SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: April 7, 2004.
Purpose: Chapter 388-475 WAC, SSI-Related Medical--Part 4 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 388-475-0800 General income exclusions, 388-475-0820 Child-related income exclusions, 388-475-0840 Work- and agency-related income exclusions, 388-475-0860 Income exclusions under federal statute or other state laws, 388-475-0880 Special income disregards, and 388-475-0900 Allocating income. Repealing WAC 388-450-0020 Income exclusions for SSI-related medical and 388-450-0150 SSI-related medical income allocation.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-450-0020 and 388-450-0150.
Statutory Authority for Adoption: RCW 74.04.050, 74.08.090.
Adopted under notice filed as WSR 03-20-079 on September 29, 2003.
Changes Other than Editing from Proposed to Adopted Version:
|•||WAC 388-475-0820 (1)(d): Wording was changed to delete the reference to WAC 388-450-0150, which is being repealed, and now reads: "(d) The SSI-related parent lives with a spouse who has no income; and"|
|•||WAC 388-475-0820(4): Was changed to reflect the current federal exclusion rate, and now reads: "(4) Up to one thousand three hundred seventy dollars per month of a child's earned income, but not more than five thousand five hundred twenty dollars, is excluded if the child is a student."|
|•||WAC 388-475-0900 (4)(b): Wording was changed to clarify that the one-half of the federal benefit rate applies to an ineligible SSI sibling, and now reads: "(b) One-half of the federal benefit rate (FBR) for each SSI ineligible sibling of the SSI related child living in the household, minus any countable income for that child. See WAC 388-478-0055 for FBR amount;"|
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.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 6, Amended 0, Repealed 2.
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 Unit3308.7
(1) The first twenty dollars per month of unearned income. If there is less than twenty dollars of unearned income in a month, the remainder is excluded from earned income in that month.
(a) The twenty-dollar limit is the same, whether applying it for a couple or for a single person.
(b) The disregard does not apply to income paid totally or partially by the federal government or a nongovernmental agency on the basis of an eligible person's needs.
(c) The twenty dollars disregard is applied after all exclusions have been taken from income.
(2) Income that is not reasonably anticipated or is received infrequently or irregularly, whether for a single person or each person in a couple when it is:
(a) Earned and does not exceed a total of ten dollars per month; or
(b) Unearned and does not exceed a total of twenty dollars per month;
(c) Increases in a client's burial funds that were established on or after November 1, 1982 if the increases are the result of:
(i) Interest earned on excluded burial funds; or
(ii) Appreciation in the value of an excluded burial arrangement that was left to accumulate and become part of separately identified burial funds.
(3) Essential expenses necessary for a client to receive compensation (e.g., necessary legal fees in order to get a settlement);
(4) Receipts, which are not considered income, when they are for:
(a) Replacement or repair of an exempt resource;
(b) Prepayment or repayment of medical care paid by a health insurance policy or medical service program; or
(c) Payments made under a credit life or credit disability policy.
(5) The fee a guardian or representative payee charges as reimbursement for providing services, when such services are a requirement for the client to receive payment of the income.
(6) Funds representing shared household costs.
(7) Crime victim's compensation.
(8) The value of a common transportation ticket, given as a gift, that is used for transportation and not converted to cash.
(9) Gifts that are not for food, clothing or shelter, and gifts of home produce used for personal consumption.
(10) The department does not consider in-kind income received from someone other than a person legally responsible for the individual unless it is earned. Therefore, the following in-kind payments are not counted when determining eligibility for SSI-related medical programs.
(a) In-kind payments for services paid by a client's employer if:
(i) The service is not provided in the course of an employer's trade or business; or
(ii) It is in the form of food and/or shelter that is:
(A) On the employer's business premises;
(B) For the employer's convenience; and
(C) If shelter, acceptance by the employee is a condition of employment.
(b) In-kind payments made to people in the following categories:
(i) Agricultural employees;
(ii) Domestic employees;
(iii) Members of the Uniformed Services;
(iv) Persons who work from home to produce specific products for the employer from materials supplied by the employer.
(a) The minor child lives with an SSI-related parent; and
(b) The minor child is not receiving a needs-based cash payment such as TANF or SSI; and
(c) The SSI-related parent is single; or
(d) The SSI-related parent lives with a spouse who has no income; and
(e) The individual applying for or receiving SSI-related medical benefits is the adult parent. The maximum allowance is one-half the Federal Benefit Rate (FBR) for each child. The child's countable income, if any, is subtracted from the maximum child's allowance. One third of the child support received for the child is excluded from the child's income before determining this allowance.
(2) Foster care payments received for a child who is not SSI-eligible and who is living in the household, placed there by a licensed, nonprofit or public child placement or childcare agency are excluded from income regardless of whether the person requesting or receiving SSI-related medical is the adult foster parent or the child who was placed.
(3) Adoption support payments, received by an adult for a child in the household that are designated for the child's needs, are excluded as income. Adoption support payments that are not specifically designated for the child's needs are not excluded and are considered unearned income to the adult.
(4) Up to one thousand three hundred seventy dollars per month of a child's earned income, but not more than five thousand five hundred twenty dollars per year, is excluded if the child is a student.
(5) Child support payments received from an absent parent for a child living in the home are considered the income of the child.
(6) Any portion of a grant, scholarship, or fellowship used to pay tuition, fees and/or other necessary educational expenses at any educational institution is excluded from income.
(7) Gifts to, or for the benefit of, a person under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that Code, is excluded as follows:
(a) In-kind gifts that are not converted to cash; or
(b) Cash gifts up to a total of two thousand dollars in a calendar year.
(8) Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children are excluded from income.
(9) Unless it is specifically contributed to the client, all earned income of an ineligible or non-applying person under the age of twenty-one who is a student:
(a) Attending a school, college, or university; or
(b) Pursuing a vocational or technical training program designed to prepare the student for gainful employment.
(1) Work related expenses:
(a) Including child care, that enable an SSI-related client to work;
(b) That allow a blind or disabled client to work and that are directly related to the person's impairment.
(2) First sixty-five dollars plus one-half of the remainder of earned income. This is considered a work allowance/incentive. This deduction does not apply to income already excluded.
(3) Any portion of self-employment income normally allowed as an income deduction by the Internal Revenue Service (IRS).
(4) Veteran's Aid and Attendance, housebound allowance, unusual/unreimbursed medical expenses (UME) paid by the VA to some disabled veterans, their spouses, widows or parents. For people receiving long-term care services, see chapter 388-513 WAC.
(5) Payments provided in cash or in-kind, to an ineligible or nonapplying spouse, under any government program that provides social services provided to the client, such as chore services or attendant care.
(6) SSA refunds for Medicare buy-in premiums paid by the client when the state also paid the premiums.
(7) Income that causes a client to lose SSI eligibility, due solely to reduction in the SSP.
(8) Department of Veteran's Affairs benefits designated for the veteran's dependent. It is considered income of that dependent.
(9) Tax rebates or special payments excluded under other statutes.
(10) Any public agency refund of taxes paid on real property or on food.
(1) Income tax refunds;
(2) Federal earned income tax credit (EITC) payments;
(3) Compensation provided to volunteers in the Corporation for National and Community Service (CNCS), formerly known as ACTION programs established by the Domestic Volunteer Service Act of 1973. P.L. 93-113;
(4) Assistance to a person (other than wages or salaries) under the Older Americans Act of 1965, as amended by section 102 (h)(1) of Pub. L. 95-478 (92 Stat. 1515, 42 U.S.C. 3020a);
(5) Federal, state and local government payments including assistance provided in cash or in-kind under any government program that provides medical or social services;
(6) Certain cash or in-kind payments a client receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;
(7) Value of food provided through a federal or nonprofit food program such as WIC, donated food program, school lunch program;
(8) Assistance based on need, including:
(a) Any federal SSI income or state supplement payment (SSP) based on financial need;
(b) Food stamps;
(e) TANF; and
(f) Bureau of Indian Affairs (BIA) general assistance.
(9) Housing assistance from a federal program such as HUD if paid under:
(a) United States Housing Act of 1937 (section 1437 et seq. Of 42 U.S.C.);
(b) National Housing Act (section 1701 et seq. Of 12 U.S.C.);
(c) Section 101 of the Housing and Urban Development Act of 1965 (section 1701s of 12 U.S.C., section 1451 of 42 U.S.C.);
(d) Title V of the Housing Act of 1949 (section 1471 et seq. Of 42 U.S.C.); or
(e) Section 202(h) of the Housing Act of 1959;
(f) Weatherization provided to low-income homeowners by programs that consider income in the eligibility determinations;
(10) Energy assistance payments including:
(a) Those to prevent fuel cutoffs, and
(b) To promote energy efficiency.
(11) Income from employment and training programs as specified in WAC 388-450-0045.
(12) Foster Grandparents program;
(13) Title IV-E and state foster care maintenance payments if the foster child is not included in the assistance unit;
(14) The value of any childcare provided or arranged (or any payment for such care or reimbursement for costs incurred for such care) under the Child Care and Development Block Grant Act, as amended by section 8(b) of P.L. 102-586 (106 Stat. 5035).
(15) Educational assistance as specified in WAC 388-450-0035.
(16) Up to two thousand dollars per year derived from an individual's interest in Indian trust or restricted land.
(17) Native American benefits and payments as specified in WAC 388-450-0040 and other Native American payments excluded by federal statute. For a complete list of these payments, see 20 CFR 416, Subpart K, Appendix, IV.
(18) Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill) (May 8,1997) settlement funds;
(19) Payments from Ricky Ray Hemophilia Relief Fund Act of 1998, P.L. 105-369;
(20) Disaster assistance paid under Federal Disaster Relief P.L. 100-387 and Emergency Assistance Act, P.L. 93-288 amended by P.L. 100-707 and for farmers P.L. 100-387;
(21) Payments to certain survivors of the Holocaust as victims of Nazi persecution; payments excluded pursuant to section 1(a) of the Victims of Nazi Persecution Act of 1994, P.L. 103-286 (108 Stat.1450);
(22) Payments made under section 500 through 506 of the Austrian General Social Insurance Act;
(23) Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV);
(24) Restitution payments and interest earned to Japanese Americans or their survivors, and Aleuts interned during World War II, established by P.L. 100-383;
(25) Payments made from the Agent Orange Settlement Funds or any other funds to settle Agent Orange liability claims established by P.L. 101-201;
(26) Payments made under section six of the Radiation Exposure Compensation Act established by P.L. 101-426;
(27) Any interest earned from payments described in subsections (1) through (26) is counted as unearned income, unless otherwise excluded by law.
(1) The department disregards the following for SSI-related medical programs:
(a) The cost of living adjustment(s) (COLA) for a client who:
(i) Is currently receiving a Social Security payment;
(ii) Was eligible for and received both SSA and SSI/State Supplement payments (SSP) in the same month for at least one month since April, 1977; and
(iii) Would continue to receive SSI/SSP payments but for the COLA increase(s) to their SSA benefits. This is commonly known as the adjustment for "Pickle people."
(b) Widow(er)'s benefits for a client who:
(i) Was entitled to SSA title II (widow/widower's) benefits in December 1983;
(ii) Was at least fifty years old, but not yet sixty at that time;
(iii) Received title II benefits and SSI in January 1984;
(iv) Would continue to be eligible for SSI/SSP payments if the title II benefits were disregarded; and
(v) Filed an application for Medicaid with the state by July 1, 1988.
(c) Widow, Widower or Surviving Divorced Spouse (title II) benefits for a client who:
(i) Received SSI/SSP benefits the month prior to receipt of title II benefits;
(ii) Would continue to be eligible for SSI/SSP benefits if the title II benefits or the COLA(s) to those benefits were disregarded;
(iii) Is not eligible for Medicare Part A. This client is considered an SSI recipient until becoming entitled to Medicare Part A.
(2) A disabled adult child (DAC) who is ineligible for SSI/SSP solely due to receipt of either Social Security benefits as a disabled adult child of a person with a Social Security account or due to receipt of a COLA to the DAC benefits, may be income eligible for CN medical if disregarding the SSA DAC benefits and COLA brings countable income below the CN standards, and the client:
(a) Is eighteen years of age or older;
(b) Remains related to the SSI program through disability or blindness;
(c) Lost SSI eligibility on or after July 1, 1988 due solely to the receipt of DAC benefits from SSA or a COLA to those benefits; and
(d) Meets the other SSI-related CN medical requirements.
(3) Clients who stop receiving an SSI cash payment due to earnings, but still meet all of the other SSI eligibility rules and have income below the higher limit established by the Social Security Act's Section 1619(b) are eligible for continued CN Medicaid.
(4) TANF income methodology is used to determine countable income for children and pregnant women applying for MN unless the SSI methodology would be more beneficial to the client. For cases using TANF methodology, follow the family medical rules and allow the:
(a) Fifty percent earned income disregard;
(b) Child care and dependent care expenses related to employment; and
(c) Child support actually paid.
(1) When income is allocated from an SSI-related person to other household members, that income is considered as the other members' income.
(2) A portion of the income of a spouse or parent is allocated to the needs of an SSI-related applicant when the spouse or parent is:
(a) Financially responsible for the SSI-related person as described in WAC 388-408-0055 and 388-506-0620. For long term care programs, see WAC 388-513-1315, 388-513-1330, 388-513-1350; for waiver programs see WAC 388-515-1505 through 388-515-1530;
(b) Living in the same household;
(c) Not receiving SSI; and
(d) Either not related to SSI or is not applying for medical assistance.
(3) Allocations to children are deducted from the nonapplying spouse's unearned income, then from their earned income, before they are deducted from the applicant's income. See WAC 388-475-0820.
(4) If the conditions in subsection (2) are met, the income to be allocated from a parent to an SSI-related minor child applying for medical benefits is the amount remaining after deducting:
(a) All allowable income exclusions and disregards as described in WAC 388-475-750 through WAC 388-475-880;
(b) One-half of the federal benefit rate (FBR) for each SSI ineligible sibling of the SSI related child living in the household, minus any countable income of that child. See WAC 388-478-0055 for FBR amount;
(c) The parent's allowance, either the one person FBR for a single parent or two person FBR for a two-parent household.
(5) A portion of the countable income of a nonapplying spouse remaining after the deductions in subsection (4) may be allocated to the SSI-related spouse as follows for CN medical determinations:
(a) If the income is less than or equal to one-half of the FBR after allowing the income exclusions in subsection (4) of this section, no income is allocated to the client.
(b) If the income is equal to or more than one-half of the FBR after allowing the income exclusions in subsection (4) of this section, all income other than the excluded amounts is allocated to the applying spouse.
(6) Deductions from the income of the nonapplying spouse of an SSI-related applicant for CN medical determinations are:
(a) Income exclusions as described in WAC 388-475-0750 through 388-478-0880;
(b) One-half of the federal benefit rate (FBR) as described in WAC 388-478-0055 for each eligible child in the household, minus the child's countable income.
(7) In determining MN medical eligibility for SSI-related applicants:
(a) If the income of the nonapplying spouse is less than the MNIL (see WAC 388-478-0070) after applying any child allocation, a portion of the applying spouse's countable income is added to the nonapplying spouse's income to raise it to the MNIL for MN;
(b) If the income of the nonapplying spouse is more than the MNIL after applying any child allocation, the entire amount exceeding the MNIL is allocated to the applying spouse.
(8) Only income and resources actually contributed to an alien applicant from their sponsor are counted as income. For allocation of income from an alien sponsor, refer to WAC 388-450-0155.
The following sections of the Washington Administrative Code are repealed:
|WAC 388-450-0020||Income exclusions for SSI-related medical.|
|WAC 388-450-0150||SSI-related medical income allocation.|