Source: https://apps.leg.wa.gov/WAC/default.aspx?dispo=true&cite=182-512&full=true
Timestamp: 2020-07-11 18:57:24
Document Index: 746253247

Matched Legal Cases: ['§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 388', '§ 388', '§ 388', '§ 388', '§ 388', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 182', '§ 388', '§ 182', '§ 182', '§ 431', '§ 155', '§ 182', '§ 388', '§ 431', '§ 155', '§ 182', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 431', '§ 155', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 388', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 182', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 388', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 431', '§ 155', '§ 182', '§ 431', '§ 155', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 431', '§ 155', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 431', '§ 155', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 388', '§ 388', '§ 182', '§ 431', '§ 155', '§ 182', '§ 182', '§ 182', '§ 388']

Chapter 182-512 WAC:
WACs > Title 182 > Chapter 182-512
Chapter 182-512 WAC
SSI-RELATED MEDICAL
HTMLPDF 182-512-0010 Supplemental security income (SSI) standards, SSI-related categorically needy income level (CNIL), and countable resource standards.
HTMLPDF 182-512-0050 SSI-related medical—General information.
HTMLPDF 182-512-0100 SSI-related medical—Categorically needy (CN) medical eligibility.
HTMLPDF 182-512-0150 SSI-related medical—Medically needy (MN) medical eligibility.
HTMLPDF 182-512-0200 SSI-related medical—Definition of resources.
HTMLPDF 182-512-0250 SSI-related medical—Ownership and availability of resources.
HTMLPDF 182-512-0260 SSI-related medical—How to count a sponsor's resources.
HTMLPDF 182-512-0300 SSI-related medical—Resources eligibility.
HTMLPDF 182-512-0350 SSI-related medical—Property and contracts excluded as resources.
HTMLPDF 182-512-0400 SSI-related medical—Vehicles excluded as resources.
HTMLPDF 182-512-0450 SSI-related medical—Life insurance excluded as a resource.
HTMLPDF 182-512-0500 SSI-related medical—Burial funds, contracts and spaces excluded as resources.
HTMLPDF 182-512-0550 SSI-related medical—All other excluded resources.
HTMLPDF 182-512-0600 SSI-related medical—Definition of income.
HTMLPDF 182-512-0650 SSI-related medical—Available income.
HTMLPDF 182-512-0700 SSI-related medical—Income eligibility.
HTMLPDF 182-512-0750 SSI-related medical—Countable unearned income.
HTMLPDF 182-512-0760 SSI-related medical—Education assistance.
HTMLPDF 182-512-0770 SSI-related medical—American Indian or Alaska Native excluded income and resources.
HTMLPDF 182-512-0780 SSI-related medical—Employment and training programs.
HTMLPDF 182-512-0785 SSI-related medical—Effect of a sponsor's income.
HTMLPDF 182-512-0790 SSI-related medical—Exemption from sponsor deeming.
HTMLPDF 182-512-0795 SSI-related medical—Budgeting a sponsor's income.
HTMLPDF 182-512-0800 SSI-related medical—General income exclusions.
HTMLPDF 182-512-0820 SSI-related medical—Child-related income exclusions and allocations.
HTMLPDF 182-512-0840 SSI-related medical—Work- and agency-related income exclusions.
HTMLPDF 182-512-0860 SSI-related medical—Income exclusions under federal statute or other state laws.
HTMLPDF 182-512-0880 SSI-related medical—Special income disregards.
HTMLPDF 182-512-0900 SSI-related medical—Deeming and allocation of income.
HTMLPDF 182-512-0920 SSI-related medical—Deeming/allocation of income from nonapplying spouse.
HTMLPDF 182-512-0940 SSI-related medical—Deeming income from an ineligible parent(s) to a child applying for SSI-related medical.
HTMLPDF 182-512-0960 SSI-related medical—Allocating income—Determining eligibility for a spouse when the other spouse receives long-term services and supports.
PDF182-512-0010
Supplemental security income (SSI) standards, SSI-related categorically needy income level (CNIL), and countable resource standards.
(1) The SSI payment standards, also known as the federal benefit rate (FBR), change each January 1st.
(2) See WAC 388-478-0055 for the amount of the state supplemental payments (SSP) for SSI recipients.
(3) See WAC 182-513-1205 for standards of clients living in an alternate living facility.
(4) The SSI-related CNIL standards are the same as the SSI payment standards for single persons and couples. Those paying out shelter costs have a higher standard than people who have supplied shelter.
(5) The countable resource standards for SSI and SSI-related CN medical programs are:
(a) One person
(b) A legally married couple
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-02-046, § 182-512-0010, filed 12/27/18, effective 1/27/19. WSR 11-23-091, recodified as § 182-512-0010, filed 11/17/11, effective 11/21/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500. WSR 08-11-098, § 388-478-0080, filed 5/20/08, effective 6/20/08. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, 74.09.530, and Section 1924 of the Social Security Act (42 U.S.C. 1396r-5). WSR 06-06-013, § 388-478-0080, filed 2/17/06, effective 3/20/06. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 42 U.S.C. 9902(2). WSR 05-06-090, § 388-478-0080, filed 3/1/05, effective 4/1/05; WSR 04-16-107, § 388-478-0080, filed 8/3/04, effective 9/3/04. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 42 U.S.C. 1396r-5. WSR 02-10-116, § 388-478-0080, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and Section 1924 (42 U.S.C. 1396R-5). WSR 01-12-073, § 388-478-0080, filed 6/4/01, effective 7/5/01. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, and 74.09.575. WSR 00-10-095, § 388-478-0080, filed 5/2/00, effective 5/2/00; WSR 99-11-054, § 388-478-0080, filed 5/17/99, effective 6/17/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. WSR 98-16-044, § 388-478-0080, filed 7/31/98, effective 9/1/98. Formerly WAC 388-511-1110.]
PDF182-512-0050
SSI-related medical—General information.
(1) The agency (which includes its designee for purposes of this chapter) provides health care coverage under the Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for SSI-related people, meaning those who meet at least one of the federal SSI program criteria as being:
(7) The agency 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 agency adopts rules that are less restrictive than those of the SSI program.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0050, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0050, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-002, § 388-475-0050, filed 4/7/04, effective 6/1/04.]
PDF182-512-0100
PDF182-512-0150
PDF182-512-0200
SSI-related medical—Definition of resources.
(1) A resource is any cash, other personal property, or real property that an applicant, recipient or other financially responsible person:
[WSR 11-24-018, recodified as § 182-512-0200, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-002, § 388-475-0200, filed 4/7/04, effective 6/1/04.]
PDF182-512-0250
SSI-related medical—Ownership and availability of resources.
(1) The agency considers personal and real property to be available to a Washington apple health applicant or recipient if the applicant or recipient:
(d) May legally use the property for his or her support.
(2) The agency counts the resources of financially responsible persons (as defined in WAC 182-506-0015) who live in the home even if those persons do not receive Washington apple health coverage.
(3) For long-term care (LTC) services, cash and other resources transferred by a Washington apple health applicant or recipient or his or her spouse to another to pay for the Washington apple health applicant or recipient's LTC services are considered resources available to the applicant or recipient unless otherwise excluded in this chapter, chapter 182-513 WAC, or chapter 182-516 WAC.
(4) A resource is considered available on the first day of the month following the month of receipt unless a rule about a specific type of resource provides for a different time period.
(5) A resource that ordinarily cannot be converted to cash within twenty working days is considered unavailable as long as a reasonable effort is being made to convert the resource to cash.
(6) A person may provide evidence showing that a resource is unavailable. A resource is not counted if the person shows sufficient evidence that the resource is unavailable.
(7) We do not count the resources of victims of family violence, as defined in WAC 388-452-0010, when:
(c) Making the resource available would place the person at risk of harm.
(8) The value of a resource is its fair market value minus encumbrances.
(9) Refer to WAC 182-512-0260 to consider additional resources when an alien has a sponsor.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 20-08-079, § 182-512-0250, filed 3/27/20, effective 4/27/20; WSR 15-07-064, § 182-512-0250, filed 3/16/15, effective 4/16/15. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0250, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as WAC 182-512-0250, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-002, § 388-475-0250, filed 4/7/04, effective 6/1/04.]
PDF182-512-0260
SSI-related medical—How to count a sponsor's resources.
(1) The agency counts part of a sponsor's resources as available to an applicant or recipient of Washington apple health (WAH) SSI-related health care coverage if:
(a) The person is a sponsored immigrant as defined in WAC 182-512-0785; and
(b) The person is not exempt from deeming under WAC 182-512-0790.
(2) The agency determines the amount of the sponsor's resources to count by:
(a) Totaling the countable resources of the sponsor and the sponsor's spouse (if the spouse signed the affidavit of support);
(c) Counting the remaining amount as a resource that is available to the person.
(3) When a sponsor has sponsored other people as well, the agency divides the result by the total number of people sponsored.
(4) A sponsor's resources are counted when determining eligibility for WAH coverage until the person becomes exempt from deeming under WAC 182-512-0790.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0260, filed 3/14/14, effective 4/14/14.]
PDF182-512-0300
SSI-related medical—Resources eligibility.
(1) At 12:00 a.m. on the first day of the month a client's countable resources must be at or below the resource standard to be eligible for noninstitutional medical benefits for that month. If the total of the client's countable resources is above the resource standard at 12:00 a.m. on the first day of the month, the client is ineligible for noninstitutional medical benefits for that entire month regardless of resource status at the time of application during that month. For resource eligibility relating to long-term care eligibility see chapter 182-513 WAC.
(3) Cash received from the sale of an excluded resource becomes a countable resource the first of the month following conversion unless the cash is:
(a) Used to replace the excluded resource;
(b) Invested in another excluded resource in the same month or within the longer time allowed for home sales under WAC 182-512-0350; or
(4) The unspent portion of a nonrecurring lump sum payment is counted as a resource on the first of the month following its receipt with the following exception: The unspent portion of any Title II (SSA) or Title XVI (SSI) retroactive payment is excluded as a resource for nine months following the month of receipt. These exclusions apply to lump sums received by the client, client's spouse or any other person who is financially responsible for the client.
(5) Clients applying for SSI-related medical coverage for long-term care (LTC) services must meet different resource rules. See chapter 182-513 WAC for LTC resource rules.
(6) The transfer of a resource without adequate consideration does not affect medical program eligibility except for LTC services described in chapters 182-513 and 182-515 WAC. In those programs, the transfer may make a client ineligible for medical benefits for a period of time. See WAC 182-513-1363 for LTC rules.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-02-046, § 182-512-0300, filed 12/27/18, effective 1/27/19. WSR 11-24-018, recodified as § 182-512-0300, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.057, 74.08.090, 74.04.050, 74.09.500. WSR 08-23-101, § 388-475-0300, filed 11/19/08, effective 12/20/08; WSR 08-14-048, § 388-475-0300, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-002, § 388-475-0300, filed 4/7/04, effective 6/1/04.]
PDF182-512-0350
PDF182-512-0400
SSI-related medical—Vehicles excluded as resources.
(1) For SSI-related medical programs, a vehicle is defined as anything used for transportation. In addition to cars and trucks, a vehicle can include boats, snowmobiles, and animal-drawn vehicles.
(2) One vehicle is excluded regardless of its value, if it is used to provide transportation for the SSI-related person or a member of the person's household.
(3) A vehicle used as the person's primary residence is excluded as the home, and does not count as the one excluded vehicle under subsection (2) of this section.
[Statutory Authority: RCW 41.05.021, 41.05.160, P.L. 111-148, 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R § 155. WSR 17-03-116, § 182-512-0400, filed 1/17/17, effective 2/17/17. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0400, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0400, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500. WSR 10-13-077, § 388-475-0400, filed 6/15/10, effective 7/16/10. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-003, § 388-475-0400, filed 4/7/04, effective 6/1/04.]
PDF182-512-0450
SSI-related medical—Life insurance excluded as a resource.
(1) The agency excludes life insurance policies that do not have or cannot accrue a cash surrender value (CSV) in determining whether owned policies exceed the life insurance exclusion limits for resources and in determining burial fund exclusion limits.
(2) Policies owned by each spouse are evaluated and counted separately.
(3) If the total face value of all policies with a CSV potential that a person owns on the same insured is equal to or less than fifteen hundred dollars, the resource is excluded.
(4) If the total face value of all policies with a CSV potential that a person owns on the same insured is more than fifteen hundred dollars, the total CSV of the policies is counted toward the resource limit, unless the person designates such policies as burial funds. If they are designated as burial funds, they must be evaluated under the burial fund exclusion described in WAC 182-512-0500.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0450, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0450, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-003, § 388-475-0450, filed 4/7/04, effective 6/1/04.]
PDF182-512-0500
PDF182-512-0550
SSI-related medical—All other excluded resources.
All resources described in this section are excluded resources for SSI-related medical programs. Unless otherwise stated, interest earned on the resource amount is counted as unearned income.
(1) Resources necessary for a person who is blind or disabled to fulfill a self-sufficiency plan approved by the agency.
(2) Retroactive payments from SSI or old age, survivors, and disability insurance (OASDI), including benefits a person receives under the interim assistance reimbursement agreement with the Social Security Administration, are excluded for nine months following the month of receipt. This exclusion applies to:
(a) Payments received by the person, the person's spouse, or any other person financially responsible for the person;
(c) OASDI payments for benefits due for a month that is two or more months before the month of continuing payment; and
(3) All resources specifically excluded by federal law, such as those described in subsections (4) through (11) of this section as long as such funds are identifiable.
(5) The excluded resources described in WAC 182-512-0770 and other resources of American Indians/Alaska Natives that are excluded by federal law.
(6) 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.
(7) Funds received from the Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims.
(8) 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.
(9) Payments or interest accrued on payments received under the Energy Employees Occupational Illness Compensation Act of 2000 (EEOICA) received by the injured person, the surviving spouse, children, grandchildren, or grandparents.
(10) Payments from:
(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) Tax refunds and earned income tax credit refunds and payments are excluded as resources for twelve months after the month of receipt.
(13) Payments from a state administered victim's compensation program for a period of nine calendar months after the month of receipt.
(14) Cash or in-kind items received as a settlement for the purpose of repairing or replacing a specific excluded resource are excluded:
(i) The person intends to repair or replace the excluded resource; and
(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 available resources when not used within the allowable time periods.
(15) Insurance proceeds or other assets recovered by a Holocaust survivor.
(16) Pension funds owned by an ineligible spouse. Pension funds are defined as funds held in a(n):
(b) Work-related pension plan (including plans for self-employed persons, 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 division of vocational rehabilitation (DVR)-approved plans for achieving self-support (PASS) accounts, allowing blind or disabled persons 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:
(21) Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children.
(22) The following are among assets that are not resources and as such are neither excluded nor counted:
(c) Gifts of domestic travel tickets.
(23) Resources accumulated in a separate account, designated by the client, that result from work activity during the client's enrollment in apple health for workers with disabilities (HWD) program under chapter 182-511 WAC.
(24) Resources listed in the program operations manual system (POMS), not otherwise excluded under this section, are excluded (see SSA POMS Section SI 01130.050 http://secure.ssa.gov/apps10/poms.nsf/lnx/0501130050).
[Statutory Authority: RCW 41.05.021, 41.05.160 and 2019 c 70. WSR 19-23-063, § 182-512-0550, filed 11/15/19, effective 1/1/20. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-13-010, § 182-512-0550, filed 6/6/19, effective 7/7/19. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0550, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0550, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, chapter 74.12 RCW, and The Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010. WSR 11-21-025, § 388-475-0550, filed 10/11/11, effective 10/29/11. 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. WSR 10-15-069, § 388-475-0550, filed 7/16/10, effective 8/16/10. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500, and Social Security Act as amended by P.L. 108-203. WSR 06-04-046, § 388-475-0550, filed 1/26/06, effective 2/26/06. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-004, § 388-475-0550, filed 4/7/04, effective 6/1/04.]
PDF182-512-0600
SSI-related medical—Definition of income.
(1) Income is anything a client receives in cash or in-kind that can be used to meet his/her needs for food or shelter. Income can be earned or unearned.
(2) Some receipts are not income because they do not meet the definition of income above. Some types of receipts that are not income are:
(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 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;
(f) Replacement of income already received (see 20 C.F.R. 416.1103 for a more complete list of receipts that are not income); and
(g) Receipts from extraction of exempt resources for a member of a federally recognized tribe.
(3) Earned income includes the following types of payments:
(a) Gross wages and salaries, including garnished amounts;
(b) Commissions and bonuses;
(d) Other special payments received because of employment;
(e) Net earnings from self-employment (WAC 182-512-0840 describes earnings exclusions);
(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 a client in connection with any publication of their work and any honoraria received for services rendered; and
(i) In-kind payments made in lieu of cash wages, including the value of food 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) Voluntary or court-ordered child support payments, including arrears, received from a noncustodial parent for the benefit of a child are the income of the child;
(d) Dividends and interest;
(e) Royalties (except for royalties earned by a client in connection with any publication of their work and any honoraria received for services rendered which would be earned income);
(g) Rents;
(h) 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) Gifts;
(j) Inheritances;
(k) Prizes and awards; and
(l) Amounts received by tribal members from gaming revenues with the exceptions cited in WAC 182-512-0770(3).
(5) Some items which may be withheld from income, but which the agency 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;
(g) Garnishments;
(h) Child support payments, court ordered or voluntary (WAC 182-512-0900 has an exception for deemors);
(i) Service fees charged on interest-bearing checking accounts;
(j) Inheritance taxes; and
(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 client:
(a) If it cannot be excluded; and
(b) After deducting all allowable disregards and deductions.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-11-050, § 182-512-0600, filed 5/10/19, effective 6/10/19. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0600, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0600, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.08.090 and ARRA of 2009 (Recovery Act), 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. WSR 10-15-069, § 388-475-0600, filed 7/16/10, effective 8/16/10. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-004, § 388-475-0600, filed 4/7/04, effective 6/1/04.]
PDF182-512-0650
SSI-related medical—Available income.
(1) Income is considered available to a person at the earliest of when it is:
(b) Credited to a person's account; or
(c) Set aside for his or her use; or
(d) Can be used to meet the person's needs for food or shelter.
(2) Anticipated nonrecurring lump sum payments are treated as income in the month received, with the exception of those listed in WAC 182-512-0700(5), and any remainder is considered a resource in the following month.
(3) Reoccurring 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.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0650, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0650, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-004, § 388-475-0650, filed 4/7/04, effective 6/1/04.]
PDF182-512-0700
PDF182-512-0750
SSI-related medical—Countable unearned income.
(1) The total amount of income benefits to which a person is entitled is treated as 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;
(c) Property insurance;
(d) Repairs and maintenance on the property; and
(e) Interest and escrow portions of a mortgage.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0750, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0750, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-004, § 388-475-0750, filed 4/7/04, effective 6/1/04.]
PDF182-512-0760
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SSI-related medical—American Indian or Alaska Native excluded income and resources.
(1) The agency excludes the following types of income from being considered when determining eligibility for Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for American Indians or Alaska Natives:
(a) Distributions from Alaska Native corporations and settlement trusts;
(b) Distributions from any property held in trust, subject to federal restrictions, located within the most recent boundaries of a prior federal reservation, or otherwise under the supervision of the Secretary of the Interior;
(c) Distributions and payments from rents, leases, rights of way, royalties, usage rights, or natural resource extraction and harvest from:
(i) Rights of ownership or possession in any lands described in (b) of this subsection; or
(ii) Federally protected rights regarding off-reservation hunting, fishing, gathering, or usage of natural resources.
(d) Distributions resulting from real property ownership interests related to natural resources and improvements that are:
(ii) Resulting from the exercise of federally protected rights relating to such real property ownership interests.
(e) Payments resulting from:
(i) Ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance; or
(ii) Rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.
(f) Student financial assistance provided under the Bureau of Indian Affairs education programs; and
(g) Any other applicable income exclusion as provided by federal law, regulation, or rule.
(2) The agency excludes the following types of resources from being considered when determining eligibility for WAH-CN and WAH-MN SSI-related programs for American Indians or Alaska Natives:
(a) Property, including real property and improvements, that is:
(i) Held in trust, subject to federal restrictions, or otherwise under the supervision of the Secretary of the Interior; and
(ii) Located on a reservation, including any federally recognized Indian tribe's reservation, pueblo, or colony, including:
(A) Former reservations in Oklahoma;
(B) Alaska Native regions established by the Alaska Native Claims Settlement Act; and
(C) Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior.
(b) Property located within the most recent boundaries of a prior federal reservation for any federally recognized tribe not described in (a) of this subsection;
(c) Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including, but not limited to, extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish and shellfish) resulting from the exercise of federally protected rights; and
(d) Ownership interests in or usage rights to items not covered in (a), (b), or (c) of this subsection that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.
(3) When determining eligibility for WAH-CN and WAH-MN SSI-related programs for American Indians or Alaska Natives, the agency counts or excludes amounts received by tribal members from exercise of gaming revenues (per capita distributions) that are retained after the month of receipt based on the type of resource in which the money is retained. If the amounts are retained in a countable resource (for example, cash, checking account, or savings account), the agency treats the amounts as a countable resource. If the amounts are converted to an excluded resource (for example, personal property like a refrigerator), the agency treats the amounts as excluded resources.
[Statutory Authority: RCW 41.05.021, 41.05.160, 42 C.F.R. § 431, 435, and 457, and 45 C.F.R. § 155; 42 U.S.C. Chapter 157. WSR 15-07-065, § 182-512-0770, filed 3/16/15, effective 4/16/15. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0770, filed 3/14/14, effective 4/14/14.]
PDF182-512-0780
SSI-related medical—Employment and training programs.
(a) The program is recognized by federal, state, or local governments; and
(b) The allowance is not a reimbursement.
(3) The agency excludes support service payments received by or made on behalf of WorkFirst recipients.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0780, filed 3/14/14, effective 4/14/14.]
PDF182-512-0785
SSI-related medical—Effect of a sponsor's income.
(a) "Sponsor" means a person who agreed to meet the needs of a sponsored immigrant by signing a United States Citizenship and Immigration Services Affidavit of Support form I-864 or I-864A. This includes a sponsor's spouse if the spouse signed the affidavit of support.
(b) "Sponsored immigrant" means a person who must have a sponsor under the Immigration and Nationality Act (INA) to be admitted into the United States for residence.
(c) "Deeming" means the agency counts a part of the sponsor's income and resources as available to the sponsored immigrant.
(d) "Exempt" means the person meets one of the conditions of WAC 182-512-0790.
(2) If the person is a sponsored immigrant and is not exempt from deeming, the person must provide the following information to be eligible for Washington apple health (WAH) SSI-related coverage even if the person is not receiving support from their sponsor:
(b) The income and resources of the sponsor; and
(c) Any additional information needed for the agency to determine if:
(i) Income must be deemed to the person's medical assistance unit (MAU); and
(ii) The amount of income that must be deemed to the MAU.
(3) If the person is not eligible for coverage because the agency does not have the information needed regarding the sponsor, eligibility for other unsponsored household members applying for coverage is not delayed. Although the sponsored immigrant may not be eligible for coverage, the following is counted when determining the eligibility of other household members:
(a) All earned or unearned income of the sponsored immigrant that is not excluded under chapter 182-512 WAC; and
(b) All deductions the sponsored immigrant would be eligible for under chapter 182-512 WAC.
(4) If the person refuses to provide the agency with the information needed regarding the sponsor, the other adult members in the MAU must provide the information. If the same person sponsored everyone in the MAU, the entire MAU is not eligible for WAH coverage until someone provides the information that is needed.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 18-15-005, § 182-512-0785, filed 7/6/18, effective 8/6/18. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0785, filed 3/14/14, effective 4/14/14.]
PDF182-512-0790
SSI-related medical—Exemption from sponsor deeming.
(1) A person who meets any of the following conditions is permanently exempt from deeming and the agency does not count the sponsor's income or resources when determining eligibility for Washington apple health (WAH) SSI-related coverage:
(a) The Immigration and Nationality Act (INA) does not require the person to have a sponsor. Immigrants who are not required to have a sponsor include those with the following status with U.S. Citizenship and Immigration Services (USCIS):
(ii) Parolee admitted under Section 212(d)(5) of the Immigration and Nationality Act (INA);
(iv) Cuban/Haitian entrant under Section 202 of the Immigration Reform and Control Act of 1986 (IRCA);
(v) Amerasians admitted with an I-551 admission code of AM1, AM2, AM3, AM6, AM7, or AM8; and
(vi) Special immigrant from Iraq or Afghanistan.
(b) The person meets the blindness or disability requirements described in WAC 182-512-0050(1);
(c) The person was sponsored by an organization or group as opposed to another person;
(d) The person is a nonqualified or undocumented alien as defined in WAC 182-503-0530 (3) and (4);
(e) The person has worked or can get credit for forty qualifying quarters of work under Title II of the Social Security Act. The agency does not count a quarter of work toward this requirement if the person working received TANF, Basic Food, SSI, CHIP, or nonemergency medicaid coverage. A quarter of work earned by the following people is counted toward the forty qualifying quarters:
(ii) The person's parents for the time they worked before the person turned eighteen years old (including the time they worked before the person's birth); and
(iii) The person's spouse if still married or if the spouse is deceased.
(f) The person has become a United States (U.S.) citizen;
(g) The sponsor is dead; or
(h) If USCIS or a court decides that the person, their child, or their parent was a victim of domestic violence from the person's sponsor and:
(i) The person no longer lives with the sponsor; and
(ii) Leaving the sponsor caused the need for coverage.
(2) A person is exempt from the deeming process while in the same assistance unit (AU) as the sponsor.
(3) If the person, their child, or their parent was a victim of domestic violence, the person is exempt from the deeming process for twelve months if:
(a) They no longer live with the person who committed the violence; and
(b) Leaving this person caused the need for health coverage.
(4) If the person's medical assistance unit (MAU) has income at or below one hundred thirty percent of the federal poverty level (FPL), the person is exempt from the deeming process for twelve months. This is called the "indigence exemption." A person may choose to use this exemption or not to use this exemption in full knowledge of the possible risks involved. See risks in subsection (5) of this section. For this rule, the agency counts the following as income:
(a) Earned and unearned income received by any member of the MAU from any source; and
(b) The value of any noncash items of value such as free rent, commodities, goods, or services received from another person or organization.
(5) A person who chooses not to use the indigence exemption must provide verification of the sponsor's income and resources and will be subject to the deeming rules described in WAC 182-512-0795.
(6) For federally funded programs, if the person uses the indigence exemption, the agency is required by law to give the U.S. Attorney General the following information:
(a) The names of the sponsored people in the person's AU;
(b) That the person is exempt from deeming due to income;
(c) The sponsor's name; and
(d) The effective date that the twelve-month exemption began.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0790, filed 3/14/14, effective 4/14/14.]
PDF182-512-0795
SSI-related medical—Budgeting a sponsor's income.
(1) The agency counts some of the income of a person's sponsor as unearned income to the medical assistance unit (MAU) if:
(a) The sponsor signed the U.S. Citizenship and Immigration Services (USCIS) Affidavit of Support form I-864 or I-864A; and
(b) The person is not exempt from the deeming process in WAC 182-512-0790.
(2) The agency determines the amount of income that must be deemed from the sponsor by taking the following steps:
(a) Add together all of the sponsor's earned and unearned income that is not excluded under WAC 182-512-0860;
(b) Add all of the spouse's earned and unearned income that is not excluded under WAC 182-512-0860;
(c) Subtract an allocation for the sponsor equal to the one-person federal benefit rate (FBR);
(d) Subtract an allocation for the sponsor's spouse as follows:
(i) If the spouse is also a cosponsor of the noncitizen, allow an allocation equal to the one-person FBR; or
(ii) If the spouse is not a cosponsor but lived in the same household as the sponsor, allow an allocation equal to one-half of the FBR.
(e) Subtract an allocation equal to one-half FBR for each dependent of the sponsor. The dependent's income is not subtracted from the sponsor's dependent's allocation; and
(f) The income remaining is deemed as unearned income to the noncitizen and is added to the noncitizen's own income.
(3) If the sponsor has sponsored other noncitizens, all of the sponsor's income is deemed to each person that they sponsored and is not divided between them.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 14-24-102, § 182-512-0795, filed 12/2/14, effective 1/2/15. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0795, filed 3/14/14, effective 4/14/14.]
PDF182-512-0800
SSI-related medical—General income exclusions.
The agency excludes, or does not consider, the following when determining a person's eligibility for Washington apple health (WAH) SSI-related medical programs:
(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 thirty dollars per calendar quarter; or
(b) Unearned and does not exceed a total of sixty dollars per calendar quarter;
(c) An increase in a person's burial funds that were established on or after November 1, 1982, if the increase is 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 person 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 person 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 agency does not consider in-kind income received from someone other than a person legally responsible for the person unless it is earned. Therefore, the following in-kind payments are not counted when determining eligibility for WAH SSI-related medical programs:
(a) In-kind payments for services paid by a person's employer if:
(i) The service is not provided in the course of an employer's trade or business; or
(ii) The service is in the form of food that is on the employer's business premises and for the employer's convenience; or
(iii) The service is in the form of shelter that is on the employer's business premises, for the employer's convenience, and required to be accepted by the employee as 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; and
(iv) Persons who work from home to produce specific products for the employer from materials supplied by the employer.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0800, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0800, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500, and Social Security Act as amended by P.L. 108-203. WSR 06-04-046, § 388-475-0800, filed 1/26/06, effective 2/26/06. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-005, § 388-475-0800, filed 4/7/04, effective 6/1/04.]
PDF182-512-0820
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PDF182-512-0860
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PDF182-512-0900
PDF182-512-0920
SSI-related medical—Deeming/allocation of income from nonapplying spouse.
The agency considers the income of financially responsible persons to determine if a portion of that income is available to other household members.
(1) A portion of the income of a nonapplying spouse is considered available to meet the needs of a Washington apple health SSI-related applicant. A nonapplying spouse is defined as someone who is:
(a) Financially responsible for the SSI-related applicant as described in WAC 182-506-0015 and 182-512-0960. For apple health institutional and home and community based waiver programs, see WAC 182-513-1315;
(b) Living in the same household with the SSI-related applicant;
(c) Not receiving a needs based payment such as temporary assistance to needy families (TANF) or state-funded cash assistance (SFA); or
(d) Not related to SSI, or is not applying for apple health coverage including spouses receiving SSI.
(2) An ineligible spouse is the spouse of an SSI cash recipient and is either not eligible for SSI for themselves or who has elected to not receive SSI cash so that their spouse may be eligible. An SSI-related applicant who is the ineligible spouse of an SSI cash recipient is not eligible for apple health categorically needy (CN) health care coverage and must be considered for health care coverage under the apple health medically needy (MN) program or for a modified adjusted gross income-based program if the person does not receive medicare.
(3) When determining whether a nonapplying spouse's income is countable, the agency:
(a) Follows the income rules described in WAC 182-512-0600 through 182-512-0780;
(b) Excludes income described in WAC 182-512-0800 (2) through (10), and all income excluded under federal statute or state law as described in WAC 182-512-0860;
(c) Excludes work-related expenses described in WAC 182-512-0840, with the exception that the sixty-five dollars plus one half earned income deduction described in WAC 182-512-0840(2) does not apply;
(d) Deducts any court ordered child support which the nonapplying spouse pays for a child outside of the home (current support or arrears); and
(e) Deducts any applicable child-related income exclusions described in WAC 182-512-0820.
(4) The agency allocates income of the nonapplying spouse to nonapplying children who reside in the home as described in WAC 182-512-0820. Allocations to children are deducted first from the nonapplying spouse's unearned income, then from their earned income.
(a) For apple health CN medical determinations, allocations to children are not allowed out of the income of the SSI-related applicant, only from the income of the nonapplying spouse.
(b) For apple health MN medical determinations, allocations to children are allowed from the income of the SSI-related applicant if the applicant is unmarried.
(5) For apple health SSI-related CN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:
(a) Less than or equal to one-half of the federal benefit rate (FBR), no income is deemed to the applicant. Compare the applicant's countable income to the one-person SSI categorically needy income level (CNIL) described in WAC 182-512-0010. For health care for workers with disabilities (HWD) applicants, compare to the one-person HWD standard described in WAC 182-505-0100 (1)(c).
(b) Greater than one-half of the FBR, then the entire nonapplying spouse's countable income is deemed to the applicant. Compare the applicant's income to the two-person SSI CNIL. For HWD applicants, compare to the two-person HWD standard described in WAC 182-505-0100 (1)(c).
(6) When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(a) of this section:
(a) Allow all allowable income deductions and exclusions as described in chapter 182-512 WAC to the SSI-related applicant's income; and
(b) Compare the net remaining income to the one-person SSI CNIL or the one-person HWD standard.
(7) When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(b) of this section:
(a) Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one twenty dollar general income exclusion to the combined amount. If there is less than twenty dollars of unearned income, the remainder of the twenty dollar general income exclusion is deducted from earned income.
(b) Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the sixty-five dollar plus one half of the remainder earned income deduction (described in WAC 182-512-0840(2)) to the combined amount.
(c) Add together the net unearned and net earned income amounts and compare the total to the two-person SSI CNIL described in WAC 182-512-0010 or the two-person HWD standard described in WAC 182-505-0100 (1)(c). If the income is equal to or below the applicable two-person standard, the applicant is eligible for apple health CN health care coverage.
(8) An SSI-related applicant under the age of sixty-five who is working, whose level of work activity and earnings is determined not to be "substantial gainful activity" in accordance with all applicable Social Security disability determination rules and standards, but who is not eligible for apple health CN coverage under the regular apple health SSI-related program, may be considered for eligibility under the HWD program. For HWD program rules, see chapter 182-511 WAC.
(9) If the SSI-related applicant's countable income is above the applicable SSI CNIL standard, the agency or its authorized representative considers eligibility under the apple health MN program or under the HWD program if the person is under the age of sixty-five and working. An SSI-related applicant who meets the following criteria is not eligible for apple health MN coverage and eligibility must be determined under HWD or under a MAGI-based apple health program:
(a) The applicant is blind or disabled and under the age of sixty-five;
(b) The applicant's level of work activity and earnings is determined to be "substantial gainful activity" in accordance with all applicable Social Security disability determination rules and standards; and
(c) The applicant is not receiving a title II Social Security cash benefit based on blindness or disability.
(10) For SSI-related apple health MN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:
(a) Less than or equal to the effective one-person MNIL described in WAC 182-519-0050, no income is deemed to the applicant and a portion of the applicant's countable income is allocated to the nonapplying spouse's income to raise it to the effective MNIL standard.
(b) Greater than the effective MNIL, then the amount in excess of the effective one-person MNIL is deemed to the applicant. Compare the applicant's income to the effective one-person MNIL.
(11) When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(a) of this section:
(a) Allocate income from the applicant to bring the income of the nonapplying spouse up to the effective one-person MNIL standard;
(b) Allow all allowable income deductions and exclusions as described in chapter 182-512 WAC to the SSI-related applicant's remaining income;
(c) Allow a deduction for medical insurance premium expenses (if applicable); and
(d) Compare the net countable income to the effective one-person MNIL.
(12) When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(b) of this section:
(a) Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one twenty dollar general income exclusion to the combined amount (if there is less than twenty dollars of unearned income, the remainder of the twenty dollar general income exclusion is deducted from earned income);
(b) Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the sixty-five dollar plus one half of the remainder earned income deduction (described in WAC 182-512-0840(2)) to the combined amount;
(c) Add together the net unearned and net earned income amounts;
(d) Allow a deduction for medical insurance premium expenses (if applicable) per WAC 182-519-0100(5); and
(e) Compare the net countable income to the effective one-person MNIL described in WAC 182-519-0050. If the income is:
(i) Equal to or below the effective one-person MNIL, the applicant is eligible for apple health MN health care coverage with no spenddown.
(ii) Greater than the effective MNIL, the applicant is only eligible for apple health MN health care coverage after meeting a spenddown liability as described in WAC 182-519-0110.
(13) The ineligible spouse of an SSI-cash recipient applying for apple health MN coverage is eligible to receive the deductions and allocations described in subsection (10)(a) of this section.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-15-014, § 182-512-0920, filed 7/6/17, effective 8/6/17. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0920, filed 3/14/14, effective 4/14/14. Statutory Authority: RCW 41.05.021. WSR 12-20-001, § 182-512-0920, filed 9/19/12, effective 10/20/12. WSR 11-24-018, recodified as § 182-512-0920, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500. WSR 11-15-023, § 388-475-0920, filed 7/8/11, effective 8/8/11.]
PDF182-512-0940
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