SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: April 7, 2004.
Purpose: Chapter 388-475 WAC, SSI-Related Medical--Part 3 of 4, SSI-related medical eligibility rules are being combined into one Washington Administrative Code (WAC) chapter, chapter 388-475 WAC, for easier reference. In some instances, the rules have been rewritten according to the clear writing standards of the Governor's Executive Order 97-02.
New sections WAC 388-475-0550 All other excluded resources, 388-475-0600 Definition of income, 388-475-0650 Available income, 388-475-0700 Income eligibility, and 388-475-0750 Countable unearned income. Repealing WAC 388-511-1130 SSI-related income availability.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-511-1130.
Statutory Authority for Adoption: RCW 74.04.050, 74.08.090.
Adopted under notice filed as WSR 03-20-078 on September 29, 2003.
Changes Other than Editing from Proposed to Adopted Version: WAC 388-475-0550 (2)(a): Structural wording of the statement was confusing so was rewritten for clarification, and now reads: "(a) Payments received by the client, spouse, or any other person financially responsible for the client;"
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 5, Amended 0, Repealed 1.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: June 1, 2004.
April 7, 2004
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3307.4
(1) Resources necessary for a client who is blind or disabled to fulfill a department approved self-sufficiency plan.
(2) Retroactive payments from SSI or RSDI, including benefits a client receives under the interim assistance reimbursement agreement with the Social Security Administration, are excluded for six months following the month of receipt. This exclusion applies to:
(a) Payments received by the client, spouse, or any other person financially responsible for the client;
(b) SSI payments for benefits due for the month(s) before the month of continuing payment;
(c) RSDI payments for benefits due for a month that is two or more months before the month of continuing payment; and
(d) Proceeds from these payments as long as they are held as cash, or in a checking or savings account. The funds may be commingled with other funds, but must remain identifiable from the other funds for this exclusion to apply. This exclusion does not apply once the payments have been converted to any other type of resource.
(3) All resources specifically excluded by federal law, such as those described in subsections (4) through (11) as long as such funds are identifiable.
(4) Payments made under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
(5) Payments made to Native Americans as listed in 20 CFR 416.1182, Appendix to subpart K, section IV, paragraphs (b) and (c), and in 20 CFR 416.1236.
(6) The following Native American/Alaska Native funds are excluded resources:
(a) Resources received from a Native Corporation under the Alaska Native Claims Settlement Act, including:
(i) Shares of stock held in a regional or village corporation;
(ii) Cash or dividends on stock received from the Native Corporation up to two thousand dollars per person per year;
(iii) Stock issued by a native corporation as a dividend or distribution on stock;
(iv) A partnership interest;
(v) Land or an interest in land; and
(vi) An interest in a settlement trust.
(b) All funds contained in a restricted Individual Indian Money (IIM) account.
(7) Restitution payment and any interest earned from this payment to persons of Japanese or Aleut ancestry who were relocated and interned during war time under the Civil Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution Act.
(8) Funds received from the Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims.
(9) Payments or interest accrued on payments received under the Radiation Exposure Compensation Act received by the injured person, the surviving spouse, children, grandchildren, or grandparents.
(10) Payments from:
(a) The Dutch government under the Netherlands' Act on Benefits for Victims of Persecution (WUV).
(b) The Victims of Nazi Persecution Act of 1994 to survivors of the Holocaust.
(c) Susan Walker vs. Bayer Corporation, et al., 96-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds.
(d) Ricky Rey Hemophilia Relief Fund Act of 1998 P.L. 105-369.
(11) The unspent social insurance payments received due to wage credits granted under sections 500 through 506 of the Austrian General Social Insurance Act.
(12) Earned income tax credit refunds and payments are excluded as resources during the month of receipt and the following month.
(13) Payments from a state administered victim's compensation program for a period of nine calendar months after the month of receipt.
(14) Cash or in-kind items received as a settlement for the purpose of repairing or replacing a specific excluded resource are excluded:
(a) For nine months. This includes relocation assistance provided by state or local government.
(b) Up to a maximum of thirty months, when:
(i) The client intends to repair or replace the excluded resource; and
(ii) Circumstances beyond the control of the settlement recipient prevented the repair or replacement of the excluded resource within the first or second nine months of receipt of the settlement.
(c) For an indefinite period, if the settlement is from federal relocation assistance.
(d) Permanently, if the settlement is assistance received under the Disaster Relief and Emergency Assistance Act or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States, or is comparable assistance received from a State or local government or from a disaster assistance organization. Interest earned on this assistance is also excluded from resources. Any cash or in-kind items received as a settlement and excluded under this subsection are considered as available resources when not used within the allowable time periods.
(15) Insurance proceeds or other assets recovered by a Holocaust survivor as defined in WAC 388-470-0026(4).
(16) Pension funds owned by an ineligible spouse. Pension funds are defined as funds held in a(n):
(a) Individual retirement account (IRA) as described by the IRS code; or
(b) Work-related pension plan (including plans for self-employed individuals, known as Keogh plans).
(17) Cash payments received from a medical or social service agency to pay for medical or social services are excluded for one calendar month following the month of receipt.
(18) SSA- or DVR-approved plans for achieving self-support (PASS) accounts, allowing blind or disabled individuals to set aside resources necessary for the achievement of the plan's goals, are excluded.
(19) Food and nutrition programs with federal involvement. This includes Washington Basic Food, school reduced and free meals and milk programs and WIC.
(20) Gifts to, or for the benefit of, a person under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that Code, as follows:
(a) In-kind gifts that are not converted to cash; or
(b) Cash gifts up to a total of two thousand dollars in a calendar year.
(22) Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children.
(23) The following are among assets that are not considered resources and as such are neither excluded nor counted:
(a) Home energy assistance/support and maintenance assistance;
(b) Retroactive in-home supportive services payments to ineligible spouses and parents; and
(c) Gifts of domestic travel tickets. For a more complete list please see POMS @ http://policy.ssa.gov/poms.nsf/lnx/0501130050.
Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
WAC 388-475-0600 SSI-related medical -- Definition of income. (1) Income is anything an individual receives in cash or in-kind that can be used to meet his/her needs for food, clothing, or shelter. Income can be earned or unearned.
(2) Some receipts are not income because they do not meet the definition of income above, including:
(a) Cash or in-kind assistance from federal, state, or local government programs whose purpose is to provide medical care or services;
(b) Some in-kind payments that are not food, clothing or shelter coming from nongovernmental programs whose purposes are to provide medical care or medical services;
(c) Payments for repair or replacement of an exempt resource;
(d) Refunds or rebates for money already paid;
(e) Receipts from sale of a resource; and
(f) Replacement of income already received. See 20 CFR 416.1103 for a more complete list of receipts that are not income.
(3) Earned income includes the following types of payments:
(a) Gross wages and salaries, including garnished amounts;
(b) Commissions and bonuses;
(c) Severance pay;
(d) Other special payments received because of employment;
(e) Net earnings from self-employment (WAC 388-475-0840 describes net earnings);
(f) Self-employment income of tribal members unless the income is specifically exempted by treaty;
(g) Payments for services performed in a sheltered workshop or work activities center;
(h) Royalties earned by an individual in connection with any publication of his/her work and any honoraria received for services rendered; or
(i) In-kind payments made in lieu of cash wages, including the value of food, clothing or shelter.
(4) Unearned income is all income that is not earned income. Some types of unearned income are:
(a) Annuities, pensions, and other periodic payments;
(b) Alimony and support payments;
(c) Dividends and interest;
(d) Royalties (except for royalties earned by an individual in connection with any publication of his/her work and any honoraria received for services rendered which would be earned income);
(e) Capital gains;
(g) Benefits received as the result of another's death to the extent that the total amount exceeds the expenses of the deceased person's last illness and burial paid by the recipient;
(i) Inheritances; or
(j) Prizes and awards.
(5) Some items which may be withheld from income, but the department considers as received income are:
(a) Federal, state, or local income taxes;
(b) Health or life insurance premiums;
(c) SMI premiums;
(d) Union dues;
(e) Penalty deductions for failure to report changes;
(f) Loan payments;
(h) Child support payments, court ordered or voluntary (WAC 388-475-0900 has an exception for deemors);
(i) Service fees charged on interest-bearing checking accounts;
(j) Inheritance taxes;
(k) Guardianship fees if presence of a guardian is not a requirement for receiving the income.
(6) Countable income, for the purposes of this chapter, means all income that is available to the individual:
(a) If it cannot be excluded, and
(b) After deducting all allowable disregards and deductions.
(a) Received, or
(b) Credited to an individual's account, or
(c) Set aside for his or her use, or
(d) Can be used to meet the client's needs for food, clothing or shelter.
(2) Anticipated nonrecurring lump sum payments are treated as income in the month received, with the exception of those listed in WAC 388-475-0700(5), and any remainder is considered a resource in the following month.
(3) Re-occurring income is considered available in the month of normal receipt, even if the financial institution posts it before or after the month of normal receipt.
(4) In-kind income received from anyone other than a legally responsible relative is considered available income only if it is earned income.
(c) Unemployment compensation,
(d) Retirement, and
(e) Disability benefits; even if their receipt makes the client ineligible for department services, unless the client can provide evidence showing good reason for not obtaining the benefits.
The department does not count this income until the client begins to receive it.
(2) Income is budgeted prospectively for all medical programs.
(3) Anticipated nonrecurring lump sum payments other than retroactive SSI/SSDI payments are considered income in the month received, subject to reporting requirements in WAC 388-418-0007(4). Any unspent portion is considered a resource the first of the following month.
(4) The department follows income and resource methodologies of the Supplemental Security Income (SSI) program defined in federal law when determining eligibility for SSI-related medical or Medicare Savings programs unless the department adopts rules that are less restrictive than those of the SSI program.
(5) Exceptions to the SSI income methodology:
(a) Lump sum payments from a retroactive SSDI benefit, when reduced by the amount of SSI received during the period covered by the payment, are not counted as income;
(b) Unspent retroactive lump sum money from SSI or SSDI is excluded as a resource for six months following receipt of the lump sum; and
(c) Both the principal and interest portions of payments from a sales contract, that meet the definition in WAC 388-475-0350(10), are unearned income.
(6) To be eligible for categorically needy (CN) SSI-related medical coverage, a client's countable income cannot exceed the CN program standard described in:
(a) WAC 388-478-0065 through 388-478-0085 for noninstitutional medical unless living in an alternate living facility; or
(b) WAC 388-513-1305(2) for noninstitutional CN benefits while living in an alternate living facility; or
(c) WAC 388-513-1315 for institutional and waiver services medical benefits.
(7) To be eligible for SSI-related medical coverage provided under the medically needy (MN) program, a client must:
(a) Have countable income at or below the MN program standard as described in WAC 388-478-0070; or
(b) Satisfy spenddown requirements described in WAC 388-519-0110, or
(c) Meet the requirements for noninstitutional MN benefits while living in an alternate living facility (ALF). See WAC 388-513-1305(3) and 388-515-1540.
(1) The total amount of benefits to which a client is entitled is available unearned income even when the benefits are:
(a) Reduced through the withholding of a portion of the benefit amount to repay a legal obligation;
(b) Garnished to repay a debt, other legal obligation, or make any other payment such as payment of Medicare premiums.
(2) Payments received on a loan:
(a) Interest paid on the loan amount is considered unearned income; and
(b) Payments on the loan principal are not considered income. However, any amounts retained on the first of the following month are considered a resource.
(3) Money borrowed by a person, which must be repaid, is not considered income. It is considered a loan. If the money received does not need to be repaid, it is considered a gift.
(4) Rental income received for the use of real or personal property, such as land, housing or machinery is considered unearned income. The countable portion of rental income received is the amount left after deducting necessary expenses of managing and maintaining the property paid in that month or carried over from a previous month. Necessary expenses are those such as:
(a) Advertising for tenants;
(b) Property taxes;
(c) Property insurance;
(d) Repairs and maintenance on the property; and
(e) Interest and escrow portions of a mortgage.
NOTE: When a client is in the business of renting properties and actively works the business (over twenty hours per week), the income is counted as earned income.
The following section of the Washington Administrative Code is repealed:
|WAC 388-511-1130||SSI-related income availability.|