Purpose: To reconcile SSI-related medical program resource eligibility rules with federal law. This continues the emergency rule adopted under WSR 05-05-088 on February 15, 2005. This adoption is necessary while the permanent rule-making process begun under WSR 04-23-101 is completed.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-475-0550, 388-475-0700, 388-475-0800, 388-475-0820, and 388-475-0860.

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

     Other Authority: Social Security Act as amended by Public Law 108-203.

     Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: The state must adopt rules to comply with federal Medicaid law in Public Law 108-203, Subtitle D, Sections 430, 431, and 435 in order to continue receiving federal funding.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 5, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 5, Repealed 0.

     Date Adopted: June 10, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (1) Resources necessary for a client who is blind or disabled to fulfill a department approved self-sufficiency plan.

     (2) Retroactive payments from SSI or RSDI, including benefits a client receives under the interim assistance reimbursement agreement with the Social Security Administration, are excluded for ((six)) nine months following the month of receipt. This exclusion applies to:

     (a) Payments received by the client, spouse, or any other person financially responsible for the client;

     (b) SSI payments for benefits due for the month(s) before the month of continuing payment;

     (c) RSDI payments for benefits due for a month that is two or more months before the month of continuing payment; and

     (d) Proceeds from these payments as long as they are held as cash, or in a checking or savings account. The funds may be commingled with other funds, but must remain identifiable from the other funds for this exclusion to apply. This exclusion does not apply once the payments have been converted to any other type of resource.

     (3) All resources specifically excluded by federal law, such as those described in subsections (4) through (11) as long as such funds are identifiable.

     (4) Payments made under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

     (5) Payments made to Native Americans as listed in 20 CFR 416.1182, Appendix to subpart K, section IV, paragraphs (b) and (c), and in 20 CFR 416.1236.

     (6) The following Native American/Alaska Native funds are excluded resources:

     (a) Resources received from a Native Corporation under the Alaska Native Claims Settlement Act, including:

     (i) Shares of stock held in a regional or village corporation;

     (ii) Cash or dividends on stock received from the Native Corporation up to two thousand dollars per person per year;

     (iii) Stock issued by a native corporation as a dividend or distribution on stock;

     (iv) A partnership interest;

     (v) Land or an interest in land; and

     (vi) An interest in a settlement trust.

     (b) All funds contained in a restricted Individual Indian Money (IIM) account.

     (7) Restitution payment and any interest earned from this payment to persons of Japanese or Aleut ancestry who were relocated and interned during war time under the Civil Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution Act.

     (8) Funds received from the Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims.

     (9) Payments or interest accrued on payments received under the Radiation Exposure Compensation Act received by the injured person, the surviving spouse, children, grandchildren, or grandparents.

     (10) Payments from:

     (a) The Dutch government under the Netherlands' Act on Benefits for Victims of Persecution (WUV).

     (b) The Victims of Nazi Persecution Act of 1994 to survivors of the Holocaust.

     (c) Susan Walker vs. Bayer Corporation, et al., 96-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds.

     (d) Ricky Rey Hemophilia Relief Fund Act of 1998 P.L. 105-369.

     (11) The unspent social insurance payments received due to wage credits granted under sections 500 through 506 of the Austrian General Social Insurance Act.

     (12) Earned income tax credit refunds and payments are excluded as resources ((during the month of receipt and the following month)) for nine months after the month of receipt.

     (13) Payments from a state administered victim's compensation program for a period of nine calendar months after the month of receipt.

     (14) Cash or in-kind items received as a settlement for the purpose of repairing or replacing a specific excluded resource are excluded:

     (a) For nine months. This includes relocation assistance provided by state or local government.

     (b) Up to a maximum of thirty months, when:

     (i) The client intends to repair or replace the excluded resource; and

     (ii) Circumstances beyond the control of the settlement recipient prevented the repair or replacement of the excluded resource within the first or second nine months of receipt of the settlement.

     (c) For an indefinite period, if the settlement is from federal relocation assistance.

     (d) Permanently, if the settlement is assistance received under the Disaster Relief and Emergency Assistance Act or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States, or is comparable assistance received from a State or local government or from a disaster assistance organization. Interest earned on this assistance is also excluded from resources. Any cash or in-kind items received as a settlement and excluded under this subsection are considered as available resources when not used within the allowable time periods.

     (15) Insurance proceeds or other assets recovered by a Holocaust survivor as defined in WAC 388-470-0026(4).

     (16) Pension funds owned by an ineligible spouse. Pension funds are defined as funds held in a(n):

     (a) Individual retirement account (IRA) as described by the IRS code; or

     (b) Work-related pension plan (including plans for self-employed individuals, known as Keogh plans).

     (17) Cash payments received from a medical or social service agency to pay for medical or social services are excluded for one calendar month following the month of receipt.

     (18) SSA- or DVR-approved plans for achieving self-support (PASS) accounts, allowing blind or disabled individuals to set aside resources necessary for the achievement of the plan's goals, are excluded.

     (19) Food and nutrition programs with federal involvement. This includes Washington Basic Food, school reduced and free meals and milk programs and WIC.

     (20) 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, 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.

     (((22))) (21) 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.

     (((23))) (22) The following are among assets that are not considered resources and as such are neither excluded nor counted:

     (a) Home energy assistance/support and maintenance assistance;

     (b) Retroactive in-home supportive services payments to ineligible spouses and parents; and

     (c) Gifts of domestic travel tickets. For a more complete list please see POMS @ http://policy.ssa.gov/poms.nsf/lnx/0501130050.

[Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-004, § 388-475-0550, filed 4/7/04, effective 6/1/04.]

     Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 04-09-004, filed 4/7/04, effective 6/1/04)

WAC 388-475-0700   SSI-related medical -- Income eligibility.   (1) In order to be eligible, a client is required do everything necessary to obtain any income to which they are entitled including (but not limited to):

     (a) Annuities,

     (b) Pensions,

     (c) Unemployment compensation,

     (d) Retirement, and

     (e) Disability benefits; even if their receipt makes the client ineligible for department services, unless the client can provide evidence showing good reason for not obtaining the benefits.

     The department does not count this income until the client begins to receive it.

     (2) Income is budgeted prospectively for all medical programs.

     (3) Anticipated nonrecurring lump sum payments other than retroactive SSI/SSDI payments are considered income in the month received, subject to reporting requirements in WAC 388-418-0007(4). Any unspent portion is considered a resource the first of the following month.

     (4) The department follows income and resource methodologies of the Supplemental Security Income (SSI) program defined in federal law when determining eligibility for SSI-related medical or Medicare Savings programs unless the department adopts rules that are less restrictive than those of the SSI program.

     (5) Exceptions to the SSI income methodology:

     (a) Lump sum payments from a retroactive SSDI benefit, when reduced by the amount of SSI received during the period covered by the payment, are not counted as income;

     (b) Unspent retroactive lump sum money from SSI or SSDI is excluded as a resource for ((six)) nine months following receipt of the lump sum; and

     (c) Both the principal and interest portions of payments from a sales contract, that meet the definition in WAC 388-475-0350(10), are unearned income.

     (6) To be eligible for categorically needy (CN) SSI-related medical coverage, a client's countable income cannot exceed the CN program standard described in:

     (a) WAC 388-478-0065 through 388-478-0085 for noninstitutional medical unless living in an alternate living facility; or

     (b) WAC 388-513-1305(2) for noninstitutional CN benefits while living in an alternate living facility; or

     (c) WAC 388-513-1315 for institutional and waiver services medical benefits.

     (7) To be eligible for SSI-related medical coverage provided under the medically needy (MN) program, a client must:

     (a) Have countable income at or below the MN program standard as described in WAC 388-478-0070; or

     (b) Satisfy spenddown requirements described in WAC 388-519-0110((, or));

     (c) Meet the requirements for noninstitutional MN benefits while living in an alternate living facility (ALF). See WAC 388-513-1305(3) ((and 388-515-1540)); or

     (d) Meet eligibility for the MN residential waiver program. See WAC 388-515-1540.

[Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-004, § 388-475-0700, filed 4/7/04, effective 6/1/04.]

     (1) The first twenty dollars per month of unearned income. If there is less than twenty dollars of unearned income in a month, the remainder is excluded from earned income in that month.

     (a) The twenty-dollar limit is the same, whether applying it for a couple or for a single person.

     (b) The disregard does not apply to income paid totally or partially by the federal government or a nongovernmental agency on the basis of an eligible person's needs.

     (c) The twenty dollars disregard is applied after all exclusions have been taken from income.

     (2) Income that is not reasonably anticipated or is received infrequently or irregularly, whether for a single person or each person in a couple when it is:

     (a) Earned and does not exceed a total of ((ten)) thirty dollars per ((month)) calendar quarter; or

     (b) Unearned and does not exceed a total of ((twenty)) sixty dollars per ((month)) calendar quarter;

     (c) Increases in a client's burial funds that were established on or after November 1, 1982 if the increases are the result of:

     (i) Interest earned on excluded burial funds; or

     (ii) Appreciation in the value of an excluded burial arrangement that was left to accumulate and become part of separately identified burial funds.

     (3) Essential expenses necessary for a client to receive compensation (e.g., necessary legal fees in order to get a settlement);

     (4) Receipts, which are not considered income, when they are for:

     (a) Replacement or repair of an exempt resource;

     (b) Prepayment or repayment of medical care paid by a health insurance policy or medical service program; or

     (c) Payments made under a credit life or credit disability policy.

     (5) The 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.

     (6) Funds representing shared household costs.

     (7) Crime victim's compensation.

     (8) The value of a common transportation ticket, given as a gift, that is used for transportation and not converted to cash.

     (9) Gifts that are not for food, clothing or shelter, and gifts of home produce used for personal consumption.

     (10) The department does not consider in-kind income received from someone other than a person legally responsible for the individual unless it is earned. Therefore, the following in-kind payments are not counted when determining eligibility for SSI-related medical programs.

     (a) In-kind payments for services paid by a client's employer if:

     (i) The service is not provided in the course of an employer's trade or business; or

     (ii) It is in the form of food and/or shelter that is:

     (A) On the employer's business premises;

     (B) For the employer's convenience; and

     (C) If shelter, acceptance by the employee is a condition of employment.

     (b) In-kind payments made to people in the following categories:

     (i) Agricultural employees;

     (ii) Domestic employees;

     (iii) Members of the Uniformed Services;

     (iv) Persons who work from home to produce specific products for the employer from materials supplied by the employer.

[Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-005, § 388-475-0800, filed 4/7/04, effective 6/1/04.]

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

     (b) The minor child is not receiving a needs-based cash payment such as TANF or SSI; and

     (c) The SSI-related parent is single; or

     (d) The SSI-related parent lives with a spouse who has no income; 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. The child's countable income, if any, is subtracted from the maximum child's allowance((. One third of the child support received for the child is excluded from the child's income)) before determining this allowance.

     (2) 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) 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) ((Up to one thousand three hundred seventy dollars per month of a child's)) Earned income((, but not more than five thousand five hundred twenty dollars per year,)) of a person under age twenty-two is excluded if ((the child)) that person is a student.

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

     (6) One-third of child support payments received for a child are excluded from the child's income.

     (7) Any portion of a grant, scholarship, ((or)) fellowship, or gift used ((to pay)) 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.

     (((7))) (8) 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.

     (((8))) (9) 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.

     (((9))) (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, 74.08.090. 04-09-005, § 388-475-0820, filed 4/7/04, effective 6/1/04.]

     (1) Income tax refunds;

     (2) Federal earned income tax credit (EITC) payments for nine months after the month of receipt;

     (3) Compensation provided to volunteers in the Corporation for National and Community Service (CNCS), formerly known as ACTION programs established by the Domestic Volunteer Service Act of 1973. P.L. 93-113;

     (4) Assistance to a person (other than wages or salaries) under the Older Americans Act of 1965, as amended by section 102 (h)(1) of Pub. L. 95-478 (92 Stat. 1515, 42 U.S.C. 3020a);

     (5) Federal, state and local government payments including assistance provided in cash or in-kind under any government program that provides medical or social services;

     (6) Certain cash or in-kind payments a client receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;

     (7) Value of food provided through a federal or nonprofit food program such as WIC, donated food program, school lunch program;

     (8) Assistance based on need, including:

     (a) Any federal SSI income or state supplement payment (SSP) based on financial need;

     (b) Food stamps;

     (c) GA-U;

     (d) CEAP;

     (e) TANF; and

     (f) Bureau of Indian Affairs (BIA) general assistance.

     (9) Housing assistance from a federal program such as HUD if paid under:

     (a) United States Housing Act of 1937 (section 1437 et seq. of 42 U.S.C.);

     (b) National Housing Act (section 1701 et seq. of 12 U.S.C.);

     (c) Section 101 of the Housing and Urban Development Act of 1965 (section 1701s of 12 U.S.C., section 1451 of 42 U.S.C.);

     (d) Title V of the Housing Act of 1949 (section 1471 et seq. of 42 U.S.C.); or

     (e) Section 202(h) of the Housing Act of 1959;

     (f) Weatherization provided to low-income homeowners by programs that consider income in the eligibility determinations;

     (10) Energy assistance payments including:

     (a) Those to prevent fuel cutoffs, and

     (b) To promote energy efficiency.

     (11) Income from employment and training programs as specified in WAC 388-450-0045.

     (12) Foster Grandparents program;

     (13) Title IV-E and state foster care maintenance payments if the foster child is not included in the assistance unit;

     (14) The value of any childcare provided or arranged (or any payment for such care or reimbursement for costs incurred for such care) under the Child Care and Development Block Grant Act, as amended by section 8(b) of P.L. 102-586 (106 Stat. 5035).

     (15) Educational assistance as specified in WAC 388-450-0035.

     (16) Up to two thousand dollars per year derived from an individual's interest in Indian trust or restricted land.

     (17) Native American benefits and payments as specified in WAC 388-450-0040 and other Native American payments excluded by federal statute. For a complete list of these payments, see 20 CFR 416, Subpart K, Appendix, IV.

     (18) Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill) (May 8, 1997) settlement funds;

     (19) Payments from Ricky Ray Hemophilia Relief Fund Act of 1998, P.L. 105-369;

     (20) Disaster assistance paid under Federal Disaster Relief P.L. 100-387 and Emergency Assistance Act, P.L. 93-288 amended by P.L. 100-707 and for farmers P.L. 100-387;

     (21) Payments to certain survivors of the Holocaust as victims of Nazi persecution; payments excluded pursuant to section 1(a) of the Victims of Nazi Persecution Act of 1994, P.L. 103-286 (108 Stat. 1450);

     (22) Payments made under section 500 through 506 of the Austrian General Social Insurance Act;

     (23) Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV);

     (24) Restitution payments and interest earned to Japanese Americans or their survivors, and Aleuts interned during World War II, established by P.L. 100-383;

     (25) Payments made from the Agent Orange Settlement Funds or any other funds to settle Agent Orange liability claims established by P.L. 101-201;

     (26) Payments made under section six of the Radiation Exposure Compensation Act established by P.L. 101-426;

     (27) Any interest earned from payments described in subsections (1) through (26) is counted as unearned income, unless otherwise excluded by law.

[Statutory Authority: RCW 74.04.050, 74.08.090. 04-09-005, § 388-475-0860, filed 4/7/04, effective 6/1/04.]

© Washington State Code Reviser's Office