reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-509 - Income and resources › Section 182-509-0365 - MAGI income-Self-employment income

Current through Register Vol. 24-14, July 15, 2024
For purposes of determining eligibility for modified adjusted
				  gross income (MAGI)-based Washington apple health (see WAC
				  182-509-0300
				  ):
(1) Self-employment income is
				income earned by a person from running a business, performing a service,
				selling items that are made, or reselling items with the intent to make a
				profit, after deducting allowable IRS self-employment expenses. This income can
				be earned if the person is carrying on a trade or business as a sole proprietor
				or an independent contractor; a member of a partnership that carries on a trade
				or business; or otherwise in business for themselves (including a part-time
				business). Examples of self-employment business structures include, but are not
				limited to:
(a) Sole proprietorship - An
				unincorporated business owned by one person.
(b) Partnership - A relationship between two
				or more people who conduct a trade or business.
(c) Corporation - An entity that conducts
				business, realizes net income or loss, pays taxes, and distributes profits to
				shareholders.
(d) S corporation -
				Similar to a corporation, but this structure passes corporate income, losses,
				deductions, and credits through to the shareholders for federal tax
				purposes.
(e) Limited liability
				company (LLC) - An entity formed by one or more people or entities through a
				special written agreement that details the organization of the LLC.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-509 - Income and resources › Section 182-509-0370 - MAGI income-How self-employment income is counted

Current through Register Vol. 24-14, July 15, 2024
For purposes of determining eligibility for modified adjusted
				  gross income (MAGI)-based Washington apple health, the medicaid agency counts
				  self-employment income by:
(1) Adding
				together gross self-employment income and any profit made from selling business
				property or equipment over a period of time; and
(2) Subtracting business expenses and income
				deductions allowed by the Internal Revenue Service that the person would be
				entitled to if they were filing a federal tax return and either:
(a) Averaging the income to come up with a
				monthly amount based on the period of time the business has been in operation
				within the last year; or
(b)
				Averaging the income over a representative period of time if the current income
				does not represent the person's projected income as shown by clear indications
				of future changes in income; or
(c)
				By averaging the self-employed income and deductions claimed on the previous
				year's tax return over a representative period of time.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-509 - Income and resources › Section 182-509-0375 - MAGI income-Lump sums

Current through Register Vol. 24-14, July 15, 2024
For purposes of determining eligibility for modified adjusted
				  gross income (MAGI)-based Washington apple health (see WAC
				  182-509-0300
				  ):
(1) A lump sum payment is money
				that a person receives but does not expect to receive on a continuing basis,
				such as an insurance settlement.
(2) A lump sum payment is only counted as
				income if it is received in the month of application, and it otherwise
				qualifies as countable income under another rule.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-510 - Supplemental security income › Section 182-510-0001 - Supplemental security income and associated categorically needy coverage

Current through Register Vol. 24-14, July 15, 2024
(1) Supplemental
				security income (SSI) is a federal cash benefit administered by the Social
				Security Administration (SSA) under the Social Security Act, 42 U.S.C. Sec.
				1381-1383f. The SSI program replaces state programs for the aged, blind and
				disabled individuals beginning January 1974. An individual who received state
				assistance in December 1973 who became eligible for SSI in January 1974 is
				considered a grandfathered client by the medicaid agency, and a mandatory
				income level (MIL) client by SSI. The individual must continue to meet the
				definition of blind or disabled that was in effect under the state plan in
				December 1973. See chapter 182-500 WAC for additional definitions.
(2) An essential person is someone needed in
				the home to care for an SSI recipient. An essential person is eligible for
				categorically needy (CN) coverage as long as he or she has lived continuously
				with the eligible person since January 1974.
(3) An ineligible spouse is the spouse of an
				SSI recipient who is not eligible for SSI-related CN coverage. An ineligible
				spouse must have his or her eligibility for Washington apple health (WAH)
				determined separately under WAC
				182-519-0100.
(4) When an individual receives SSI, the
				agency accepts the SSA's determination of medicaid entitlement. The individual
				is eligible for CN coverage without submitting an additional application as
				long as he or she:
(a) Remains entitled to
				SSI ;
(b) Is no longer entitled to
				SSI , but the SSA is in the process of determining eligibility under the Social
				Security Act, 42 U.S.C. Sec. 1619(b); or
(c) Currently has 1619(b) status as described
				in WAC 182-512-0880(3).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-510 - Supplemental security income › Section 182-510-0005 - Supplemental security income, essential person, and ineligible spouse

Current through Register Vol. 24-14, July 15, 2024
(1) If you are a
				supplemental security income (SSI) recipient, you automatically get
				categorically needy (CN) coverage (WAC
				182-512-0100 ) unless you:
(a) Refuse to provide private medical
				insurance information; or
(b)
				Refuse to assign the right to recover insurance funds to the agency (WAC
				182-503-0540 ).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-510 - Supplemental security income › Section 182-510-0010 - Eligibility after supplemental security income ends

Current through Register Vol. 24-14, July 15, 2024
(1) Your categorically needy (CN) coverage
				(WAC 182-512-0100 ) continues after
				supplemental security income (SSI) ends if:
(a) Countable income exceeds the SSI income
				standard due solely to the annual cost-of-living adjustment (COLA);
				or
(b) A timely request for a
				hearing has been filed. CN coverage is continued until the Social Security
				Administration (SSA) makes a final decision on the hearing request and on any
				subsequent timely appeals.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1000 - Apple health for workers with disabilities (HWD)-Program description

Current through Register Vol. 24-14, July 15, 2024
This section describes the apple health for workers with
				  disabilities (HWD) program.
(1) The
				HWD program provides categorically needy (CN) scope of care as described in WAC
				182-501-0060.
(2) The HWD program also provides long-term
				services and supports described in chapters 182-513 and 182-515 WAC for a
				client who meets the functional requirements for those programs, are approved
				for those services, and choose to enroll in HWD.
(3) The medicaid agency approves HWD coverage
				for twelve months effective the first of the month in which a person applies
				and meets program requirements. See WAC
				182-511-1100
				for retroactive coverage for months before the month of application.
(4) A person who is eligible for another
				medicaid program may choose not to participate in the HWD program.
(5) A person is not eligible for HWD coverage
				for a month in which the person received medicaid benefits under the medically
				needy (MN) program.
11-24-018, recodified as WAC
					 182-511-1000, filed 11/29/11,
					 effective 12/1/11. Statutory Authority:
					 RCW
					 74.04.050,
					 74.08.090,
					 74.09.530, and
					 74.09.700. 06-24-036, §
					 388-475-1000, filed 11/30/06, effective 1/1/07. Statutory Authority:
					 RCW
					 74.08.090, Section 1902(a)(10)(A)(ii) of the
					 Social Security Act, and 2001 c 7 § 209(5), Part II. 02-01-073, §
					 388-475-1000, filed 12/14/01, effective
					 1/14/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1050 - Apple health for workers with disabilities (HWD)-Program requirements

Current through Register Vol. 24-14, July 15, 2024
This section describes requirements a person must meet to be
				  eligible for the apple health for workers with disabilities (HWD)
				  program.
(1) To qualify for the HWD
				program, a person must:
(a) Meet the general
				requirements for a medical program described in WAC
				182-503-0505(3)(a)
				through (f);
(b) Be at least age sixteen ;
(c) Meet the federal disability requirements
				described in WAC
				182-511-1150;
				and
(d) Be employed full or part
				time (including self-employment) as described in WAC
				182-511-1200.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1060

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 41.05.021, Patient Protection and Affordable
					 Care Act ( Public Law
					 111-148 ), 42 C.F.R. §§ 431, 435, and
					 457, and 45 C.F.R. § 155. WSR 13-14-019, §
											182-511-1060, filed 6/24/13,
					 effective 7/25/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1100 - Apple health for workers with disabilities (HWD)-Retroactive coverage

Current through Register Vol. 24-14, July 15, 2024
This section describes requirements for retroactive coverage
				  provided under the apple health for workers with disabilities (HWD)
				  program.
(1) Retroactive coverage
				refers to the period of up to three months before the month in which a person
				applies for the HWD program.
(2)
				To qualify for retroactive coverage under the HWD program, a person must first:
(a) Meet all program requirements described
				in WAC
				182-511-1050
				for each month of the retroactive period; and
(b) Pay the premium amount for each month
				requested within one hundred twenty days of being billed for such
				coverage.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1150 - Apple health for workers with disabilities (HWD)-Disability requirements

Current through Register Vol. 24-14, July 15, 2024
This section describes the disability requirements for the
				  following groups of individuals who may qualify for the apple health for
				  workers with disabilities (HWD) program.
(1) A person age sixteen through age
				sixty-four must meet the requirements of the Social Security Act in section
				1902(a)(10)(A)(ii):
(a) (XV) for the basic
				coverage group (BCG); or
(b) (XVI)
				for the medical improvement group (MIG).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1200 - Apple health for workers with disabilities (HWD)-Employment requirements

Current through Register Vol. 24-14, July 15, 2024
This section describes the employment requirements for the
				  basic coverage group (BCG) and the medical improvement group (MIG) for the
				  apple health for workers with disabilities (HWD) program.
(1) For the purpose of the HWD program,
				employment means a person:
(a) Gets paid for
				working;
(b) Has earnings that are
				subject to federal income tax; and
(c) Has payroll taxes taken out of earnings
				received, unless self-employed.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-511 - Apple health for workers with disabilities (HWD) › Section 182-511-1250 - Apple health for workers with disabilities (HWD)-Premium payments

Current through Register Vol. 24-14, July 15, 2024
This section describes how the medicaid agency calculates the
				  premium amount a person must pay for apple health for workers with disabilities
				  (HWD) coverage. This section also describes program requirements regarding the
				  billing and payment of HWD premiums.
(1) When determining the HWD premium amount,
				the agency counts only the income of the person approved for the program. It
				does not count the income of another household member.
(2) When determining countable income used to
				calculate the HWD premium, the agency applies the following rules:
(a) Income is considered available and owned
				when it is:
(i) Received; and
(ii) Can be used to meet the person's needs
				for food, clothing, and shelter, except as described in WAC
				182-512-0600(5),
				182-512-0650,
				and
				182-512-0700(1).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0010 - Supplemental security income (SSI) standards, SSI-related categorically needy income level (CNIL), and countable resource standards

Current through Register Vol. 24-14, July 15, 2024
(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
$2,000
(b) A legally married couple
$3,000
11-23-091, recodified as WAC
					 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. 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 ). 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). 05-06-090, §
					 388-478-0080, filed 3/1/05, effective 4/1/05; 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. 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 ). 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. 00-10-095, §
					 388-478-0080, filed 5/2/00, effective 5/2/00; 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. 98-16-044, §
					 388-478-0080, filed 7/31/98, effective 9/1/98. Formerly WAC
					 388-511-1110.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0050 - SSI-related medical - General information

Current through Register Vol. 24-14, July 15, 2024
(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:
(a) Age sixty-five or older;
(b) Blind with:
(i) Central visual acuity of 20/200 or less
				in the better eye with the use of a correcting lens; or
(ii) A field of vision limitation so the
				widest diameter of the visual field subtends an angle no greater than twenty
				degrees.
(c) Disabled:
(i) "Disabled" means unable to engage in any
				substantial gainful activity by reason of any medically determinable physical
				or mental impairment, which:
(A) Can be
				expected to result in death; or
(B)
				Has lasted or can be expected to last for a continuous period of not less than
				twelve months; or
(C) In the case
				of a child seventeen years of age or younger, if the child suffers from any
				medically determinable physical or mental impairment of comparable
				severity.
(ii) Decisions
				on SSI-related disability are subject to the authority of:
(A) Federal statutes and regulations codified
				at 42 U.S.C. Section 1382c and 20 C.F.R., parts 404 and 416 , as amended;
				and
(B) Controlling federal court
				decisions, which define the OASDI and SSI disability standard and determination
				process.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0100 - SSI-related medical - Categorically needy (CN) medical eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) Washington
				apple health (WAH) categorically needy (CN) coverage is available for an
				SSI-related person who meets the criteria in WAC
				182-512-0050, SSI-related
				medical-General information.
(2) To
				be eligible for SSI-related WAH CN medical programs, a person must also have:
(a) Countable income and resources at or
				below the SSI-related WAH CN medical monthly standard (refer to WAC
				182-512-0010 ) or be eligible for
				an SSI cash grant but choose not to receive it; or
(b) Countable resources at or below the SSI
				resource standard and income above the SSI-related WAH CN medical monthly
				standard, but the countable income falls below that standard after applying
				special income disregards as described in WAC
				182-512-0880; or
(c) Met requirements for long-term care (LTC)
				WAH CN income and resource requirements that are found in chapters 182-513 and
				182-515 WAC if wanting LTC or waiver services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0150 - SSI-related medical-Medically needy (MN) medical eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) Washington
				apple health (WAH) medically needy (MN) health care coverage is available for
				any of the following:
(a) A person who is
				SSI-related and not eligible for WAH categorically needy (CN) medical coverage
				because the person has countable income that is above the WAH CN income level
				(CNIL) (or for long-term care (LTC) recipients, above the special income limit
				(SIL)):
(i) The person's countable income is
				at or below WAH MN standards, leaving no spenddown requirement; or
(ii) The person's countable income is above
				WAH MN standards requiring the person to spenddown their excess income (see
				subsection (4) of this section). See WAC
				182-512-0500
				through
				182-512-0800
				for rules on determining countable income, and WAC
				182-519-0050
				for program standards or chapter 182-513 WAC for institutional
				standards.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0200 - SSI-related medical - Definition of resources

Current through Register Vol. 24-14, July 15, 2024
(1) A resource is any cash, other personal
				property, or real property that an applicant, recipient or other financially
				responsible person:
(a) Owns;
(b) Has the right, authority, or power to
				convert to cash (if not already cash); and
(c) Has the legal right to use for his/her
				support and maintenance.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0250 - SSI-related medical-Ownership and availability of resources

Current through Register Vol. 24-14, July 15, 2024
(1) The agency
				considers personal and real property to be available to a Washington apple
				health applicant or recipient if the applicant or recipient:
(a) Owns the property;
(b) Has the authority to convert the property
				into cash;
(c) Can expect to
				convert the property to cash within twenty working days; and
(d) May legally use the property for his or
				her support.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0260 - SSI-related medical-How to count a sponsor's resources

Current through Register Vol. 24-14, July 15, 2024
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0300 - SSI-related medical-Resources eligibility

Current through Register Vol. 24-14, July 15, 2024
(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.
(2) An excluded resource converted to another
				excluded resource remains excluded.
(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
(c) Spent.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0350 - SSI-related medical-Property and contracts excluded as resources

Current through Register Vol. 24-14, July 15, 2024
(1) The agency
				excludes the following resources when determining eligibility for SSI-related
				medical assistance:
(a) A client's household
				goods and personal effects;
(b) One
				home (which can be any shelter), including the land on which the dwelling is
				located, and all contiguous property and related out-buildings in which the
				client has ownership interest for long-term care programs, see WAC
				182-513-1350
				for home equity limits, when:
(i) The client
				uses the home as a primary residence;
(ii) The client's spouse lives in the home;
(iii) The client does not
				currently live in the home, but the client or the client's representative has
				stated the client intends to return to the home; or
(iv) A relative, who is financially or
				medically dependent on the client, lives in the home and either the dependency
				is documented or a written statement of dependency is provided by the client,
				the client's authorized representative, or by the client's dependent
				relative.
(c) The value
				of ownership interest in jointly owned real property is an excluded resource
				for as long as sale of the property would cause undue hardship to a co-owner
				due to loss of housing. Undue hardship would result if the co-owner:
(i) Uses the property as the client's
				principal place of residence;
(ii)
				Would have to move if the property were sold; and
(iii) Has no other readily available
				housing.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0400 - SSI-related medical - Vehicles excluded as resources

Current through Register Vol. 24-14, July 15, 2024
(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.
11-24-018, recodified as WAC
					 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. 10-13-077, §
					 388-475-0400, filed 6/15/10, effective 7/16/10. Statutory Authority:
					 RCW
					 74.04.050,
					 74.08.090. 04-09-003, §
					 388-475-0400, filed 4/7/04, effective
					 6/1/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0450 - SSI-related medical - Life insurance excluded as a resource

Current through Register Vol. 24-14, July 15, 2024
(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.
11-24-018, recodified as WAC
					 182-512-0450, filed 11/29/11,
					 effective 12/1/11. Statutory Authority:
					 RCW
					 74.04.050,
					 74.08.090. 04-09-003, §
					 388-475-0450, filed 4/7/04, effective
					 6/1/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0500 - SSI-related medical-Burial funds, contracts and spaces excluded as resources

Current through Register Vol. 24-14, July 15, 2024
(1) For the
				purposes of this section, burial funds are funds set aside and clearly
				designated solely for burial and related expenses, and kept separate from all
				other resources not intended for burial. These include:
(a) Revocable burial contracts;
(b) Revocable burial trusts; or
(c) Other revocable burial arrangements. The
				designation is effective the first day of the month in which the person
				intended the funds to be set aside for burial.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0550 - SSI-related medical-All other excluded resources

Current through Register Vol. 24-14, July 15, 2024
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;
(b) SSI payments for
				benefits due for the month(s) before the month of continuing payment;
(c) OASDI 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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0600 - SSI-related medical-Definition of income

Current through Register Vol. 24-14, July 15, 2024
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0650 - SSI-related medical - Available income

Current through Register Vol. 24-14, July 15, 2024
(1) Income is considered available to a
				person at the earliest of when it is:
(a)
				Received; or
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0700 - SSI-related medical-Income eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) In order to be eligible, a person is
				required to do everything necessary to obtain any income to which he or she is
				entitled including (but not limited to):
(a)
				Annuities;
(b) Pensions;
(c) Unemployment compensation;
(d) Retirement; and
(e) Disability benefits; even if their
				receipt makes the person ineligible for agency services, unless the person can
				provide evidence showing good reason for not obtaining the benefits.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0750 - SSI-related medical - Countable unearned income

Current through Register Vol. 24-14, July 15, 2024
The agency counts unearned income for Washington apple
				  health (WAH) SSI-related medical programs as follows:
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0760 - SSI-related medical-Education assistance

Current through Register Vol. 24-14, July 15, 2024
(1) The agency does not count:
(a) Educational assistance in the form of
				grants, loans or work study, issued from Title IV of the Higher Education
				Amendments (Title IV HEA) and Bureau of Indian Affairs (BIA) education
				assistance programs. Examples of Title IV HEA and BIA educational assistance
				include, but are not limited to:
(i) College
				work study (federal and state);
(ii) Pell grants; and
(iii) BIA higher education grants.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0770 - SSI-related medical-American Indian/Alaska Native excluded income and resources

Current through Register Vol. 24-14, July 15, 2024
(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:
(i) Located on or near a reservation or
				within the most recent boundaries of a prior federal reservation; or
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0780 - SSI-related medical-Employment and training programs

Current through Register Vol. 24-14, July 15, 2024
(1) The agency excludes income received from
				the following programs:
(a) Payments issued
				under the Workforce Investment Act (WIA);
(b) Payments issued under the National and
				Community Service Trust Act of 1993. This includes payments made through the
				AmeriCorps program;
(c) Payments
				issued under Title I of the Domestic Volunteer Act of 1973, such as VISTA,
				AmeriCorps VISTA, University Year for Action, and Urban Crime Prevention
				Program; and
(d) All payments
				issued under Title II of the Domestic Volunteer Act of 1973. These include:
(i) Retired Senior Volunteer Program
				(RSVP);
(ii) Foster Grandparents
				Program; and
(iii) Senior Companion
				Program.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0785 - SSI-related medical-Effect of a sponsor's income

Current through Register Vol. 24-14, July 15, 2024
(1) The following definitions apply to this
				section:
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0790 - SSI-related medical-Exemption from sponsor deeming

Current through Register Vol. 24-14, July 15, 2024
(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):
(i) Refugee;
(ii) Parolee admitted under Section 212(d)(5)
				of the Immigration and Nationality Act (INA);
(iii) Asylee;
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0795 - SSI-related medical-Budgeting a sponsor's income

Current through Register Vol. 24-14, July 15, 2024
(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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0800 - SSI-related medical-General income exclusions

Current through Register Vol. 24-14, July 15, 2024
The agency excludes, or does not consider, the following when
				  determining a person's eligibility for Washington apple health 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.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0820 - SSI-related medical-Child-related income exclusions and allocations

Current through Register Vol. 24-14, July 15, 2024
(1) For the
				purposes of Washington apple health SSI-related medical eligibility
				determinations under chapter 182-512 WAC, a child is defined as a person who
				is:
(a) Unmarried;
(b) Living in the household of the
				SSI-related applicant;
(c) The
				natural, adopted or stepchild of the SSI-related applicant or the applicant's
				spouse;
(d) Not receiving a
				needs-based cash payment such as TANF or SSI; and
(e) Either:
(i) Age seventeen or younger; or
(ii) Age twenty-one or younger and meets the
				SSI-related definition of a student described in subsection (6) of this
				section.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0840 - SSI-related medical - Work- and agency-related income exclusions

Current through Register Vol. 24-14, July 15, 2024
The agency excludes the following when determining
				  eligibility for Washington apple health (WAH) SSI-related medical
				  programs:
(1) Work related expenses:
(a) That enable an SSI-related person to
				work; or
(b) That allows a blind or
				disabled person to work and that are directly related to the person's
				impairment.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0860 - SSI-related medical-Income exclusions under federal statute or other state laws

Current through Register Vol. 24-14, July 15, 2024
The Social Security Act and other federal statutes or state
				  laws list income that the agency excludes when determining eligibility for
				  Washington apple health (WAH) SSI-related medical programs. These exclusions
				  include, but are not limited to:
(1)
				Income tax refunds;
(2) Federal
				earned income tax credit (EITC) payments for 12 months after the month of
				receipt;
(3) Compensation provided
				to volunteers in the Corporation for National and Community Service (CNCS),
				formerly known as ACTION programs established by the Domestic Volunteer Service
				Act of 1973. P.L.
				93-113;
(4) Assistance to a person (other than wages
				or salaries) under the Older Americans Act of 1965, as amended by
				section
				102(h)(1) of
				Pub. L.
				95-478(92 Stat. 1515,
				42 U.S.C.
				3020a) ;
(5) Federal, state and local government
				payments including assistance provided in cash or in-kind under any government
				program that provides medical or social services;
(6) Certain cash or in-kind payments a person
				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) Basic Food;
(c) State-funded cash assistance;
(d) CEAP;
(e) TANF; and
(f) Bureau of Indian Affairs (BIA) general
				assistance.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0880 - SSI-related medical-Special income disregards

Current through Register Vol. 24-14, July 15, 2024
Portions of a person's income the agency otherwise counts are
				  disregarded when determining eligibility for Washington apple health
				  SSI-related medical programs.
(1) The
				agency disregards cost of living adjustments (COLAs) to Social Security
				benefits and provides categorically needy (CN) SSI-related medicaid benefits
				under the Pickle Amendment criteria of 42 C.F.R. 435.135 (1)(a) to a person
				who:
(a) Is currently receiving Title II
				Social Security benefits;
(b) Was
				eligible for and received SSI or State Supplement payments (SSP) but became
				ineligible for those payments after April, 1977; and
(c) Would still be eligible for SSI or SSP
				payments if the amount of Social Security COLA increases paid under section
				215(i) of the Social Security Act were deducted from the person's current Title
				II Social Security benefits.
(d) To
				satisfy this provision, a person must have been eligible for and received SSI
				or SSP payments and in the same month was entitled to, but did not necessarily
				receive, a Title II Social Security benefit for at least one month since April
				1977. This includes a person who receives a Title II Social Security benefit
				payment the month after the last SSI or SSP payment is made due to the fact
				that Social Security is paid the month after entitlement begins.
(e) For purposes of this section, the agency
				also disregards COLAs received by a person, their financially responsible
				spouse, and other financially responsible family members, such as a
				parent.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0900 - SSI-related medical - Deeming and allocation of income

Current through Register Vol. 24-14, July 15, 2024
The agency considers income of financially responsible
				  persons to determine if a portion of that income must be regarded as available
				  to other household members.
(1)
				Deeming is the process of determining how much of another person's income is
				counted when determining Washington apple health (WAH) eligibility of an
				SSI-related applicant. When income is deemed to the SSI-related applicant from
				other household members, that income is considered the applicant's income.
				Income is deemed only:
(a) From a nonapplying
				spouse who lives with the SSI-related applicant; or
(b) From a parent(s) residing with an
				SSI-related applicant child.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-512 - SSI-related medical › Section 182-512-0920 - SSI-related medical-Deeming/allocation of income from nonapplying spouse

Current through Register Vol. 24-14, July 15, 2024
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.