowing the income exclusions in subsection (4) of this section, all income other than the excluded amounts is allocated to the applying spouse.

     (6) Deductions from the income of the nonapplying spouse of an SSI-related applicant for CN medical determinations are:

     (a) Income exclusions as described in WAC 388-475-0750 through 388-478-0880;

     (b) One-half of the federal benefit rate (FBR) as described in WAC 388-478-0055 for each eligible child in the household, minus the child's countable income.

     (7) In determining MN medical eligibility for SSI-related applicants:

     (a) If the income of the nonapplying spouse is less than the MNIL (see WAC 388-478-0070) after applying any child allocation, a portion of the applying spouse's countable income is added to the nonapplying spouse's income to raise it to the MNIL for MN;

     (b) If the income of the nonapplying spouse is more than the MNIL after applying any child allocation, the entire amount exceeding the MNIL is allocated to the applying spouse.

     (8))) Deeming is the process of determining how much of another person's income is counted when determining eligibility of an SSI-related applicant. When income is deemed to the SSI-related applicant from other household members, that income is considered the applicant's income. Income is deemed only:

     (a) From a nonapplying spouse who lives with the SSI-related applicant; or

     (b) From a parent(s) residing with an SSI-related applicant child.

     (2) An allocation is an amount deducted from income counted in the eligibility determination and considered to be set aside for the support of a person other than the SSI-related applicant. When income is allocated to other household members from the SSI-related applicant(s) or from the applicant's spouse, that income is not counted as income of the SSI applicant.

     (3) An SSI-related person applying for categorically needy (CN) medical coverage must have countable income at or below the SSI categorically needy income level (CNIL) described in WAC 388-478-0080 unless the person is working and meets all requirements for the healthcare for workers with disabilities (HWD) program described in WAC 388-475-1000 through 388-475-1250.

     (4) For institutional or home and community based waiver programs, use rules described in WAC 388-513-1315.

     (5) The department follows rules described in WAC 388-475-0600 through 388-475-0880 to determine the countable income of an SSI-related applicant or SSI-related couple.

     (6) If countable income of the applicant exceeds the one-person SSI CNIL prior to considering the income of a nonapplying spouse or children, the applicant is not eligible for CN medical coverage and the department determines eligibility for the medically needy (MN) program. If the countable income does not exceed the SSI CNIL, see WAC 388-475-0920 to determine if income is to be deemed to the applicant from the nonapplying spouse.

     (7) If countable income (after allowable deductions) of an SSI-related couple both applying for medical coverage exceeds the two-person SSI CNIL, the couple is not eligible for CN medical coverage and the department determines eligibility for the medically needy (MN) program.

     (8) For CN medical coverage, allocations to children are deducted from the nonapplying spouse's unearned income, then from their earned income before income is deemed to the SSI-related applicant. See WAC 388-475-0820.

     (9) For MN medical coverage, allocations to children are deducted from the income of the SSI-related applicant or SSI-related applicant couple. See subsection (10) of this section to determine the amount of the allocation.

     (10) An SSI-related individual or couple applying for MN medical coverage is allowed an allocation to a nonapplying spouse, their SSI recipient spouse or their dependent child(ren) to reduce countable income before comparing income to the medically needy income level (MNIL) described in WAC 388-478-0070. The department allocates income:

     (a) Up to the one-person MNIL to a nonapplying spouse or SSI recipient spouse minus the spouse's countable income; and

     (b) Up to one-half of the federal benefit rate (FBR) to each dependent minus each dependent's countable income. See WAC 388-475-0820 for child exclusions.

     (11) A portion of a nonapplying spouse's income may be deemed to the SSI-related applicant:

     (a) See WAC 388-475-0920(5) to determine how much income is deemed from a nonapplying spouse to the SSI-related applicant when determining CN eligibility; and

     (b) See WAC 388-475-0920(10) to determine how much income is deemed from a nonapplying spouse to the SSI-related applicant when determining MN eligibility.

     (12) A portion of the income of an ineligible parent or parents is allocated to the needs of an SSI-related applicant child. See WAC 388-475-0940 (4) through (7) to determine how much income is allocated from ineligible parent(s).

     (13) Only income and resources actually contributed to an alien applicant from their sponsor are counted as income. For allocation of income from an alien sponsor, refer to WAC 388-450-0155.

[Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-005, § 388-475-0900, filed 4/7/04, effective 6/1/04.]

     (1) A portion of the income of a nonapplying spouse is considered available to meet the needs of an SSI-related applicant. A nonapplying spouse is defined as someone who is:

     (a) Financially responsible for the SSI-related applicant as described in WAC 388-408-0055 and 388-475-0960. For institutional and home and community based waiver programs, see WAC 388-513-1315;

     (b) Living in the same household with the SSI-related applicant;

     (c) Not receiving a needs based payment such as temporary assistance to needy families (TANF), state funded cash assistance (SFA); or

     (d) Not related to SSI, or is not applying for medical assistance including spouses receiving SSI.

     (2) An ineligible spouse is the spouse of an SSI cash recipient and is either not eligible for SSI for themselves or who has elected to not receive SSI cash so that their spouse may be eligible. An SSI-related applicant who is the ineligible spouse of an SSI cash recipient is not eligible for categorically needy (CN) medical coverage and must be considered for medical coverage under the medically needy (MN) program.

     (3) When determining whether a nonapplying spouse's income is countable, the department:

     (a) Follows the income rules described in WAC 388-475-0600 through 388-475-0750;

     (b) Excludes income described in WAC 388-475-0800 (2) through (11), and all income excluded under federal statute or state law as described in WAC 388-475-0860.

     (c) Excludes work-related expenses described in WAC 388-475-0840, with the exception that the sixty-five dollars plus one half earned income deduction described in WAC 388-475-0840(2) does not apply;

     (d) Deducts any court ordered child support which the nonapplying spouse pays for a child outside of the home (current support or arrears); and

     (e) Deducts any applicable child-related income exclusions described in WAC 388-475-0820.

     (4) The department allocates income of the nonapplying spouse to nonapplying children who reside in the home as described in WAC 388-475-0820. Allocations to children are deducted first from the nonapplying spouse's unearned income, then from their earned income.

     (a) For CN medical determinations, allocations to children are not allowed out of the income of the SSI-related applicant, only from the income of the nonapplying spouse.

     (b) For MN medical determinations, allocations to children are allowed from the income of the SSI-related applicant if the applicant is unmarried.

     (5) For SSI-related CN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:

     (a) Less than or equal to one-half of the federal benefit rate (FBR), no income is deemed to the applicant. Compare the applicant's countable income to the one-person SSI categorically needy income level (CNIL) described in WAC 388-470-0040. For healthcare for workers with disabilities (HWD) applicants, compare to the one-person HWD standard described in WAC 388-478-0075 (1)(c).

     (b) Greater than one-half of the FBR, then the entire nonapplying spouse's countable income is deemed to the applicant. Compare the applicant's income to the two-person SSI CNIL. For HWD applicants, compare to the two-person HWD standard described in WAC 388-478-0075 (1)(c).

     (6) When income is not deemed to the SSI-related applicant from the nonapplying spouse per section (5)(a):

     (a) Allow all allowable income deductions and exclusions as described in chapter 388-475 WAC to the SSI-related applicant's income; and

     (b) Compare the net remaining income to the one-person SSI CNIL or the one-person HWD standard.

     (7) When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(b) of this section:

     (a) Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one twenty dollar general income exclusion to the combined amount.

     (b) Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the sixty-five dollar plus one half of the remainder earned income deduction (described in WAC 388-475-0840(2)) to the combined amount.

     (c) Add together the net unearned and net earned income amounts and compare the total to the two-person SSI CNIL or the two-person HWD standard described in WAC 388-478-0075 (1)(c). If the income is equal to or below the applicable two-person standard, the applicant is eligible for CN medical coverage.

     (8) An SSI-related applicant under the age of sixty-five who is working at or below the substantial gainful activity (SGA) level but who is not eligible for CN coverage under the regular SSI-related program, may be considered for eligibility under the MN program or under the HWD program. The SGA level is determined annually by the Social Security Administration and is posted at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0410501015.

     (9) If the SSI-related applicant's countable income is above the applicable SSI CNIL standard, the department considers eligibility under the MN program or under the HWD program if the individual is under the age of sixty-five and working. An SSI-related applicant who meets the following criteria is not eligible for MN coverage and eligibility must be determined under HWD:

     (a) A blind or disabled individual who is under the age of sixty-five;

     (b) Who has earned income over the SGA level; and

     (c) Is not receiving a Title II social security cash benefit based on blindness or disability.

     (10) For SSI-related MN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:

     (a) Less than or equal to the one person MNIL described in WAC 388-478-0070, no income is deemed to the applicant and a portion of the applicant's countable income is allocated to the nonapplying spouse's income to raise it to the MNIL.

     (b) Greater than the MNIL, then the amount in excess of the one-person MNIL is deemed to the applicant. Compare the applicant's income to the one-person MNIL.

     (11) When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(a) of this section:

     (a) Allocate income from the applicant to bring the income of the nonapplying spouse up to the one-person MNIL standard;

     (b) Allow all allowable income deductions and exclusions as described in chapter 388-475 WAC to the SSI-related applicant's remaining income;

     (c) Allow a deduction for medical insurance premium expenses (if applicable); and

     (d) Compare the net countable income to the one-person MNIL.

     (12) When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(b) of this section:

     (a) Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one twenty dollar general income exclusion to the combined amount;

     (b) Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the sixty-five dollar plus one half of the remainder earned income deduction (described in WAC 388-475-0840(2)) to the combined amount;

     (c) Add together the net unearned and net earned income amounts;

     (d) Allow a deduction for medical insurance premium expenses (if applicable) per WAC 388-519-0100(5); and

     (e) Compare the net countable income to the one-person MNIL described in WAC 388-478-0070. If the income is:

     (i) Equal to or below the one-person MNIL, the applicant is eligible for MN medical coverage with no spenddown.

     (ii) Greater than the MNIL, the applicant is only eligible for MN medical coverage after meeting a spenddown liability as described in WAC 388-519-0110.

     (13) The ineligible spouse of an SSI-cash recipient applying for MN coverage is eligible to receive the deductions and allocations described in subsection (10)(a) of this section.

[]

     (1) A portion of the income of a parent(s) is considered available to the SSI-related applicant child when the child is age seventeen or younger and the parent(s) is:

     (a) Financially responsible for the SSI-related child as described in WAC 388-408-0055(2);

     (b) The natural, adoptive, or step-parent of the child;

     (c) Living in the same household with the child;

     (d) Not receiving a needs-based payment such as TANF, SFA or SSI; and

     (e) Not related to SSI or not applying for medical assistance.

     (2) If an SSI-related applicant between the ages of eighteen to twenty-one lives with their parents, only consider the parent's income available to the applicant if it is actually contributed to the applicant. If income is not contributed, count only the applicant's own separate income.

     (3) Income that is deemed to the child is considered as that child's income.

     (4) When determining whether a parent's income is countable, the department follows:

     (a) The income rules described in WAC 388-475-0600 through 388-475-0750; and

     (b) Excludes income described in WAC 388-475-0800 and WAC 388-475-0840, and all income excluded under a federal statute or state law as described in WAC 388-475-0860.

     (5) When determining the amount of income to be deemed from a parent(s) to an SSI-related minor child for categorically needy (CN) and medically needy (MN) coverage, the department reduces the parent(s) countable income in the following order:

     (a) Court ordered child support paid out for a child not in the home;

     (b) An amount equal to one half of the federal benefit rate (FBR) for each SSI-eligible sibling living in the household, minus any countable income of that child. See WAC 388-478-0055 for FBR amount;

     (c) A twenty dollar general income exclusion;

     (d) A deduction equal to sixty-five dollars plus one-half of the remainder from any remaining earned income of the parent(s);

     (e) An amount equal to the one-person SSI CNIL for a single parent or the two-person SSI CNIL for a two parent household;

     (f) Any income remaining after these deductions is considered countable income to the SSI-related child and is added to the child's own income. If there is more than one child applying for SSI-related medical coverage, the deemed parental income is divided equally between the applicant children; and

     (g) The deductions described in this section are deducted first from unearned income then from earned income unless they are specific to earned income.

     (6) The SSI-related applicant child is also allowed all applicable income exclusions and disregards described in chapter 388-475 WAC from their own income. After determining the child's nonexcluded income, the department:

     (a) Allows the twenty dollar general income exclusion from any unearned income;

     (b) Deducts sixty-five dollars plus one half of the remainder from any earned income which has not already been excluded under the student earned income exclusion (see WAC 388-475-0820).

     (c) Adds the child's countable income to the amount deemed from their parent(s). If the combination of the child's countable income plus deemed parental income is equal to or less than the SSI CNIL, the child is eligible for SSI-related CN medical coverage.

     (7) If the combination of the child's countable income plus deemed parental income is greater than the SSI CNIL, the department considers the child for SSI-related medically needy (MN) coverage. Any amount exceeding the medically needy income level (MNIL) is used to calculate the amount of the child's spenddown liability as described in WAC 388-519-0110. See WAC 388-478-0070 for the current MNIL standards.

[]

     (2) An institutionalized individual (adult or child) who is not SSI-related may be considered under the long-term care for families and children programs described in WAC 388-505-0230 through 388-505-0265.

     (3) The department considers the income and resources of spouses as available to each other through the end of the month in which the spouses stopped living together. See WAC 388-513-1330 and 388-513-1350 when a spouse is institutionalized.

     (4) The department considers income and resources separately as of the first day of the month following the month of separation when spouses stop living together because of placement into a boarding home (assisted living, enhanced adult residential center, adult residential center), adult family home (AFH), adult residential rehabilitation center/adult residential treatment facility (ARRC/ARTF), or division of developmental disabilities-group home (DDD-GH) facility when:

     (a) Only one spouse enters the facility;

     (b) Both spouses enter the same facility but have separate rooms; or

     (c) Both spouses enter separate facilities.

     (5) The department considers income and resources jointly when both spouses are placed in a boarding home, AFH, ARRC/ARTF, or DDD-GH facility and share a room.

     (6) When determining SSI-related categorically needy (CN) or medically needy (MN) eligibility for a community spouse applying for medical coverage, the department counts:

     (a) The separate income of the community spouse; plus

     (b) One half of any community income received by the community spouse and the institutionalized spouse; plus

     (c) Any amount allocated to the community spouse from the institutionalized spouse. The terms "community spouse" and "institutional spouse" are defined in WAC 388-513-1301.

     (7) For the purposes of determining the countable income of a community spouse applying for medical coverage as described in subsection (6) above, it does not matter whether the spouses reside together or not. Income that is allocated and actually available to a community spouse is considered that person's income.

     (8) For the purposes of determining the countable income of a community spouse or children applying for medical coverage under family, pregnancy or children's medical programs, the department uses the following rules to determine if the income of the institutionalized person is considered in the eligibility calculation:

     (a) When the institutionalized spouse or parent lives in the same home with the community spouse and/or children, their income is counted in the determination of household income following the rules for the medical program that is being considered.

     (b) When the institutionalized spouse or parent does not live in the same home as the spouse and/or children, only income that is allocated and available to the household is counted.

     (9) When determining the countable income of a community spouse applying for medical coverage under the MN program, the department allocates income from the community spouse to the institutionalized spouse in an amount up to the one-person medically needy income level (MNIL) less the institutionalized spouse's income, when:

     (a) The community spouse is living in the same household as the institutionalized spouse; and

     (b) The institutionalized spouse is receiving home and community-based waiver or institutional hospice services described in WAC 388-515-1505; and

     (c) The institutionalized spouse has gross income of less than the MNIL.

     (10) See WAC 388-408-0055 for rules on how to determine medical assistance units for households that include SSI-related persons. A separate medical assistance unit is always established for individuals who meet institutional status described in WAC 388-513-1320.

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     The following section of the Washington Administrative Code is repealed:

WAC 388-506-0620

SSI-related medical clients.

© Washington State Code Reviser's Office