PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Economic Services Administration)
(Community Services Division)
Effective Date of Rule: June 1, 2012.
Purpose: These amendments eliminate reference[s] to general assistance (GA) and disability lifeline (DL) terminated effective October 31, 2011, and establish the aged, blind, or disabled (ABD) cash assistance program and pregnant women assistance program established November 1, 2011. These amendments are necessary to comply with the changes outlined in ESHB 2082, Laws of 2011.
Amending WAC 388-273-0020 Who may receive WTAP?, 388-406-0005 Can I apply for cash, medical, or Basic Food?, 388-406-0045 Is there a good reason my application for cash or medical assistance has not been processed?, 388-406-0055 When do my benefits start?, 388-408-0005 What is a cash assistance unit?, 388-416-0010 Medical certification periods for recipients of cash assistance programs, 388-424-0010 Citizenship and alien status -- Eligibility for TANF, medicaid, and CHIP, 388-424-0015 Immigrant eligibility restrictions for the state family assistance, general assistance, and ADATSA programs, 388-436-0030 Eligibility for CEAP depends on other possible cash benefits, 388-442-0010 How does being a fleeing felon impact my eligibility for benefits?, 388-450-0040 Native American benefits and payments, 388-450-0045 How do we count income from employment and training programs?, 388-450-0095 Allocating income -- General, 388-450-0100 Allocating income -- Definitions, 388-450-0115 Allocating the income of a financially responsible person excluded from the assistance unit, 388-450-0120 Allocating the income of financially responsible parents to a pregnant or parenting minor, 388-450-0130 Allocating the income of a nonapplying spouse to a caretaker relative, 388-450-0156 When am I exempt from deeming?, 388-450-0170 TANF/SFA earned income incentive and deduction, 388-460-0020 Who is a protective payee?, 388-460-0040 When is a protective payee assigned to TANF/SFA pregnant or parenting minors?, 388-468-0005 Residency, 388-473-0010 What are ongoing additional requirements and how do I qualify?, 388-474-0010 How does being a Supplemental Security Income (SSI) client affect your cash assistance eligibility?, 388-474-0020 What can a general assistance-unemployable (GA-U) client expect when supplemental security income (SSI) benefits begin?, 388-476-0005 Social Security number requirements, 388-478-0035 Maximum earned income limits for TANF, SFA and RCA and 388-486-0005 Unmarried pregnant or parenting minors -- Required living arrangement; repealing WAC 388-400-0025 Who is eligible for disability lifeline benefits?, 388-404-0010 Age requirement for GA-U and ADATSA, 388-408-0010 Who is in my assistance unit for general assistance?, 388-418-0025 Effect of changes on medical program eligibility, 388-424-0016 Citizenship and alien status -- Immigrant eligibility restrictions for state medical benefits, 388-448-0001 What are the incapacity requirements for general assistance?, 388-448-0010 How do we decide if you are incapacitated?, 388-448-0020 Which health professionals can I go to for medical evidence?, 388-448-0030 What medical evidence do I need to provide?, 388-448-0035 How we assign severity ratings to your impairment, 388-448-0040 PEP step I -- Review of medical evidence required for eligibility determination, 388-448-0050 PEP step II -- How we determine the severity of mental impairments, 388-448-0060 PEP step III -- How we determine the severity of physical impairments, 388-448-0070 PEP step IV -- How we determine the severity of multiple impairments, 388-448-0080 PEP step V -- How we determine your ability to function in a work environment if you have a mental impairment, 388-448-0090 PEP step V -- How we determine your ability to function in a work environment if you have a physical impairment, 388-448-0100 PEP step VI -- How we evaluate capacity to perform relevant past work, 388-448-0110 PEP step VII -- How we evaluate your capacity to perform other work, 388-448-0120 How we decide how long you are incapacitated, 388-448-0130 Treatment and referral requirements, 388-448-0140 When does a person have good cause for refusing or failing to participate in medical treatment or referrals to other agencies?, 388-448-0150 Penalty for refusing or failure to participate in medical treatment or other agency referrals, 388-448-0160 When do my disability lifeline benefits end?, 388-448-0180 How do we redetermine your eligibility when we decide you are eligible for general assistance expedited medicaid (GAX)?, 388-448-0200 Can I get general assistance while waiting for supplemental security income (SSI)?, 388-448-0210 What is interim assistance and how do I assign it to you?, 388-448-0220 How does alcohol or drug dependence affect my eligibility for disability lifeline?, 388-448-0250 Are there limits on the number of months I may receive disability lifeline benefits?, 388-450-0110 Allocating the income of a GA-U client to legal dependents, 388-450-0135 Allocating income of an ineligible spouse to a GA-U client, 388-450-0175 Does the department offer an income deduction for the general assistance program as an incentive for clients to work?, 388-462-0011 Post adoption cash benefit and 388-478-0030 Payment standards for disability lifeline and ADATSA; and creating new WAC 388-400-0055 Who is eligible for the pregnant women assistance (PWA) program?, 388-400-0060 Who is eligible for aged, blind, or disabled (ABD) cash assistance?, 388-408-0060 Who is in my assistance unit for aged, blind, or disabled (ABD) cash assistance?, 388-449-0001 What are the disability requirements for aged, blind, or disabled (ABD) program?, 388-449-0005 Sequential evaluation process step 1 -- How does the department determine if you are performing substantial gainful employment?, 388-449-0010 What evidence do we consider to determine disability?, 388-449-0015 What medical evidence do I need to provide?, 388-449-0020 How does the department evaluate functional capacity for mental health impairments?, 388-449-0030 How does the department evaluate functional capacity for physical impairments?, 388-449-0035 How does the department assign severity ratings to my impairment?, 388-449-0040 How does the department determine the severity of mental impairments?, 388-449-0045 How does the department determine the severity of physical impairments?, 388-449-0050 How does the department determine the severity of multiple impairments?, 388-449-0060 Sequential evaluation process step II -- How does the department review medical evidence to determine if I am eligible for benefits?, 388-449-0070 Sequential evaluation process step III -- How does the department determine if you meet SSA listing of impairments criteria?, 388-449-0080 Sequential evaluation process step IV -- How does the department evaluate if I am able to perform relevant past work?, 388-449-0100 Sequential evaluation process step V -- How does the department evaluate if I can perform other work when determining disability?, 388-449-0150 When does my eligibility for aged, blind, or disabled (ABD) cash benefits end?, 388-449-0200 Am I eligible for cash assistance for aged, blind, or disabled (ABD) while waiting for supplemental security income (SSI)?, 388-449-0210 What is interim assistance and how do I assign it to the department?, 388-449-0220 How does alcohol or drug dependence affect my eligibility for the ABD cash and pregnant women assistance programs?, 388-449-0225 Am I required to participate in vocational rehabilitation services if I receive ABD cash grant?, 388-450-0112 Does the department allocate the income of an ABD cash client to legal dependents?, 388-450-0137 Does the department allocate income of an ineligible spouse to an ABD cash client?, 388-450-0177 Does the department offer an income deduction for the ABD cash program as an incentive for clients to work?, 388-478-0027 What are the payment standards for pregnant women assistance (PWA)?, and 388-478-0033 What are the payment standards for aged, blind, or disabled (ABD) cash assistance?
Citation of Existing Rules Affected by this Order: Repealing WAC 388-400-0025, 388-404-0010, 388-408-0010, 388-418-0025, 388-424-0016, 388-448-0001, 388-448-0010, 388-448-0020, 388-448-0030, 388-448-0035, 388-448-0040, 388-448-0050, 388-448-0060, 388-448-0070, 388-448-0080, 388-448-0090, 388-448-0100, 388-448-0110, 388-448-0120, 388-448-0130, 388-448-0140, 388-448-0150, 388-448-0160, 388-448-0180, 388-448-0200, 388-448-0210, 388-448-0220, 388-448-0250, 388-450-0110, 388-450-0135, 388-450-0175, 388-462-0011 and 388-478-0030; and amending WAC 388-273-0020, 388-406-0005, 388-406-0045, 388-406-0055, 388-408-0005, 388-416-0010, 388-424-0010, 388-424-0015, 388-436-0030, 388-442-0010, 388-450-0040, 388-450-0045, 388-450-0095, 388-450-0100, 388-450-0115, 388-450-0120, 388-450-0130, 388-450-0156, 388-450-0170, 388-460-0020, 388-460-0040, 388-468-0005, 388-473-0010, 388-474-0010, 388-474-0020, 388-476-0005, 388-478-0035, and 388-486-0005.
Statutory Authority for Adoption: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, 74.08A.100, 74.04.770, 74.04.0052, 74.04.655, 74.04.770, 74.08.043, 74.08.335.
Other Authority: ESHB 2082, chapter 36, Laws of 2011 1st sp. sess.
Adopted under notice filed as WSR 12-05-023 on February 7, 2012.
Changes Other than Editing from Proposed to Adopted Version: The department originally proposed rules under WSR 11-22-032 on October 26, 2011. Due to significant changes made to the proposed rules, the department filed a supplemental notice as WSR 12-05-023 on February 7, 2012. After the supplemental notice was filed, the department made changes for clarity and to improve readability, and also amended:
| • | WAC 388-449-0005 (1)(b) to remove reference to requiring verification from the individual's employer. |
| • | WAC 388-449-0100(3) to retitle "Social restrictions" as "Social and cognitive limitations." |
| • | WAC 388-449-0200(2) to add: "(c) You are so fearful of the treatment that your fear could interfere with the treatment or reduce its benefits; or (d) You practice an organized religion that prohibits the treatment." |
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 27, Amended 28, Repealed 33.
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 27, Amended 28, Repealed 33.
Date Adopted: April 24, 2012.
Katherine I. Vasquez
Rules Coordinator
4334.11(a) Be age eighteen or older or, if under eighteen, be the responsible head of household, and either;
(b) Be receiving one of the following programs from us:
(i) Temporary assistance for needy families (TANF);
(ii) State family assistance (SFA);
(iii) ((General assistance)) Pregnant women assistance
(PWA);
(iv) Aged, blind, or disabled (ABD) cash assistance;
(v) Refugee assistance;
(((v))) (vi) Food assistance;
(((vi))) (vii) State Supplemental Security Income (SSI);
(((vii))) (viii) Medical assistance, including medicare
cost sharing programs;
(((viii))) (ix) Community options program entry system
(COPES);
(((ix))) (x) Chore services; or
(c) Have completed using community service voice mail services, and been identified to the department as eligible for WTAP by the community agency that provided your community service voice mail program; and
(2) Apply to a local exchange company for WTAP and request the lowest available flat rate telephone service at the WTAP rate. In exchange areas where wireline service is not available without service extension, you may apply to a wireless carrier:
(a) "Local exchange company" means a telephone company that is required by the Washington utilities and transportation commission to offer WTAP benefits and offers local calling, i.e., calling without long distance charges.
(b) "Flat rate service" is telephone service with a single monthly payment that allows unlimited local calling for a specified length of time. The local exchange flat rate includes any federal end user access charges and other charges necessary to obtain the service; and
(3) You must have the local telephone service billed in your name.
[Statutory Authority: RCW 74.08.090, 80.36.440, 2002 c 104. 02-18-106, § 388-273-0020, filed 9/3/02, effective 10/4/02. Statutory Authority: RCW 74.08.090, 80.36.440. 01-09-023, § 388-273-0020, filed 4/9/01, effective 6/1/01.]
(1) You can get pregnant women assistance (PWA), if you:
(a) Are pregnant as verified by a medical professional;
(b) Meet the citizenship/alien status requirements of WAC 388-424-0010;
(c) Live in the state of Washington per WAC 388-468-0005;
(d) Do not live in a public institution unless specifically allowed under RCW 74.08.025;
(e) Meet TANF/SFA:
(i) Income requirements under chapter 388-450 WAC;
(ii) Resource requirements under chapter 388-470 WAC; and
(iii) Transfer of property requirements under chapter 388-488 WAC.
(f) Tell us your social security number as required under WAC 388-476-0005;
(g) Report changes of circumstances as required under WAC 388-418-0005; and
(2) If you are an unmarried pregnant minor your living arrangements must meet the requirements of WAC 388-486-0005.
(3) You cannot get PWA if you:
(a) Are eligible for temporary assistance for needy families (TANF) benefits;
(b) Are eligible for state family assistance (SFA) benefits;
(c) Refuse or fail to meet a TANF or SFA eligibility rule;
(d) Refuse or fail to participate in drug or alcohol treatment as required in WAC 388-449-0220 without good cause; or
(e) Are eligible for supplemental security income (SSI) benefits.
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(a) Are:
(i) At least sixty-five years old;
(ii) Blind as defined by the Social Security Administration (SSA); or
(iii) Likely to be disabled as defined in WAC 388-449-0001 through 388-449-0100; and
(b) Are at least eighteen years old or, if under eighteen, a member of a married couple;
(c) Are in financial need according to ABD cash income and resource rules in chapters 388-450, 388-470 and 388-488 WAC. We determine who is in your assistance unit according to WAC 388-408-0060;
(d) Meet the citizenship/alien status requirements under WAC 388-424-0015;
(e) Provide a social security number as required under WAC 388-476-0005;
(f) Reside in the state of Washington as required under WAC 388-468-0005;
(g) Sign an interim assistance reimbursement authorization agreeing to repay the monetary value of general assistance, disability lifeline, or aged blind or disabled benefits subsequently duplicated by supplemental security income benefits as described under WAC 388-449-0200, 388-449-0210 and 388-474-0020;
(h) Report changes of circumstances as required under WAC 388-418-0005; and
(i) Complete a mid-certification review and provide proof of any changes as required under WAC 388-418-0011.
(2) You aren't eligible for aged, blind, or disabled cash benefits if you:
(a) Are eligible for temporary assistance for needy families (TANF) benefits;
(b) Are eligible for state family assistance (SFA) benefits;
(c) Refuse or fail to meet a TANF or SFA eligibility rule;
(d) Refuse or fail to participate in drug or alcohol treatment as required in WAC 388-449-0220 without good cause;
(e) Refuse or fail to follow through with the SSI application as required in WAC 388-449-0200 without good cause;
(f) Refuse or fail to participate in vocational rehabilitation services as required in WAC 388-449-0225 without good cause;
(g) Are eligible for supplemental security income (SSI) benefits;
(h) Are an ineligible spouse of an SSI recipient; or
(i) Failed to follow a Social Security Administration (SSA) program rule or application requirement and SSA denied or terminated your benefits.
(3) If you reside in a public institution and meet all other requirements, your eligibility for ABD cash depends on the type of institution. A "public institution" is an institution that is supported by public funds, and a governmental unit either is responsible for it or exercises administrative control over it.
(a) You may be eligible for ABD cash if you are:
(i) A patient in a public medical institution; or
(ii) A patient in a public mental institution and:
(A) Sixty-five years of age or older; or
(B) Twenty years of age or younger.
(4) You aren't eligible for ABD cash when you are in the custody of or confined in a public institution such as a state penitentiary or county jail including placement:
(a) In a work release program; or
(b) Outside of the institution including home detention.
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(2) You must meet certain eligibility requirements in order to receive a program benefit.
(3) You can apply for someone else if you are:
(a) A legal guardian, caretaker, or authorized representative applying for:
(i) A dependent child;
(ii) An incapacitated person; or
(iii) Someone who is deceased.
(b) Applying for someone who cannot apply for some other reason. We may ask why the applicant is unable to apply on their own behalf.
(4) If you get Supplemental Security Income (SSI), you do not need to apply for medical benefits. We automatically open medical benefits for you.
(5) A person or agency may apply for ((GAU)) ABD cash or
medical assistance for you if:
(a) You temporarily live out-of-state; and
(b) You are a Washington state resident.
(6) When you are confined or incarcerated in a Washington state public institution, you may apply for cash or medical assistance if you meet the following criteria:
(a) You are confined by or in the following public institutions:
(i) Department of corrections;
(ii) City or county jail; or
(iii) Institution for mental diseases (IMD).
(b) Staff at the public institution provide medical records including diagnosis by a mental health professional that you have a mental disorder (as defined in the Diagnostic and Statistical Manual of Psychiatric Disorders, most recent edition) that affects your thoughts, mood or behavior so severely that it prevents you from performing any kind of work.
(7) We will make an eligibility determination for medical assistance prior to your release from confinement and will authorize medical benefits upon your release from confinement when you:
(a) Meet the criteria of subsection (6) in this section; and
(b) Were receiving medicaid ((or general assistance
benefits)) immediately before confinement or within the five
years prior to confinement.
(8) If you meet the criteria in subsection (6) but did
not receive medicaid ((or general assistance benefits)) within
the five years prior to confinement, the department will
process your request for medical assistance within the time
frames in WAC 388-406-0035.
(9) If you are applying for assistance for a youth leaving incarceration in a juvenile rehabilitation administration or county juvenile detention facility, you may apply for assistance within forty-five days prior to release. We will process your application for medical assistance when we receive it, and if eligible, we will authorize medical benefits upon the youth's release from confinement.
[Statutory Authority: RCW 74.08.060, 74.04.050, 74.04.057, 74.08.090, and 2009 c 198. 09-19-129, § 388-406-0005, filed 9/22/09, effective 11/1/09. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.060, 74.08.090, 74.09.555, and 2007 c 359. 08-09-042, § 388-406-0005, filed 4/10/08, effective 5/11/08. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.09.555. 06-08-047, § 388-406-0005, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510. 03-22-039, § 388-406-0005, filed 10/28/03, effective 12/1/03. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 74.08.090. 02-11-137, § 388-406-0005, filed 5/21/02, effective 7/1/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0405 and 388-504-0410.]
(1) We do not have a good reason for not processing your application for TANF or SFA within thirty days if:
(a) We did not give or send you a notice of what information we needed to determine your eligibility within twenty days from the date of your application;
(b) We did not give or send you a notice that we needed additional information or action within five calendar days of the date we learned that more information was needed to determine eligibility;
(c) We did not process your application within five calendar days from getting the information needed to decide eligibility; and
(d) We decide good cause exists but do not document our decision in the case record on or before the time limit for processing the application ends.
(2) We do have a good reason for not processing your application timely if:
(a) You do not give us the information or take an action needed for us to determine eligibility;
(b) We have an emergency beyond our control; or
(c) There is no other available verification for us to determine eligibility and the eligibility decision depends on information that has been delayed such as:
(i) Medical documentation;
(ii) For cash assistance, extensive property appraisals; or
(iii) Out-of-state documents or correspondence.
(3) For medical assistance, good cause exists only when the department otherwise acted promptly at all stages of the application process.
(4) For ((general assistance (GA))) ABD cash assistance,
good cause exists if you apply when you are confined in a
Washington State public institution as defined in WAC 388-406-0005 (6)(a).
[Statutory Authority: RCW 74.08.060, 74.04.050, 74.04.057, 74.08.090, and 2009 c 198. 09-19-129, § 388-406-0045, filed 9/22/09, effective 11/1/09. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 74.08.090. 02-14-023, § 388-406-0045, filed 6/21/02, effective 7/1/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0045, filed 7/31/98, effective 9/1/98. Formerly WAC 388-504-0480.]
(1) Cash assistance, your benefits start:
(a) The date we have enough information to make an eligibility decision; or
(b) No later than the thirtieth day for TANF, SFA, PWA, or RCA; or
(c) No later than the forty-fifth day for ((general
assistance (GA))) aged, blind, or disabled (ABD) cash
assistance unless:
(i) You are confined in a Washington state public institution as defined in WAC 388-406-0005 (6)(a) on the forty-fifth day, in which case your benefits will start on the date you are released from confinement; or
(ii) You are approved for ABD cash assistance at the time of your medical care services (MCS) incapacity review as described in WAC 182-508-0160, in which case your benefits will start on the date you provided sufficient medical evidence to establish disability as defined in WAC 388-449-0001.
(2) Basic Food, your benefits start from the date you applied unless:
(a) You are recertified for Basic Food. If you are recertified for Basic Food, we determine the date your benefits start under WAC 388-434-0010;
(b) You applied for Basic Food while living in an institution. If you apply for Basic Food while living in an institution, the date you are released from the institution determines your start date as follows. If you are expected to leave the institution:
(i) Within thirty days of the date we receive your application, your benefits start on the date you leave the institution; or
(ii) More than thirty days from the date we receive your application, we deny your application for Basic Food. You may apply for Basic Food again when your date of release from the institution is closer.
(c) We were unable to process your application within thirty days because of a delay on your part. If you caused the delay, but submit required verification by the end of the second thirty-day period, we approve your benefits starting the date you provide the required verification. We start your benefits from this date even if we denied your application for Basic Food.
(d) We initially denied your application for Basic Food and your assistance unit (AU) becomes categorically eligible (CE) within sixty days from the date you applied. If your AU becoming CE under WAC 388-414-0001 makes you eligible for Basic Food, the date we approve Basic Food is the date your AU became CE.
(e) You are approved for transitional food assistance under chapter 388-489 WAC. We determine the date transitional benefits start as described under WAC 388-489-0015.
(f) You receive transitional food assistance with people you used to live with, and are now approved to receive Basic Food in a different assistance unit:
(i) We must give the other assistance unit ten days notice as described under WAC 388-458-0025 before we remove you from the transitional food assistance benefits.
(ii) Your Basic Food benefits start the first of the month after we remove you from the transitional benefits. For example, if we remove you from transitional benefits on November 30th, you are eligible for Basic Food on December 1st.
(3) Medical assistance, the date your benefits start is stated in chapter 388-416 WAC.
(4) For long-term care, the date your services start is stated in WAC 388-106-0045.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, and 74.08A.010 and 7 C.F.R. 273.2(h). 10-11-033, § 388-406-0055, filed 5/11/10, effective 7/1/10. Statutory Authority: RCW 74.08.060, 74.04.050, 74.04.055, 74.04.057, 74.08.090, and 2009 c 198. 09-20-031, § 388-406-0055, filed 9/29/09, effective 11/1/09. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, and 74.08A.010. 05-19-060, § 388-406-0055, filed 9/16/05, effective 11/1/05. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510. 03-22-039, § 388-406-0055, filed 10/28/03, effective 12/1/03. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 74.08.090. 02-14-023, § 388-406-0055, filed 6/21/02, effective 7/1/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-406-0055, filed 7/31/98, effective 9/1/98.]
(a) "We" means the department of social and health services.
(b) "You" means a person that is applying for or getting benefits from the department.
(c) "Assistance unit" or "AU" is the group of people who live together and whose income or resources we count to decide your eligibility for benefits and the amount of benefits you get.
(2) For ((GA-U)) ABD cash, we decide who is in the AU
under WAC ((388-408-0010)) 388-408-0060.
(3) For TANF, PWA, or SFA, we decide who is in the AU by taking the following steps:
(a) We start with who must be in the AU under WAC 388-408-0015;
(b) We add those you choose to have in the AU under WAC 388-408-0025; and
(c) We remove those who are not allowed in the AU under WAC 388-408-0020.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057. 03-17-066, § 388-408-0005, filed 8/18/03, effective 9/18/03. Statutory Authority: RCW 74.04.050, 74.04.057, 2000 2nd sp.s. c 1. 01-03-121, § 388-408-0005, filed 1/22/01, effective 3/1/01. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-408-0005, filed 7/31/98, effective 9/1/98.]
(2) If you are married and live with your spouse, we decide who to include in the AU based on who is aged, blind, or likely to be disabled:
(a) If you are both aged, blind, or likely to be disabled as defined in WAC 388-400-0060 and 388-449-0001, we include both of you in the same AU.
(b) If only one spouse is aged, blind, or likely to be disabled, we include only the aged, blind, or likely to be disabled spouse in the AU. We count some of the income of the spouse that is not in the AU as income to the AU under WAC 388-450-0137.
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(a) Temporary assistance for needy families (TANF);
(b) Aged, blind, or disabled (ABD) cash assistance;
(c) Pregnant women assistance (PWA);
(d) Supplemental Security Income (SSI); or
(((c))) (e) Refugee assistance.
(2) The certification period for the medical programs
associated with the cash programs in subsection (1) of this
section continues as long as eligibility for these programs
lasts. When a client's cash assistance is terminated,
eligibility for medical assistance is continued until
eligibility is redetermined as described in WAC
((388-418-0025)) 182-504-0100.
(3) The certification period for medical can begin up to
three months prior to the month of application for clients
described in subsection (1) of this section if the conditions
in WAC ((388-416-0015(6))) 182-504-0015(6) apply.
(((4) The certification period for medical care services
begins on the date eligibility begins for the following cash
assistance programs:
(a) General assistance for unemployable persons (GA-U); or
(b) Alcohol and Drug Abuse Treatment and Support Act (ADATSA) programs, when the client is either receiving a grant or waiting for treatment to begin.
(5) The certification period for medical care services for clients in subsection (4) of this section runs concurrently with the period of eligibility for the client's cash assistance program.))
[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-416-0010, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-416-0010, filed 7/31/98, effective 9/1/98. Formerly WAC 388-521-2110, 388-521-2120, 388-522-2210 and 388-524-2420.]
(a) A United States (U.S.) citizen;
(b) A U.S. national;
(c) An American Indian born outside the U.S.;
(d) A "qualified alien";
(e) A victim of trafficking; or
(f) A Hmong or Highland Lao.
(2) A "qualified alien" who first physically entered the U.S. before August 22, 1996 as described in WAC 388-424-0006(1) may receive TANF, medicaid, and CHIP.
(3) A "qualified alien" who first physically entered the
U.S. on or after August 22, 1996 cannot receive TANF,
medicaid, or CHIP for five years after obtaining status as a
qualified alien unless the criteria in WAC 388-424-0006(4)
((or (5))) are met.
(4) A lawfully present "nonqualified alien" child or pregnant woman as defined in WAC 388-424-0001 who meet residency requirements as defined in WAC 388-468-0005 may receive medicaid or CHIP.
(5) An alien who is ineligible for TANF, medicaid or CHIP because of the five-year bar or because of their immigration status may be eligible for:
(a) Emergency benefits as described in WAC 388-436-0015 (consolidated emergency assistance program) and WAC 388-438-0110 (alien medical program); or
(b) State-funded cash or chemical dependency benefits as
described in WAC 388-424-0015 (state family assistance (SFA),
((disability lifeline (DL))) aged, blind, or disabled (ABD)
cash, and the Alcohol and Drug Addiction Treatment and Support
Act (ADATSA)), and medical benefits as described in WAC
((388-424-0016)) 182-503-0532; or
(c) Pregnancy medical benefits for noncitizen women as described in WAC 388-462-0015(3); or
(d) State-funded apple health for kids as described in WAC 388-505-0210(5).
[Statutory Authority: RCW 74.04.050, 74.04.057, and 74.08.090. 11-16-056, § 388-424-0010, filed 7/29/11, effective 8/29/11. Statutory Authority: RCW 74.04.050, 74.04.055, 74.08.090, and CHIPRA of 2009, P.L. No. 111-3, Sec. 214; Sec. 8120, Title VIII, Division A of Department of Defense Appropriation Act of 2010, P.L. No. 111-118. 10-15-068, § 388-424-0010, filed 7/16/10, effective 8/16/10. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, 74.08A.120, and P.L. No. 111-3 (H.R. 2, Title II, Sec. 214 -Children's Health Insurance Program Reauthorization Act of 2009); P.L. No. 111-08 Omnibus Appropriations Act of 2009, Office of Refugee Resettlement State Letter #09-17. 09-15-082, § 388-424-0010, filed 7/14/09, effective 8/14/09. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08A.320, 74.08.090, and Public Law 110-161 Section 525; Public Law 110-181 Section 1244; FNS Admin Notice 08-17; State Letter 04-12 from the Office of Refugee Resettlement. 08-14-116, § 388-424-0010, filed 6/30/08, effective 8/1/08. Statutory Authority: RCW 74.08.090, 74.09.530, and 74.09.415. 05-23-013, § 388-424-0010, filed 11/4/05, effective 1/1/06. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-004, § 388-424-0010, filed 7/7/04, effective 8/7/04. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-424-0010, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, and Public Law 106-395. 02-03-008, § 388-424-0010, filed 1/4/02, effective 2/4/02. Statutory Authority: RCW 74.08.090 and 74.08A.100. 99-17-023, § 388-424-0010, filed 8/10/99, effective 9/10/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-424-0010, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0520 and 388-518-1805.]
(a) A "qualified alien" as defined in WAC 388-424-0001 who is ineligible for TANF due to the five-year bar as described in WAC 388-424-0006(3); or
(b) A nonqualified alien who meets the Washington state residency requirements as listed in WAC 388-468-0005, including a noncitizen American Indian who does not meet the criteria in WAC 388-424-0001.
(2) To receive ((general assistance (GA))) aged, blind,
or disabled (ABD) cash or pregnant women assistance (PWA)
benefits, you must be ((ineligible for the TANF, SFA, or SSI
program for a reason other than failure to cooperate with
program requirements, and belong to one of the following
groups as defined in WAC 388-424-0001)):
(a) A U.S. citizen;
(b) A U.S. national;
(c) An American Indian born outside the U.S.;
(d) A "qualified alien" or similarly defined lawful immigrant such as victim of trafficking as defined in WAC 388-424-0001; or
(e) A nonqualified alien ((who meets the Washington state
residency requirements as listed in WAC 388-468-0005))
described in WAC 388-424-0001 who:
(i) Has verified their intent to stay in the United States indefinitely; and
(ii) The United States Immigration and Customs Enforcement is not taking steps to enforce their departure.
(((3) To receive ADATSA benefits, you must belong to one
of the following groups as defined in WAC 388-424-0001:
(a) A U.S. citizen;
(b) A U.S. national;
(c) An American Indian born outside the U.S.;
(d) A "qualified alien" or similarly defined lawful immigrant such as victim of trafficking; or
(e) A nonqualified alien who meets the Washington state residency requirements as listed in WAC 388-468-0005.))
[Statutory Authority: RCW 74.04.050, 74.04.057, and 74.08.090. 11-16-056, § 388-424-0015, filed 7/29/11, effective 8/29/11. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-004, § 388-424-0015, filed 7/7/04, effective 8/7/04. Statutory Authority: RCW 74.04.050, 74.08.090. 00-08-060, § 388-424-0015, filed 3/31/00, effective 4/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-424-0015, filed 7/31/98, effective 9/1/98. Formerly WAC 388-518-1805.]
(a) TANF or SFA, unless the family has had its case grant
terminated due to WAC 388-310-1600 ((within the last six
months));
(b) Pregnant women assistance (PWA);
(c) RCA;
(((c) Disability lifeline (DL))) (d) Aged, blind, or
disabled (ABD) cash;
(((d))) (e) Supplemental Security Income (SSI);
(((e))) (f) Medical assistance for those applicants
requesting help for a medical need;
(((f))) (g) Food assistance for those applicants
requesting help for a food need;
(((g))) (h) Housing assistance from any available source
for those applicants requesting help for a housing need;
(((h))) (i) Unemployment compensation, veteran's
benefits, industrial insurance benefits, Social Security
benefits, pension benefits, or any other source of financial
benefits the applicant is potentially eligible to receive.
(2) The department may require the applicant, or anyone in the assistance unit, to apply for and take any required action to receive benefits from programs described in the above subsection (1)(a) through (h).
(3) The department may not authorize CEAP benefits to any household containing a member who is:
(a) Receiving cash benefits from any of the following programs:
(i) TANF/SFA;
(ii) PWA;
(iii) RCA;
(((iii))) (iv) DCA; or
(((iv) DL)) (v) ABD cash.
(b) Receiving reduced cash benefits for failure to comply
with program requirements of TANF/SFA, or RCA.((.))
(4) The department may authorize CEAP to families reapplying for TANF/SFA who are not eligible for TANF cash benefits under WAC 388-310-1600 until they complete the four week participation requirement.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, and 74.04.660. 11-02-037, § 388-436-0030, filed 12/29/10, effective 2/1/11. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 07-07-103, § 388-436-0030, filed 3/19/07, effective 4/19/07. Statutory Authority: RCW 74.04.660. 99-24-130, § 388-436-0030, filed 12/1/99, effective 1/1/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-436-0030, filed 7/31/98, effective 9/1/98.]
(2) If you are a fleeing felon, or violating a condition
of probation or parole as determined by an administrative body
or court that has the authority to make this decision, you are
not eligible for TANF/SFA, ((GA)) PWA, ABD cash, or Basic Food
benefits.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.025, 74.08.090 and 21 U.S.C. 862a (d)(1)(A). 05-21-100, § 388-442-0010, filed 10/18/05, effective 11/18/05. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, and 2004 c 54. 04-18-002, § 388-442-0010, filed 8/19/04, effective 9/19/04. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, and 74.04.510. 00-05-007, § 388-442-0010, filed 2/4/00, effective 3/6/00. Statutory Authority: RCW 74.08.090 and 74.04.510. 99-16-024, § 388-442-0010, filed 7/26/99, effective 9/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-442-0010, filed 7/31/98, effective 9/1/98.]
(a) "We" and "us" refer to the department of social and health services.
(b) "You" means the applicant or recipient.
(c) "Disabled" is defined by the Social Security Administration for supplemental security income (SSI) as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months with available treatment.
(d) "Physical impairment" means a diagnosable physical illness.
(e) "Mental impairment" means a diagnosable mental disorder. We exclude any diagnosis of or related to alcohol or drug abuse or addiction.
(2) We determine if you are likely to be disabled when:
(a) You apply for ABD cash benefits;
(b) You become employed;
(c) You obtain work skills by completing a training program; or
(d) We receive new information that indicates you may be employable.
(3) We determine you are likely to be disabled if:
(a) You are determined to meet SSA disability criteria by the Social Security Administration (SSA);
(b) You are determined to meet SSA disability criteria by disability determination services (DDDS) based on the most recent DDDS determination;
(c) The Social Security Administration (SSA) stops your supplemental security income (SSI) payments solely because you are not a citizen;
(d) You are eligible for long-term care services from aging and disability services administration for a medical condition that is expected to last twelve months or more or result in death; or
(e) You are approved through the sequential evaluation process (SEP) defined in WAC 388-449-0005 through 388-449-0100. The SEP is the sequence of five steps. Step 1 considers whether you are currently working. Steps 2 and 3 consider medical evidence and whether you are likely to meet or equal a listed impairment under Social Security's rules. Steps 4 and 5 consider your residual functional capacity and vocational factors such as age, education, and work experience in order to determine your ability to do your past work or other work.
(4) If you have a physical or mental impairment and you are impaired by alcohol or drug addiction and do not meet the other disability criteria in subsection (2) (a) through (d) above, we decide if you are eligible for ABD cash by applying the sequential evaluation process described in WAC 388-449-0005 through 388-449-0100. You aren't eligible for ABD cash benefits if you are disabled primarily because of alcoholism or drug addiction.
(5) In determining disability, we consider only your ability to perform basic work-related activities. "Basic work-related activities" are activities that anyone would be required to perform in a work setting. They consist of: sitting, standing, walking, lifting, carrying, handling, and other physical functions (including manipulative or postural functions such as pushing, pulling, reaching, handling, stooping, or crouching), seeing, hearing, communicating, remembering, understanding and following instructions, responding appropriately to supervisors and coworkers, tolerating the pressures of a work setting, maintaining appropriate behavior, and adapting to changes in a routine work setting.
(6) We determine you are not likely to meet SSI disability criteria if SSA denied your application for SSI or Social Security Disability Insurance (SSDI) based on disability in the last twelve months unless:
(a) You file a timely appeal with SSA;
(b) SSA decides you have good cause for a late appeal; or
(c) You give us medical evidence of a potentially disabling condition that SSA did not consider or medical evidence confirming your condition has deteriorated.
[]
(1) You must be earning less than the SGA standard as defined by the Social Security Administration (SSA) to be eligible for ABD cash, unless:
(a) You work under special conditions that go beyond the employer providing reasonable accommodation, such as a sheltered workshop; or
(b) You provide evidence you work occasionally or part-time because your impairment limits the hours you are able to work compared to unimpaired workers in the same job.
[]
(1) For a physical impairment, a health professional licensed in Washington State or where the examination was performed:
(a) A physician, which includes:
(i) Medical doctor (M.D.);
(ii) Doctor of osteopathy (D.O.);
(iii) Doctor of optometry (O.D.) for visual disorders;
(iv) Doctor of podiatry (D.P.) for foot disorders; and
(v) Qualified speech-language pathologists, for purposes of establishing speech or language impairments only.
(2) For a mental impairment, professionals licensed in Washington State or where the examination was performed:
(a) A psychiatrist; or
(b) A psychologist.
(3) We accept medical evidence of how your impairment(s) affect your ability to function from "treating medical sources" once a diagnosis of a medically determinable impairment has been established by an "acceptable medical source" listed in (1) and (2) above, "treating medical sources" include:
(a) All medical professionals listed in (1) and (2) above;
(b) A physician treating you for a mental impairment;
(c) A physician's assistant for physical impairments; and
(d) An advanced nurse practitioner for conditions within their certification.
(4) "Other evidence" means information from other sources not listed in subsection (1), (2), or (3) of this section who can provide supporting documentation of functioning for impairments established by acceptable medical sources in subsections (1) or (2) of this section. Sources of "other evidence" include public and private agencies, schools, parents, caregivers, employers, and practitioners such as social workers, mental health professionals, naturopaths, chiropractors, physical therapists, and audiologists.
[]
(1) Objective evidence for physical impairments means:
(a) Laboratory test results;
(b) Pathology reports;
(c) Radiology findings including results of X rays and computer imaging scans;
(d) Clinical findings, including but not limited to ranges of joint motion, blood pressure, temperature or pulse, and documentation of a physical examination; and
(e) Hospital history and physical reports and admission and discharge summaries; or
(f) Other medical history and physical reports related to your current impairments.
(2) Objective evidence for mental impairments means:
(a) Clinical interview observations, including objective mental status exam results and interpretation.
(b) Explanation of how examination findings meet the clinical and diagnostic criteria of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
(c) Hospital, outpatient and other treatment records related to your current impairments.
(d) Testing results, if any, including:
(i) Description and interpretation of tests of memory, concentration, cognition or intelligence; or
(ii) Interpretation of medical tests to identify or exclude a connection between the mental impairment and physical illness.
(3) Medical evidence sufficient for a disability determination must be from a medical professional described in WAC 388-449-0010 and must include:
(a) A diagnosis for the impairment, or impairments, based on an examination performed by an acceptable medical source defined in WAC 388-449-0010 within five years of application;
(b) A clear description of how the impairment relates to your ability to perform the work-related activities listed in WAC 388-449-0005;
(c) Documentation of how long a condition has impaired your ability to perform work related activities;
(d) A prognosis, or written statement of how long an impairment will impair your ability to perform work related activities; and
(e) A written statement from a medical professional (defined in WAC 388-449-0010) describing what you are capable of doing despite your impairment (medical source statement) based on an examination performed within ninety days of the date of application or forty-five days before the month of disability review.
(4) We consider documentation in addition to objective evidence to support the acceptable medical source or treating provider's opinion that you are unable to perform substantial gainful employment, such as proof of hospitalization.
(5) When making a disability decision, we don't use your report of symptoms as evidence unless objective evidence shows there is an impairment that could reasonably be expected to produce those symptoms.
(6) We don't use symptoms related to substance abuse or a diagnosis of chemical dependency when determining disability if we have evidence substance use is material to your impairment(s).
(7) We consider substance use to be material to your impairment(s) if you are disabled primarily because of drug or alcohol abuse or addiction.
(8) If your impairment will persist at least sixty days after you stop using drugs or alcohol, we do not consider substance use to be material to your impairment.
(9) If you can't obtain medical evidence sufficient for us to determine if you are likely to be disabled without cost to you, and you meet the other eligibility conditions in WAC 388-400-0060, we pay the costs to obtain objective evidence based on published payment limits and fee schedules.
(10) We determine the likelihood of disability based solely on the objective information we receive. We are not obligated to accept another agency's or person's decision that you are disabled or unemployable.
[]
(1) We evaluate cognitive and social functioning by assessing your ability to:
(a) Understand, remember, and persist in tasks by following very short and simple instructions.
(b) Understand, remember, and persist in tasks by following detailed instructions.
(c) Perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances without special supervision.
(d) Learn new tasks.
(e) Perform routine tasks without special supervision.
(f) Adapt to changes in a routine work setting.
(g) Make simple work-related decisions.
(h) Be aware of normal hazards and take appropriate precautions.
(i) Ask simple questions or request assistance.
(j) Communicate and perform effectively in a work setting with public contact.
(k) Communicate and perform effectively in a work setting with limited public contact.
(l) Complete a normal workday and workweek without interruptions from psychologically based symptoms.
(m) Set realistic goals and plan independently.
(n) Maintain appropriate behavior in a work setting.
[]
(1) "Exertion level" means having strength, flexibility, and mobility to lift, carry, stand or walk as needed to fulfill job duties in the following work levels. For this section, "occasionally" means less than one-third of the time and "frequently" means one-third to two-thirds of the time.
The following table is used to determine your exertion
level. Included in this table is a strength factor, which is
your ability to perform physical activities, as defined in
Appendix C of the Dictionary of Occupational Titles (DOT),
Revised Edition, published by the U.S. Department of Labor as
posted on the Occupational Information Network (O*NET).
| If you are able to: | Then we assign this exertion level |
| (a) Lift ten pounds maximum and frequently lift or carry lightweight articles. Walking or standing only for brief periods. | Sedentary |
| (b) Lift twenty pounds maximum and frequently lift or carry objects weighing up to ten pounds. Walk six out of eight hours per day or stand during a significant portion of the workday. Sitting and using pushing or pulling arm or leg movements most of the day. | Light |
| (c) Lift fifty pounds maximum and frequently lift or carry up to twenty-five pounds. | Medium |
| (d) Lift one hundred pounds maximum and frequently lift or carry up to fifty pounds. | Heavy |
(3) "Functional physical capacity" means the degree of strength, agility, flexibility, and mobility you can apply to work-related activities. We consider the effect of the physical impairment on the ability to perform work-related activities when the severity of the physical impairment(s) is moderate, marked, or severe. We determine functional physical capacity based on your exertional and nonexertional limitations. All limitations must be substantiated the medical evidence and directly related to the diagnosed impairment(s).
(4) "Nonexertional physical limitation" means a restriction on work activities that does not affect strength, mobility, agility, or flexibility. Nonexertional restrictions may include, among other things, your inability to work at heights or in an area where you would be exposed to chemicals.
(5) "Functional limitations" means a restriction on work activities related to unrelieved pain or the effects of prescribed medication. We determine your functional limitations based on objective documentation from a medical professional as described in WAC 388-449-0010. We may also use other evidence as described in WAC 388-449-0010. We evaluate functioning by assessing your ability to:
(a) Perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances.
(b) Perform routine tasks without undue supervision.
(c) Make simple work-related decisions.
(d) Be aware of normal hazards and take appropriate precautions.
(e) Ask simple questions or request assistance.
(f) Maintain appropriate behavior in a work setting.
[]
| Effect on Work Activities | Degree of Impairment | Numerical Value |
| (a) There is no effect on your performance of one or more basic work-related activities. | None | 1 |
| (b) There is no significant limit on your performance of one or more basic work-related activities. | Mild | 2 |
| (c) There are significant limits on your performance of one or more basic work-related activities. | Moderate | 3 |
| (d) There are very significant limits on your performance of one or more basic work-related activities. | Marked | 4 |
| (e) You are unable to perform basic work-related activities. | Severe | 5 |
(3) A contracted doctor reviews your medical evidence and the ratings assigned to your impairment when:
(a) The medical evidence indicates functional limitations consistent with at least a moderate physical or mental health impairment;
(b) Your impairment has lasted or is expected to last, twelve months or more with available medical treatment; and
(c) You are not an active ABD recipient previously determined likely to be disabled as defined in WAC 388-449-0010 through 388-449-0100.
(4) The contracted doctor reviews your medical evidence, severity rating, and functional assessment to determine whether:
(a) The Medical evidence is objective and sufficient to support the findings of the provider;
(b) The description of the impairment(s) is supported by the medical evidence; and
(c) The severity rating and assessment of functional limitations assigned by DSHS are consistent with the medical evidence.
(5) If the medical provider's description of your impairment(s) is not consistent with the objective evidence, we will:
(a) Assign a severity rating and functional limitations consistent with the objective medical evidence; and
(b) Clearly describe why we rejected the medical evidence provider's opinion; and
(c) Identify the medical evidence used to make the determination.
[]
(1) We review the following psychological evidence to determine the severity of your mental impairment:
(a) Psychosocial and treatment history records;
(b) Clinical findings of specific abnormalities of behavior, mood, thought, orientation, or perception;
(c) Results of psychological tests; and
(d) Symptoms observed by the examining practitioner, and other evidence, that show how your impairment affects your ability to perform basic work-related activities.
(2) We exclude diagnosis and symptoms related to alcohol or substance abuse or addiction, if we have evidence substance use is material to your impairment.
(3) If you are diagnosed with mental retardation, the diagnosis must be based on the Wechsler Adult Intelligence Scale (WAIS). The following test results determine the severity rating:
| Intelligence Quotient (IQ) Score | Severity Rating |
| 85 or above | None (1) |
| 71 to 84 | Moderate (3) |
| 60 to 70 | Marked (4) |
| 59 or lower | Severe (5) |
(a) Short term memory impairment;
(b) Perceptual or thinking disturbances;
(c) Disorientation to time and place; or
(d) Labile, shallow, or coarse affect.
(5) We base the severity of an impairment diagnosed as a mood, thought, personality, anxiety, memory, or cognitive disorder on a clinical assessment of the intensity and frequency of symptoms that:
(a) Affect your ability to perform basic work related activities; and
(b) Are consistent with a diagnosis of a mental impairment as listed in the most recent published edition of the Diagnostic and Statistical Manual of Mental Disorders.
(6) We consider the combined effect of your symptoms on your ability to perform basic work activities. We determine the severity rating for a functional mental impairment as follows:
| Symptom Ratings or Condition | Severity Rating |
| (a) The clinical findings and objective evidence are consistent with a significant limitation on performing one or more basic work activities. | Moderate (3) |
| (b) You are diagnosed with a
functional disorder with psychotic
features. (c) You have had two or more hospitalizations for psychiatric reasons in the past two years. (d) You have had more than six months of continuous psychiatric inpatient or residential treatment in the past two years. (e) The clinical findings and objective evidence are consistent with a very significant limitations on ability to perform one or more basic work activities. |
Marked (4) |
| (f) The clinical findings and objective evidence are consistent with the inability to perform work activities. | Severe (5) |
| Condition | Severity Rating |
| (a) Two or more disorders with
moderate severity (3) ratings; or (b) One or more disorders rated moderate severity (3), and one rated marked severity (4). |
Marked (4) |
| (c) Two or more disorders rated marked severity (4). | Severe (5) |
[]
We assign to each physical impairment a severity rating that is supported by medical evidence.
[]
(2) When you have two or more diagnosed impairments that limit work activities, we assign an overall severity rating as follows:
| Your Condition | Severity Rating |
| (i) All impairments are mild and there is no cumulative effect on basic work activities. | Mild |
| (ii) All impairments are mild and there is a significant cumulative effect on one or more basic work activities. | Moderate |
| (iii) Two or more impairments are of moderate severity and there is a very significant cumulative effect on basic work activities. | Marked |
| (iv) Two are more impairments are of marked severity. | Severe |
[]
(1) We require written medical evidence to determine disability. The medical evidence must:
(a) Contain sufficient information as described under WAC 388-449-0015;
(b) Be written by an acceptable medical source or treating provider described in WAC 388-449-0010;
(c) Document the existence of a potentially disabling condition by an acceptable medical source described in WAC 388-449-0010; and
(d) Document the impairment has lasted or is expected to last twelve continuous months or more with available treatment, or result in death.
(2) If the information received isn't clear, we may require more information before we determine whether you meet ABD disability requirements. As examples, we may require you to get more medical tests or be examined by a medical specialist.
(3) We deny disability if:
(a) We don't have evidence that your impairment is of at least moderate severity as defined in WAC 388-449-0035, 388-449-0040, 388-449-0045, or 388-449-0050;
(b) Your impairment hasn't lasted or isn't expected to last twelve or more months with available treatment or result in death; or
(c) We have evidence drug or alcohol abuse or addiction is material to your impairment(s).
[]
[]
(2) We evaluate your work experience to determine if you have relevant past work and transferable skills. "Relevant past work" means work:
(a) Defined as substantial gainful activity per WAC 388-449-0005;
(b) You have performed in the past fifteen years; and
(c) You performed long enough to acquire the knowledge and skills necessary to continue performing the job. You must meet the specific vocational preparation level as defined in Appendix C of the Dictionary of Occupational Titles.
(3) For each relevant past work situation, we compare:
(a) The exertional, nonexertional, and skill requirements of the job based on the Appendix C of the Dictionary of Occupational Titles; and
(b) Current cognitive, social, exertional, and nonexertional factors that significantly limit your ability to perform past work.
(4) We deny disability when we determine that you are able to perform any of your relevant past work.
(5) We approve disability when you are fifty-five years of age or older and don't have the physical, cognitive, or social ability to perform past work.
[]
(1) We evaluate education in terms of formal schooling or other training to acquire skills that enable you to meet job requirements. We classify education as:
| If you | Then your education level is |
| (a) Can't read or write a simple communication, such as two sentences or a list of items. | Illiterate |
| (b) Have no formal schooling or vocational training beyond the sixth grade. | Marginal education |
| (c) Have no formal schooling or
vocational training beyond the
eleventh grade; or (d) Had participated in special education in basic academic classes of reading, writing or mathematics in high school. |
Limited education |
| (e) Have received a high school
diploma or general equivalency degree
(GED) and don't meet the special
education definition in (d) above; or (f) Have received skills training and were awarded a certificate, degree or license. |
High school and above level of education |
| Exertional level | Your age | Your education level | Work history | Nonexertional and functional limitations |
| Restricted to less than sedentary | Any age | Any level | Does not apply | Does not apply |
| Restricted to sedentary | Any age | Any level | Does not apply | You have nonexertional or functional impairments that preclude all sedentary work |
| Restricted to sedentary | Fifty and older | Any level | Does not apply | Does not apply |
| Restricted to sedentary | Forty-five and older | Marginal education, illiterate, or unable to communicate in English | Unskilled or none | Does not apply |
| Restricted to light | Any age | Any level | Does not apply | You have nonexertional or functional impairments that preclude all sedentary work |
| Restricted to light | Fifty and older | Marginal education or unable to communicate in English | Does not apply | Does not apply |
| Your age | Your education | Work history | Social and cognitive limitations |
| Any age | Any level | Any level | Substantial loss of ability to: • Understand, remember, and persist in tasks by following very short and simple instructions; • Perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances without special supervision; • Perform routine tasks without special supervision; • Adapt to changes in a routine work setting; • Make simple work-related decisions; • Be aware of normal hazards and take appropriate precautions; • Ask simple questions or request assistance; • Communicate and perform effectively in a work setting; • Complete a normal workday and workweek without interruptions from psychologically based symptoms; or • Maintain appropriate behavior in a work setting. |
| Fifty and older | Any level | Any level | Substantial loss of ability to: • Understand, remember, and persist in tasks by following detailed instructions; • Set realistic goals and plan independently; or • Learn new tasks. |
(5) We approve disability when you have both mental and physical impairments, with an overall severity that is moderate, marked, or severe, and you meet the criteria below:
| Your age | Your education level | Exertional level | Social and cognitive limitations | Other vocational factors |
| Any age | Any level | Restricted to light or less | You have a
substantial loss of
ability to: • Communicate and perform effectively in a work setting; or • Maintain appropriate behavior in a work setting. |
No transferable skills to work level |
| Fifty or older | Limited education or unable to communicate in English | Restricted to light or less | Does not apply | No transferable skills to work level |
| Any age | Marginal education, illiterate, or unable to communicate in English | Restricted to medium or less | You have a
substantial loss of
ability to: • Communicate and perform effectively in a work setting with limited public contact; or • Maintain appropriate behavior in a work setting. |
No transferable skills to work level |
(a) Deny disability; and
(b) Give you examples of jobs you can do in the national economy despite your impairments(s).
(7) If there are no jobs you can do in the national economy despite your impairment(s), we approve disability.
[]
(2) If your application for SSI is denied:
(a) We review your eligibility for the ABD cash program;
(b) We stop your benefits if you do not provide proof you have filed an appeal with SSA within sixty days of a SSI denial for not being disabled.
(3) We stop your benefits after the final decision on your application for SSI/SSA benefits or if you fail to follow through with any part of the SSI/SSA application or appeals process.
[]
(a) Have filed your SSI application with the Social Security Administration (SSA), follow through with SSA directions and requirements to process your application including keeping all interview and consultative examination appointments, and do not withdraw your application;
(b) Agree to assign the initial or reinstated SSI payment to us provided under WAC 388-449-0210;
(c) Are otherwise eligible according to WAC 388-400-0060; and
(d) Meet disability criteria listed in WAC 388-449-0001.
(2) To demonstrate your impairments are disabling despite medical treatment, you must participate in medical treatment for the impairments that keep you from working, unless you meet one of the following good cause reasons:
(a) The treatment provider has identified a risk that the treatment may cause further limitations or loss of a function or an organ and you are not willing to take that risk;
(b) Treatment is not available because you can't obtain it without cost to you;
(c) You are so fearful of the treatment that your fear could interfere with the treatment or reduce its benefits; or
(d) You practice an organized religion that prohibits the treatment.
(3) If you refuse or fail to participate in medical treatment without good cause, your benefits will end and you will remain ineligible until you reapply and provide proof you are pursuing treatment as recommended.
[]
(1) "Assign" means that you sign a written authorization for the Social Security Administration (SSA) to send the SSI retroactive payment to us.
(2) "Interim assistance" means the monetary value of benefits we paid to you or on your behalf during:
(a) The time between your SSI application date and the month recurring SSI payments begin; or
(b) The period your SSI payments were suspended or terminated, and later reinstated.
[]
(2) You must accept an assessment referral and participate in drug or alcohol treatment if a certified chemical dependency counselor indicates a need for treatment, unless you meet one of the following good cause reasons:
(a) We determine that your physical or mental health impairment prevents you from participating in treatment.
(b) The outpatient chemical dependency treatment you need isn't available in the county you live in.
(c) You need inpatient chemical dependency treatment at a location that you can't reasonably access.
(3) If you refuse or fail to complete an assessment or treatment without good cause, your benefits will end until you provide proof you are pursuing an assessment or treatment as required.
[]
[]
(1) The following types of income are not counted when a client's benefits are computed:
(a) Up to two thousand dollars per individual per calendar year received under the Alaska Native Claims Settlement Act, P.L. 92-203 and 100-241;
(b) Income received from Indian trust funds or lands held in trust by the Secretary of the Interior for an Indian tribe or individual tribal member. Income includes:
(i) Interest; and
(ii) Investment income accrued while such funds are held in trust.
(c) Income received from Indian judgement funds or funds held in trust by the Secretary of the Interior distributed per capita under P.L. 93-134 as amended by P.L. 97-458 and 98-64. Income includes:
(i) Interest; and
(ii) Investment income accrued while such funds are held in trust.
(d) Up to two thousand dollars per individual per calendar year received from leases or other uses of individually owned trust or restricted lands, P.L. 103-66;
(e) Payments from an annuity fund established by the Puyallup Tribe of Indians Settlement Act of 1989, P.L. 101-41, made to a Puyallup Tribe member upon reaching twenty-one years of age; and
(f) Payments from the trust fund established by the P.L. 101-41 made to a Puyallup Tribe member.
(2) Other Native American payments and benefits that are excluded by federal law are not counted when determining a client's benefits. Examples include but are not limited to:
(a) White Earth Reservation Land Settlement Act of 1985, P.L. 99-264, Section 16;
(b) Payments made from submarginal land held in trust for certain Indian tribes as designated by P.L. 94-114 and P.L. 94-540;
(c) Payments under the Seneca Nation Settlement Act, P.L. 101-503; and
(d) For medical assistance, receipt of money by a member of a federally recognized tribe from exercising federally protected rights or extraction of protected resources, such as fishing, shell-fishing, or selling timber, is considered conversion of an exempt resource during the month of receipt. Any amounts remaining from the conversion of this exempt resource on the first of the month after the month of receipt will remain exempt if the funds were used to purchase another exempt resource. Any amounts remaining in the form of countable resources (such as in checking or savings accounts) on the first of the month after receipt, will be added to other countable resources for eligibility determinations.
[Statutory Authority: RCW 74.08.090 and ARRA of 2009, Public Law 111-5, Section 5006(b); 42 C.F.R. 435.601, EEOICPA of 2000, Public Law 106398, Sec. 1, app., Title XXXVI (Oct. 30, 2000) (section 1 adopting as Appendix H.R. 5408), Section 3646 of the Appendix. 10-15-069, § 388-450-0040, filed 7/16/10, effective 8/16/10. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0040, filed 7/31/98, effective 9/1/98. Formerly WAC 388-511-1140.]
(1) We treat payments issued under the Workforce Investment Act (WIA) as follows:
(a) For cash assistance and medical programs for families, children, and pregnant women, we exclude all payments.
(b) For Basic Food:
(i) We exclude OJT earnings for children who are eighteen years of age or younger and under parental control as described in WAC 388-408-0035.
(ii) We count OJT earnings as earned income for people who are:
(A) Age nineteen and older; or
(B) Age eighteen or younger and not under parental control.
(iii) We exclude all other payments.
(2) We exclude all payments issued under the National and Community Service Trust Act of 1993. This includes payments made through the AmeriCorps program.
(3) We treat payments issued under Title I of the Domestic Volunteer Act of 1973, such as VISTA, AmeriCorps Vista, university year for action, and urban crime prevention program as follows:
(a) For cash assistance and medical programs for families, children, and pregnant women, we exclude all payments.
(b) For Basic Food, we count most payments as earned income. We exclude the payments if you:
(i) Received Basic Food or cash assistance at the time you joined the Title I program; or
(ii) Were participating in the Title I program and received an income disregard at the time of conversion to the Food Stamp Act of 1977. We continue to exclude the payments even if you do not get Basic Food every month.
(4) We exclude all payments issued under Title II of the Domestic Volunteer Act of 1973. These include:
(a) Retired senior volunteer program (RSVP);
(b) Foster grandparents program; and
(c) Senior companion program.
(5) We count training allowances from vocational and rehabilitative programs as earned income when:
(a) The program is recognized by federal, state, or local governments; and
(b) The allowance is not a reimbursement.
(6) ((When GAU clients receive training allowances we
allow:
(a) The earned income incentive and work expense deduction specified under WAC 388-450-0175, when applicable; and
(b) The actual cost of uniforms or special clothing required for the course as a deduction, if enrolled in a remedial education or vocational training course.
(7))) We exclude support service payments received by or made on behalf of WorkFirst participants.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090. 06-17-017, § 388-450-0045, filed 8/4/06, effective 9/4/06. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510. 03-03-071, § 388-450-0045, filed 1/15/03, effective 3/1/03. Statutory Authority: RCW 74.08.090 and 74.04.510. 02-03-019, § 388-450-0045, filed 1/4/02, effective 2/1/02; 99-16-024, § 388-450-0045, filed 7/26/99, effective 9/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0045, filed 7/31/98, effective 9/1/98.]
(1) Allocation is the process of determining how much of a financially responsible person's income is considered available to meet the needs of legal dependents within or outside of an assistance unit.
(2) In-bound allocation means income possessed by a financially responsible person outside the assistance unit which is considered available to meet the needs of legal dependents in the assistance unit.
(3) Out-bound allocation means income possessed by a financially responsible assistance unit member which is set aside to meet the needs of a legal dependent outside the assistance unit.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0095, filed 7/31/98, effective 9/1/98.]
(1) "Dependent" means a person who:
(a) Is or could be claimed for federal income tax purposes by the financially responsible person; or
(b) The financially responsible person is legally obligated to support.
(2) "Financially responsible person" means a parent, stepparent, adoptive parent, spouse or caretaker relative.
(3) A "disqualified assistance unit member" means a person who is:
(a) An unmarried pregnant or parenting minor under age eighteen who has not completed a high school education or general education development (GED) certification and is not participating in those educational activities which would lead to the attainment of a high school diploma or GED;
(b) An unmarried pregnant or parenting minor under age eighteen who is not living in a department-approved living situation;
(c) The financially responsible person who does not report to the department within five days of the date it becomes reasonably clear that the absence of a child will exceed ninety days;
(d) A person who has been convicted in federal or state court of having made a fraudulent statement or representation about their place of residence in order to receive assistance from two or more states at the same time as defined in WAC 388-446-0010; and
(e) A person who has been convicted of unlawfully receiving public assistance as defined under WAC 388-446-0005.
(4) "Ineligible assistance unit member" means an individual who is:
(a) Ineligible for cash assistance due to the citizenship/alien status requirements in WAC 388-424-0010;
(b) Ineligible to receive assistance under WAC 388-442-0010 for having been convicted after August 21, 1996, under federal or state law, of possession, use or distribution of a controlled substance;
(c) Ineligible to receive assistance under WAC 388-442-0010 for fleeing to avoid prosecution or custody or confinement after conviction for a crime or attempt to commit a crime;
(d) Ineligible to receive assistance under WAC 388-442-0010 for violating a condition of probation or parole which was imposed under a federal or state law as determined by an administrative body or court of competent jurisdiction;
(e) The spouse of a woman who receives cash benefits from
the ((GA-S)) PWA program; or
(f) The adult parent of a minor parent's child.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, § 388-450-0100, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.08.090 and 74.04.510. 99-16-024, § 388-450-0100, filed 7/26/99, effective 9/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0100, filed 7/31/98, effective 9/1/98.]
(1) The income of an ABD cash client is reduced by the following:
(a) The ABD cash earned income disregard as specified in WAC 388-450-0177; and
(b) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.
(2) When a ABD cash client in a medical institution, alcohol or drug treatment center, congregate care facility or adult family home has income, the income is countable to meet the client's needs after the income is reduced by the following:
(a) The payment standard amount for the nonapplying spouse and legal dependents living in the home; and
(b) The standard of assistance the client is eligible for while in an alternative care facility.
[]
The income of a financially responsible person excluded from the assistance unit is available to meet the needs of the assistance unit after the income is reduced by the following:
(1) A ninety dollar work expense deduction from the financially responsible person(s) excluded from the assistance unit who is employed;
(2) The payment standard amount for the ineligible assistance unit members living in the home; and
(3) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0115, filed 7/31/98, effective 9/1/98.]
The income of nonapplying financially responsible parent(s) of a pregnant or parenting minor is countable to meet the needs of the minor and the child(ren) after the income is reduced by the following:
(1) A ninety dollar work expense from the financially responsible parent's gross income from employment;
(2) An amount not to exceed the department's standard of need for:
(a) The financially responsible parent and dependent living in the home who are not applying for or receiving cash benefits and not a disqualified individual; and
(b) Court or administratively ordered current or back support for legal dependents.
(3) Spousal maintenance payments made to meet the needs of individuals not living in the home.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0120, filed 7/31/98, effective 9/1/98.]
(1) The community income of the nonapplying spouse and applying spouse is combined. See WAC 388-450-0005 to determine what income is available as community income.
(2) Subtract a one person payment standard as specified in WAC 388-478-0020.
(3) The remainder is allocated to the caretaker relative.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0130, filed 7/31/98, effective 9/1/98.]
(1) When an ABD cash client is married and lives with the nonapplying spouse, the following income is available to the client:
(a) The remainder of the client's wages, retirement benefits or separate property after reducing the income by:
(i) The ABD cash work incentive deduction, as specified in WAC 388-450-0177; and
(ii) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents.
(b) The remainder of the nonapplying spouse's wages, retirement benefits and separate property after reducing the income by:
(i) An amount not to exceed the department's standard of need for court or administratively ordered current or back support for legal dependents; and
(ii) The payment standard amount as specified under WAC 388-478-0033 which includes ineligible assistance unit members.
(c) One-half of all other community income, as provided in WAC 388-450-0005.
[]
(a) The Immigration and Nationality Act (INA) does not require you to have a sponsor. Immigrants who are not required to have a sponsor include those with the following status with United States Citizenship and Immigration Services (USCIS):
(i) Refugee;
(ii) Parolee;
(iii) Asylee;
(iv) Cuban/Haitian entrant; or
(v) Special immigrant from Iraq or Afghanistan.
(b) You were sponsored by an organization or group as opposed to an individual;
(c) You do not meet the alien status requirements to be eligible for benefits under chapter 388-424 WAC;
(d) You have worked or can get credit for forty qualifying quarters of work under Title II of the Social Security Act. We do not count a quarter of work toward this requirement if the person working received TANF, food stamps, Basic Food, SSI, CHIP, or nonemergency medicaid benefits. We count a quarter of work by the following people toward your forty qualifying quarters:
(i) Yourself;
(ii) Each of your parents for the time they worked before you turned eighteen years old (including the time they worked before you were born); and
(iii) Your spouse if you are still married or your spouse is deceased.
(e) You become a United States (U.S.) Citizen;
(f) Your sponsor is dead; or
(g) If USCIS or a court decides that you, your child, or your parent was a victim of domestic violence from your sponsor and:
(i) You no longer live with your sponsor; and
(ii) Leaving your sponsor caused your need for benefits.
(2) You are exempt from the deeming process while you are in the same AU as your sponsor;
(3) For children and pregnancy medical programs, you are exempt from sponsor deeming requirements.
(4) For Basic Food, you are exempt from deeming while you are under age eighteen.
(5) For state family assistance, ((disability lifeline
(DL))) aged, blind, or disabled (ABD) cash, pregnant women
assistance (PWA), state-funded Basic Food benefits, and
state-funded medical assistance for legal immigrants you are
exempt from the deeming process if:
(a) Your sponsor signed the affidavit of support more than five years ago;
(b) Your sponsor becomes permanently incapacitated; or
(c) You are a qualified alien according to WAC 388-424-0001 and you:
(i) Are on active duty with the U.S. armed forces or you are the spouse or unmarried dependent child of someone on active duty;
(ii) Are an honorably discharged veteran of the U.S. armed forces or you are the spouse or unmarried dependent child of an honorably discharged veteran;
(iii) Were employed by an agency of the U.S. government or served in the armed forces of an allied country during a military conflict between the U.S. and a military opponent; or
(iv) Are a victim of domestic violence and you have petitioned for legal status under the Violence Against Women Act.
(6) If you, your child, or your parent was a victim of domestic violence, you are exempt from the deeming process for twelve months if:
(a) You no longer live with the person who committed the violence; and
(b) Leaving this person caused your need for benefits.
(7) If your AU has income at or below one hundred thirty percent of the federal poverty level (FPL), you are exempt from the deeming process for twelve months. This is called the "indigence exemption." You may choose to use this exemption or not to use this exemption in full knowledge of the possible risks involved. See risks in subsection (9) below. For this rule, we count the following as income to your AU:
(a) Earned and unearned income your AU receives from any source; and
(b) Any noncash items of value such as free rent, commodities, goods, or services you receive from an individual or organization.
(8) If you use the indigence exemption, and are eligible for a federal program, we are required by law to give the United States attorney general the following information:
(a) The names of the sponsored people in your AU;
(b) That you are exempt from deeming due to your income;
(c) Your sponsor's name; and
(d) The effective date that your twelve-month exemption began.
(9) If you use the indigence exemption, and are eligible for a state program, we do not report to the United States attorney general.
(10) If you choose not to use the indigence exemption:
(a) You could be found ineligible for benefits for not verifying your sponsor's income and resources; or
(b) You will be subject to regular deeming rules under WAC 388-450-0160.
[Statutory Authority: RCW 74.04.050, 74.04.057, and 74.08.090. 11-16-056, § 388-450-0156, filed 7/29/11, effective 8/29/11. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, and 7 U.S.C. 2014(i); 7 C.F.R. § 273.4(c); USDA Food and Nutrition Service final rules for the FSRIA of 2002 (farm bill) final rule announcement. 10-15-043, § 388-450-0156, filed 7/13/10, effective 8/1/10. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, § 388-450-0156, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, and 74.04.510. 03-05-030, § 388-450-0156, filed 2/10/03, effective 4/1/03. Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.510 and Title 7, Chapter II, Part 273 of the Code of Federal Regulations. 01-21-026, § 388-450-0156, filed 10/9/01, effective 11/1/01.]
(1) If a client works, the department only counts some of the income to determine eligibility and benefit level.
(2) We only count fifty percent of your monthly gross earned income. We do this to encourage you to work.
(3) If you pay for care before we approve your benefits, we subtract the amount you pay for those dependent children or incapacitated adults who get cash assistance with you.
(a) The amount we subtract is:
(i) Prorated according to the date you are eligible for benefits;
(ii) Cannot be more than your gross monthly income; and
(iii) Cannot exceed the following for each dependent child or incapacitated adult:
| Dependent Care Maximum Deductions | ||||||||||
| Hours Worked Per Month | Child Two Years of Age & Under | Child Over Two Years of Age or Incapacitated Adult | ||||||||
| 0 - | 40 | $ | 50.00 | $ | 43.75 | |||||
| 41 - | 80 | $ | 100.00 | $ | 87.50 | |||||
| 81 - | 120 | $ | 150.00 | $ | 131.25 | |||||
| 121 or | More | $ | 200.00 | $ | 175.00 | |||||
(i) The person providing the care must be someone other than the parent or stepparent of the child or incapacitated adult; and
(ii) You must verify the expense.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057. 04-03-051, § 388-450-0170, filed 1/15/04, effective 2/15/04. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-450-0170, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-450-0170, filed 7/31/98, effective 9/1/98.]
We only count fifty percent of your monthly gross earned income. We do this to encourage you to work.
[]
(2) Clients are assigned to protective payees for the following reasons:
(a) Emergency or temporary situations where a child is left without a caretaker (TANF/SFA) per WAC 388-460-0030;
(b) Mismanagement of money (TANF/SFA, ((GA)) PWA, ABD
cash, or WCCC) per WAC 388-460-0035; or
(c) Pregnant or parenting minors per WAC 388-460-0040.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, and chapter 74.08A RCW. 06-10-034, § 388-460-0020, filed 4/27/06, effective 6/1/06. Statutory Authority: RCW 74.08A.010(4), 74.08A.340, 74.08.090, 74.04.050. 02-14-083, § 388-460-0020, filed 6/28/02, effective 7/1/02.]
(1) Head of a household;
(2) Under age eighteen;
(3) Unmarried; and
(4) Pregnant or have a dependent child.
[Statutory Authority: RCW 74.08A.010(4), 74.08A.340, 74.08.090, 74.04.050. 02-14-083, § 388-460-0040, filed 6/28/02, effective 7/1/02.]
(1) A resident is a person who:
(a) Currently lives in Washington and intends to continue living here permanently or for an indefinite period of time; or
(b) Entered the state looking for a job; or
(c) Entered the state with a job commitment.
(2) A person does not need to live in the state for a specific period of time to be considered a resident.
(3) A child under age eighteen is a resident of the state where the child's primary custodian lives.
(4) With the exception of subsection (5) of this section, a client can temporarily be out of the state for more than one month. If so, the client must supply the department with adequate information to demonstrate the intent to continue to reside in the state of Washington.
(5) Basic Food program assistance units who are not categorically eligible do not meet residency requirements if they stay out of the state more than one calendar month.
(6) A client may not receive comparable benefits from another state for the cash and Basic Food programs.
(7) A former resident of the state can apply for the
((GA-U)) ABD cash program while living in another state if:
(a) The person:
(i) Plans to return to this state;
(ii) Intends to maintain a residence in this state; and
(iii) Lives in the United States at the time of the application.
(b) In addition to the conditions in subsection (7)(a)(i)(ii), and (iii) being met, the absence must be:
(i) Enforced and beyond the person's control; or
(ii) Essential to the person's welfare and is due to physical or social needs.
(c) See WAC 388-406-0035, 388-406-0040, and 388-406-0045 for time limits on processing applications.
(8) Residency is not a requirement for detoxification services.
(9) A person is not a resident when the person enters Washington state only for medical care. This person is not eligible for any medical program. The only exception is described in subsection (10) of this section.
(10) It is not necessary for a person moving from another state directly to a nursing facility in Washington state to establish residency before entering the facility. The person is considered a resident if they intend to remain permanently or for an indefinite period unless placed in the nursing facility by another state.
(11) For purposes of medical programs, a client's residence is the state:
(a) Paying a state Supplemental Security Income (SSI) payment; or
(b) Paying federal payments for foster or adoption assistance; or
(c) Where the noninstitutionalized individual lives when medicaid eligibility is based on blindness or disability; or
(d) Where the parent or legal guardian, if appointed, for an institutionalized:
(i) Minor child; or
(ii) Client twenty-one years of age or older, who became incapable of determining residential intent before reaching age twenty-one.
(e) Where a client is residing if the person becomes incapable of determining residential intent after reaching twenty-one years of age; or
(f) Making a placement in an out-of-state institution; or
(g) For any other institutionalized individual, the state of residence is the state where the individual is living with the intent to remain there permanently or for an indefinite period.
(12) In a dispute between states as to which is a person's state of residence, the state of residence is the state in which the person is physically located.
[Statutory Authority: RCW 74.08.090. 03-20-060, § 388-468-0005, filed 9/26/03, effective 10/27/03. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-468-0005, filed 7/31/98, effective 9/1/98.]
Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 05-19-059, filed 9/16/05,
effective 10/17/05)
WAC 388-473-0010
What are ongoing additional
requirements and how do I qualify?
"Ongoing additional
requirement" means a need beyond essential food, clothing, and
shelter needs and is necessary to help you continue living
independently.
(1) We may authorize ongoing additional requirement benefits if you are active in one of the following programs:
(a) Temporary assistance for needy families (TANF), or tribal TANF;
(b) State family assistance (SFA);
(c) Pregnant women assistance (PWA);
(d) Refugee cash;
(((d) General assistance cash)) (e) Aged, blind, or
disabled (ABD) cash assistance; or
(((e))) (f) Supplemental Security Income (SSI).
(2) You apply for an ongoing additional requirement benefit by notifying staff who maintain your cash or medical assistance that you need additional help to live independently.
(3) We authorize ongoing additional requirement benefits only when we determine the item is essential to you. We make the decision based on proof you provide of:
(a) The circumstances that create the need; and
(b) How the need affects your health, safety and ability to continue to live independently.
(4) We authorize ongoing additional requirement benefits by increasing your monthly cash assistance benefit.
(5) We use the following review cycle table to decide when to review your need for the additional benefit(s).
| REVIEW CYCLE | |
| Program | Frequency (Months) |
| TANF/RCA | 6 Months |
| (( |
12 Months |
| SSI | 24 Months |
| All | Any time need or circumstances are expected to change |
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 05-19-059, § 388-473-0010, filed 9/16/05, effective 10/17/05; 01-01-070, § 388-473-0010, filed 12/12/00, effective 2/1/01; 00-15-053, § 388-473-0010, filed 7/17/00, effective 9/1/00.]
(2) If you are an ineligible spouse you cannot get the SSI state supplement when you are:
(a) The caretaker relative of a child who receives TANF or SFA; and
(b) Required to be included in the TANF or SFA assistance unit with the child (see WAC 388-408-0015); or
(c) Receiving refugee assistance.
(3) If you are an ineligible spouse and get an SSI state
supplement (WAC 388-474-0012), you cannot get ((general
assistance (GA))) aged, blind, or disabled (ABD) cash
assistance.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.04.630. 02-11-033, § 388-474-0010, filed 5/7/02, effective 6/7/02. Statutory Authority: RCW 74.08.090, 74.04.057, 74.04.050. 01-19-023, § 388-474-0010, filed 9/12/01, effective 11/1/01. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-474-0010, filed 7/31/98, effective 9/1/98.]
(1) If you got advance, emergency or retroactive SSI cash
assistance for any period where you ((got GA-U)) received
general assistance (GA), disability lifeline (DL), or aged,
blind, or disabled (ABD) cash assistance, you must repay the
department the amount of ((GA-U)) cash assistance paid to you
for the matching time period.
(2) When you apply for ((GA-U)) ABD cash you must sign
DSHS 18-235(X), interim assistance reimbursement agreement
(IARA) to ((get GA-U)) receive ABD cash assistance.
(3) You cannot use your ((GA-U)) ABD money to replace
money deducted from your SSI check to repay an SSI
overpayment.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090 and 74.04.630. 02-11-033, § 388-474-0020, filed 5/7/02, effective 6/7/02. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-474-0020, filed 7/31/98, effective 9/1/98.]
(2) If the person is unable to provide the SSN, either because it is not known or has not been issued, the person must:
(a) Apply for the SSN;
(b) Provide proof that the SSN has been applied for; and
(c) Provide the SSN when it is received.
(3) Assistance will not be delayed, denied or terminated pending the issuance of an SSN by the Social Security Administration. However, a person who does not comply with these requirements is not eligible for assistance.
(4) For cash, medical, and food assistance benefits, a person cannot be disqualified from receiving benefits for refusing to apply for or supply an SSN based on religious grounds.
(5) For food assistance programs:
(a) A person can receive benefits for the month of application and the following month if the person attempted to apply for the SSN and made every effort to provide the needed information to the Social Security Administration.
(b) If a person is unable to provide proof of application for a SSN for a newborn:
(i) The newborn can receive Basic Food with the household while effort is being made to get the SSN.
(ii) For the newborn to continue receiving Basic Food benefits; the household must provide proof of application for SSN or the SSN for the newborn, at the next recertification, or within six months following the month the baby is born, whichever is later.
(6) For medical programs, a newborn as described in WAC 388-505-0210(1) is eligible for categorically needy (CN) medical without meeting the SSN requirement until the baby's first birthday.
(7) There is no SSN requirement for the following programs:
(a) The consolidated emergency assistance program;
(b) The refugee cash and medical assistance program;
(c) The alien emergency medical program; and
(d) ((The state-funded pregnant woman program; and
(e))) Detoxification services.
[Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.055, 74.04.057, 74.04.510, and Title 7, 273.6 C.F.R. 10-17-101, § 388-476-0005, filed 8/17/10, effective 9/17/10. Statutory Authority: RCW 74.08.090. 03-20-061, § 388-476-0005, filed 9/26/03, effective 10/27/03. Statutory Authority: RCW 74.08.090 and 74.04.510. 99-17-025, § 388-476-0005, filed 8/10/99, effective 10/1/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-476-0005, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0530.]
| Assistance Unit Size | Payment Standard |
| 1 | $197 |
| Assistance Unit Size | Payment Standard |
| 1 | $120 |
[]
| Assistance Unit Size | Payment standard |
| 1 | $197 |
| 2 | $248 |
| Assistance Unit Size | Payment Standard |
| 1 | $120 |
| 2 | $152 |
[]
(2) The following definitions apply to terms used in this section:
(a) "Unmarried" means a person who ((have)) has never
been married or whose marriage has been annulled. It does not
include a person who has been divorced or widowed.
(b) "Minor" means a person younger than eighteen years of age.
(c) "Legal guardian" means a court-appointed legal guardian or court-appointed permanent custodian.
(d) "Relative" is a person who is related to the pregnant or parenting minor as defined under RCW 74.15.020(4).
(3) An unmarried pregnant or parenting minor is not
eligible for TANF, SFA or ((GA-S)) PWA unless the person:
(a) Has been emancipated by a court; or
(b) Lives in a home approved by the department and has a protective payee.
(4) The home of a minor's parent, legal guardian, or adult relative may be approved unless:
(a) The minor has no living parent, legal guardian, or adult relative that can be located or those persons do not want the minor to live with them;
(b) The minor or the minor's child is being or has been seriously harmed either physically, emotionally or sexually in the home of the parent, legal guardian, or adult relative;
(c) Substantial evidence exists of an act or failure to act by the parent, legal guardian, or adult relative that presents imminent or serious harm to the minor or the minor's child if they lived there; or
(d) The department determines that it is in the best interest of the minor or the minor's child to waive the requirement of living in the home of a parent, legal guardian, or adult relative.
(5) If the home of a minor's parent, legal guardian, or adult relative is not available or suitable, one of the following alternatives may be approved:
(a) A facility or home licensed under chapter 74.15 RCW that provides a supportive and supervised living arrangement requiring residents to learn parenting skills;
(b) A maternity home;
(c) Other adult-supervised living arrangement; or
(d) The minor's current or proposed living arrangement, if the department determines it is appropriate.
(6) A home that includes the other natural parent of the minor's child or unborn child is never approved if:
(a) The minor is under age sixteen; and
(b) The other parent is eighteen or older and meets the age criteria for rape of a child as set forth in RCW 9A.44.073, 9A.44.076, and 9A.44.079.
(7) The income of a minor parent found ineligible under this section is treated according to WAC 388-450-0100 and 388-450-0115 when determining the eligibility and benefit level of the minor parent's child.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-486-0005, filed 7/31/98, effective 9/1/98.]
The following sections of the Washington Administrative Code are repealed:
| WAC 388-400-0025 | Who is eligible for disability lifeline benefits? |
| WAC 388-404-0010 | Age requirement for GA-U and ADATSA. |
| WAC 388-408-0010 | Who is in my assistance unit for general assistance? |
| WAC 388-418-0025 | Effect of changes on medical program eligibility. |
| WAC 388-424-0016 | Citizenship and alien status -- Immigrant eligibility restrictions for state medical benefits. |
| WAC 388-448-0001 | What are the incapacity requirements for general assistance? |
| WAC 388-448-0010 | How do we decide if you are incapacitated? |
| WAC 388-448-0020 | Which health professionals can I go to for medical evidence? |
| WAC 388-448-0030 | What medical evidence do I need to provide? |
| WAC 388-448-0035 | How we assign severity ratings to your impairment. |
| WAC 388-448-0040 | PEP step I -- Review of medical evidence required for eligibility determination. |
| WAC 388-448-0050 | PEP step II -- How we determine the severity of mental impairments. |
| WAC 388-448-0060 | PEP step III -- How we determine the severity of physical impairments. |
| WAC 388-448-0070 | PEP step IV -- How we determine the severity of multiple impairments. |
| WAC 388-448-0080 | PEP step V -- How we determine your ability to function in a work environment if you have a mental impairment. |
| WAC 388-448-0090 | PEP step V -- How we determine your ability to function in a work environment if you have a physical impairment. |
| WAC 388-448-0100 | PEP step VI -- How we evaluate capacity to perform relevant past work. |
| WAC 388-448-0110 | PEP step VII -- How we evaluate your capacity to perform other work. |
| WAC 388-448-0120 | How we decide how long you are incapacitated. |
| WAC 388-448-0130 | Treatment and referral requirements. |
| WAC 388-448-0140 | When does a person have good cause for refusing or failing to participate in medical treatment or referrals to other agencies? |
| WAC 388-448-0150 | Penalty for refusing or failure to participate in medical treatment or other agency referrals. |
| WAC 388-448-0160 | When do my disability lifeline benefits end? |
| WAC 388-448-0180 | How do we redetermine your eligibility when we decide you are eligible for general assistance expedited medicaid (GAX)? |
| WAC 388-448-0200 | Can I get general assistance while waiting for supplemental security income (SSI)? |
| WAC 388-448-0210 | What is interim assistance and how do I assign it to you? |
| WAC 388-448-0220 | How does alcohol or drug dependence affect my eligibility for disability lifeline? |
| WAC 388-448-0250 | Are there limits on the number of months I may receive disability lifeline benefits? |
| WAC 388-450-0110 | Allocating the income of a GA-U client to legal dependents. |
| WAC 388-450-0135 | Allocating income of an ineligible spouse to a GA-U client. |
| WAC 388-450-0175 | Does the department offer an income deduction for the general assistance program as an incentive for clients to work? |
| WAC 388-462-0011 | Post adoption cash benefit. |
| Number of Family Members | Maximum Earned Income Level | Number of Family Members | Maximum Monthly Earned Income Level | ||
| 1 | $610 | 6 | $1,472 | ||
| 2 | 770 | 7 | 1,700 | ||
| 3 | 955 | 8 | 1,882 | ||
| 4 | 1,124 | 9 | 2,066 | ||
| 5 | 1,295 | 10 or more | 2,246 | ||
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.770, 74.08.090, and chapters 74.08A and 74.12 RCW. 11-16-029, § 388-478-0035, filed 7/27/11, effective 8/27/11. Statutory Authority: RCW 74.04.050, 74.04.055, and 2008 c 329 § 207 (1)(e). 08-16-105, § 388-478-0035, filed 8/5/08, effective 9/5/08. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-478-0035, filed 7/31/98, effective 9/1/98.]
4285.5 The following section of the Washington Administrative Code is repealed:
| WAC 388-478-0030 | Payment standards for disability lifeline and ADATSA. |