EAZ	Search All DSHS manuals ACES EAZ Social Services WCCC Work First   for:
Acronyms  Revisions  WAC Number Index  Site Map  WCCC  DSHS Home

SSI-Related Medical - Income

Revised October 28, 2007

Purpose: To describe how various types and amounts of income affect a client’s eligibility and benefit level for either Categorically Needy (CN) or Medically Needy (MN) medical coverage.

WAC 388-475-0600 SSI related medical -- Definition of income. WAC 388-475-0650 SSI related medical -- Available income. WAC 388-475-0700 SSI related medical -- Income eligibility. WAC 388-475-0750 SSI related medical -- Countable unearned income. WAC 388-475-0800 SSI-related medical -- General Income Exclusions WAC 388-475-0820 SSI-related medical -- Child-related income exclusions WAC 388-475-0840 SSI-related medical -Work- and agency-related income exclusions. WAC 388-475-0860 SSI-related medical -- Income exclusions under federal statute or other state laws. WAC 388-475-0880 Special Income disregards for SSI-related medical programs WAC 388-475-0900 SSI-related medical -- Allocating income.

Income Eligibility Availability of Income Income Exclusions Special Income Types Income Allocation See also Chapter 388-450 WAC (Income) and Chapter 388-517 WAC (Medicare Savings Programs). There are Federal laws requiring the department to exclude some receipts for varying amounts of time. One example of these exclusions is Earned Income Tax Credit (EITC). We do not count the receipt of EITC or Advanced EITC as either a resource or earned income in the month of receipt or the next month. However, any retained amount from the EITC is considered a resource in the SECOND month after the month of receipt (20 CFR 416.1235)

WAC 388-475-0600 Effective June 1, 2004 WAC 388-475-0600 SSI related medical -- Definition of income. Income is anything an individual receives in cash or in kind that can be used to meet his/her needs for food, clothing, or shelter. Income can be earned or unearned.  Some receipts are not income because they do not meet the definition of income above, including: Cash or in kind assistance from federal, state, or local government programs whose purpose is to provide medical care or services; Some in kind payments that are not food, clothing or shelter coming from nongovernmental programs whose purposes are to provide medical care or medical services; Payments for repair or replacement of an exempt resource; Refunds or rebates for money already paid; Receipts from sale of a resource; and Replacement of income already received. See 20 CFR 416.1103 for a more complete list of receipts that are not income. Earned income includes the following types of payments: Gross wages and salaries, including garnished amounts; Commissions and bonuses; Severance pay; Other special payments received because of employment; Net earnings from self employment (WAC 388-475-0840 describes net earnings); Self employment income of tribal members unless the income is specifically exempted by treaty; Payments for services performed in a sheltered workshop or work activities center; Royalties earned by an individual in connection with any publication of his/her work and any honoraria received for services rendered; or In kind payments made in lieu of cash wages, including the value of food, clothing or shelter. Unearned income is all income that is not earned income. Some types of unearned income are: Annuities, pensions, and other periodic payments; Alimony and support payments; Dividends and interest; Royalties (except for royalties earned by an individual in connection with any publication of his/her work and any honoraria received for services rendered which would be earned income); Capital gains; Rents; 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; Gifts; Inheritances; or Prizes and awards. Some items which may be withheld from income, but the department considers as received income are: Federal, state, or local income taxes; Health or life insurance premiums; SMI premiums; Union dues; Penalty deductions for failure to report changes; Loan payments; Garnishments; Child support payments, court ordered or voluntary (WAC 388-475-0900 has an exception for deemors); Service fees charged on interest bearing checking accounts; Inheritance taxes; Guardianship fees if presence of a guardian is not a requirement for receiving the income. Countable income, for the purposes of this chapter, means all income that is available to the individual: If it cannot be excluded, and After deducting all allowable disregards and deductions. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION Items an individual may receive that are not considered income include: Food and shelter received during a medical confinement; Weatherization assistance; Receipt of non-cash items that will be an excluded resource in the following month; Proceeds from a loan the individual takes out; or Bills paid by someone else directly.

NOTE: Proceeds from timber sales are considered a resource, not income, in the month received. This was a court decision – conversion of a resource: Cootes v. Sullivan, No. 91 36073 (9th Cir. 1992).

EXAMPLE Riley just bought his first home. He paid the closing costs that were on the papers, and a month later was sent $300 because the actual closing costs were less than estimated. The $300 is not income; it is a refund of money he already paid.

EXAMPLE Debbie just sold her 1989 Toyota because she decided to use public transportation instead of spending money on car repairs. The money she gets for selling the car is not income. She exchanged one resource (the car) for another (cash).

WAC 388-475-0650 Effective June 1, 2004 WAC 388-475-0650 SSI related medical -- Available income. Income is considered available to a client at the earliest of when it is:  Received, or Credited to an individual's account, or Set aside for his or her use, or Can be used to meet the client's needs for food, clothing or shelter. Anticipated nonrecurring lump sum payments are treated as income in the month received, with the exception of those listed in WAC 388-475-0700(5), and any remainder is considered a resource in the following month. Re-occurring income is considered available in the month of normal receipt, even if the financial institution posts it before or after the month of normal receipt. In kind income received from anyone other than a legally responsible relative is considered available income only if it is earned income. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION When recurring income is received in advance or electronically deposited in the client’s account, the income is considered available for the month it would normally be received. For example: if the Social Security check normally received in February is electronically deposited on January 31st because February 1st is on a weekend, the income is still counted for February. Unanticipated non-recurring lump sums cannot be counted as income in the month received because medical programs must budget prospectively and can only count income that can be anticipated. However, any amounts remaining the first of the month after the month of receipt are considered a resource. Income that has been anticipated in a different amount than was actually received is not an overpayment if the anticipated amount was reasonable. If the anticipated amount was based on false information or information known at the time to be incomplete, or if the department made an error in calculation, there may be an overpayment.

WAC 388-475-0700 Effective February 26, 2006 WAC 388-475-0700 SSI related medical -- Income eligibility. In order to be eligible, a client is required do everything necessary to obtain any income to which they are entitled:  Including (but not limited to): annuities, pensions, unemployment compensation, retirement and disability benefits; Even if their receipt makes the client ineligible for department services, Unless the client can provide evidence showing good reason for not obtaining the benefits. The department does not count this income until the client begins to receive it. Income is budgeted prospectively for all medical programs. Anticipated nonrecurring lump sum payments other than retroactive SSI/SSDI payments are considered income in the month received, subject to reporting requirements in WAC 388-418-0007(4). Any unspent portion is considered a resource the first of the following month. The department follows income and resource methodologies of the Supplemental Security Income (SSI) program defined in federal law when determining eligibility for SSI related medical or Medicare Savings programs unless the department adopts rules that are less restrictive than those of the SSI program. Exceptions to the SSI income methodology: Lump sum payments from a retroactive SSDI benefit, when reduced by the amount of SSI received during the period covered by the payment, are not counted as income; Unspent retroactive lump sum money from SSI or SSDI is excluded as a resource for nine months following receipt of the lump sum; and Both the principal and interest portions of payments from a sales contract, that meet the definition in WAC 388-475-0350(10), are unearned income. To be eligible for categorically needy (CN) SSI related medical coverage, a client's countable income cannot exceed the CN program standard described in: WAC 388-478-0065 through WAC 388-478-0085 for noninstitutional medical unless living in an alternate living facility; or WAC 388-513-1305(2) for noninstitutional CN benefits while living in an alternate living facility; or WAC 388-513-1315 for institutional and waiver services medical benefits. To be eligible for SSI related medical coverage provided under the medically needy (MN) program, a client must: Have countable income at or below the MN program standard as described in WAC 388-478-0070; or Satisfy spenddown requirements described in WAC 388-519-0110; Meet the requirements for non-institutional MN benefits while living in an alternate living facility (ALF). See WAC 388-513-1305(3); or Meet eligibility for the MN waiver programs.  See WAC 388-515-1540 and WAC 388-515-1550. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION Anticipated non-recurring lump sum payments are those such as a structured settlement with a defined date of receipt. For example, a client reports on April 10 that she will receive a settlement on a lawsuit that specifies a payment of $5,000 on 7/1. We can anticipate the $5,000 receipt in July and count that as income for July. If the client has $100 of that money left on 8/1, that $100 would be counted as a resource effective 8/1.

WAC 388-475-0750 Effective June 1, 2004 WAC 388-475-0750 SSI related medical -- Countable unearned income. The department counts unearned income for SSI related medical programs as follows:  The total amount of benefits to which a client is entitled is available unearned income even when the benefits are: Reduced through the withholding of a portion of the benefit amount to repay a legal obligation, or Garnished to repay a debt, other legal obligation, or make any other payment such as payment of Medicare premiums. Payments received on a loan: Interest paid on the loan amount is considered unearned income; and Payments on the loan principal are not considered income. However, any amounts retained on the first of the following month are considered a resource. 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. 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: Advertising for tenants; Property taxes; Property insurance; Repairs and maintenance on the property; and Interest and escrow portions of a mortgage. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

NOTE: When a client is in the business of renting properties and actively works the business (over twenty hrs per week), the income is counted as earned income.

CLARIFYING INFORMATION Self-employment income is based on the net earnings reported on the federal income tax return. See Worker Responsibility. Income and resources of spouses are considered available to each other through the end of the month in which the spouses stop living together. See Long Term Care for exceptions. Child support paid by the client is not an allowable income exclusion for SSI-related medical eligibility (20 CFR 416.1123(b)(2), POMS 00830.115) Income payments received from annuities, pension funds and/or retirement funds are considered unearned income when the fund itself is not available as a resource. Goods and services received “in-kind” from an employer are considered differently depending on the classification of the employee. For example: an apartment manager’s housing, provided by an employer, is earned income, while a migrant farm worker’s housing, provided by the employer, is not considered as income for SSI-related medical purposes. Income (such as fishing income) of tribal members is counted as self-employment income unless the income is specifically excluded due to exercise of treaty rights. A tribal member working for a specific business (such as a retail store or restaurant) is considered an employee of that business, unless that tribal member owns the business. If the business is owned by the tribe, the tribal member is still considered an employee. For an in-kind payment to be considered income it must be food, clothing, shelter or something that can be used to get food, clothing or shelter. When it is necessary to place a value on them, in-kind payments are valued at current market value. In-kind income in the form of food or shelter that is provided by an employer is countable earned income unless: It is provided on the employer’s premises; It is provided for the employer’s convenience; and, if it is shelter, Its acceptance by the employee is a condition of employment. In these cases, the income is considered unearned. Rent payments received from roomers and/or boarders are considered unearned income. Money paid by a person who is “sharing” the cost of food and/or housing (rent, utilities, etc.) is not considered income. Housing costs are adjusted according to how they are “shared”. For example, if the apartment rent is $750 per month and a husband, wife and child are sharing the costs with an unrelated person, only the costs that each AU pays is allowed for that shelter expense. If the family pays $500 and the other person, $250, then the shelter cost for the family is $500. If that family only pays ½ of the rent for the apartment ($375), then $375 is considered their shelter cost. The interest portion of payments on sales and/or real estate contracts owned by a client who is resource eligible is counted as unearned income when the combined value of all resources is at or below the resource standard. Count only the portion of the payment that goes toward interest as unearned income. Puyallup Tribe Settlement Income: Budget interest income from the annuity fund payment or the initial investments as newly acquired income. Receipt of gaming money by tribal members is considered unearned income in the month received. Gaming money set aside in trust funds by the tribe is not considered available until it may be accessed by the tribal member for whom it is set aside.

EXAMPLE A tribe pays $5,000 per month gaming money to each tribal member. For tribal members under age 18, $4,000 per month is set-aside in a trust fund which can be used by the child on or after the 18th birthday. The $1,000 received each month is considered income in the month received. The $4,000 per month set-aside is not considered until the child reaches 18. The month after the child turns 18, any money remaining from the trust fund is considered an available resource and that month’s $5,000 is considered income.

Life insurance policy benefits, which an SSI-related client receives as a beneficiary, are counted as unearned income, except for any of the money spent on the insured’s (deceased person’s) last illness and burial expenses. Funds that do not represent an appreciable gain are not counted as income, including: Receipts from the sale or exchange of a resource; Money borrowed or receipt of repayment on a loan; Payments made replacing income that has been lost, stolen or destroyed; Interest left to accumulate on funds set aside for burial. In-kind support or payments made by friends or families providing items not covered by Medicaid, (e.g. payment for rent, telephone or cable services), or payments of bills incurred by the client that are paid directly to the persons owed, are not counted as income. Cash provided by any non-governmental medical services program or under a health insurance policy (except cash to cover food, clothing or shelter) is not counted when it is: Repayment of medical care, prescriptions or medical services the client has already paid for, or A payment restricted to the future purchase of such services. Interest earned on excluded income and resources is considered unearned income and appropriate disregards may apply. Unearned income that is used to pay personal income taxes is not excluded. Home equity conversion plans: a security interest in the home is given in exchange for a lump sum, a periodic cash payment, or a line of credit. The most common home equity conversion plan is a reverse mortgage that allows the homeowner to borrow from the equity in the home with no repayment as long as they live in the home. The funds received under a home equity conversion plan are a loan, and thus do not count as income; however: Interest earned on any money received under the home conversion plan is considered unearned income, and Money retained into the following month is considered a resource as of the first of the month following the month of receipt.

WORKER RESPONSIBILITIES Self-employment income – How to determine: Use the most recent tax return whenever it is available: If unavailable, use the business records that show profit and loss to verify the most recent tax year’s income. Current business records can also be used if the client’s circumstances have changed so much that the use of the tax return would be inaccurate. Assume that any deductions taken on the tax return or business records as allowable by the IRS, absent evidence to the contrary. Divide the net earnings by the number of months the business existed to obtain a monthly total. Verified net loss can reduce other income. Divide the total net loss by the number of months the business existed before subtracting it from the net average monthly profit in #3 above. Apply income disregards to the net earnings from self-employment. Explain and document any significant decrease in net income from the last tax year to the current one. Obtain updated verification of self-employed income annually. Rental income from rental property (excluding renting a room within the home) – How to determine: Deduct the usual and necessary expenses paid in a month (not just incurred in that month) from the gross rental income received in that month, including: Interest and escrow portions of a mortgage payment including taxes and insurance; Real estate insurance and relevant taxes if paid separately from the mortgage payment; Utilities that are paid from the rental amount; Repairs and maintenance to the rental property; Yard maintenance such as lawn mowing and snow removal; Cost of advertising for tenants; Other necessary expenses as allowed by the IRS, except depreciation. If the expenses paid in one month are more than the gross rental income received in that month, carry the excess expenses over into the next month and subtract from the gross rental income received in that month. Income from sales and real estate contracts: only the amount of the underlying mortgage is deducted from payments received from the contract. See the Resource section, WAC 388-475-0350 for treatment of payments made under sales and real estate contracts. Expenses related to hospital, medical, funeral and interment expenses can be excluded from the life insurance payment by a beneficiary.

EXAMPLE An SSI-related client receives $2,000 from her uncle’s life insurance policy. She spends $900 on his last illness and burial expenses. Count $1,100 as unearned income in the month it is received

WAC 388-475-0800 Effective February 26, 2006 WAC 388-475-0800 SSI-related medical -- General Income Exclusions The department excludes, or does not consider, the following when determining a client's eligibility for SSI-related medical programs:  The first twenty dollars per month of unearned income. If there is less than $20 of unearned income in a month, the remainder is disregarded from earned income in that month. The twenty-dollar limit is the same, whether applying it for a couple or for a single person. 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. The $20 disregard is applied after all exclusions have been taken from income. 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: Earned and does not exceed a total of thirty dollars per calendar quarter, or Unearned and does not exceed a total of sixty dollars per calendar quarter. Increases in a client's burial funds that were established on or after November 1, 1982 if the increases are the result of: Interest earned on excluded burial funds; or Appreciation in the value of an excluded burial arrangement that was left to accumulate and become part of separately identified burial funds. Essential expenses necessary for a client to receive compensation, (e.g., necessary legal fees in order to get a settlement); Receipts, which are not considered income, when they are for: Replacement or repair of an exempt resource; Prepayment or repayment of medical care paid by a health insurance policy or medical service program; or Payments made under a credit life or credit disability policy. The fee a guardian or representative payee charges as reimbursement for providing services, when such services are a requirement for the client to receive payment of the income. Funds representing shared household costs. Crime victim’s compensation. The value of a common transportation ticket, given as a gift, that is used for transportation and not converted to cash. Gifts that are not for food, clothing or shelter, and gifts of home produce used for personal consumption. The department does not consider in-kind income received from someone other than a person legally responsible for the individual unless it is earned. Therefore, the following in-kind payments are not counted when determining eligibility for SSI-related medical programs. In-kind payments for services paid by a client’s employer if: The service is not provided in the course of an employer’s trade or business; or It is in the form of food and/or shelter that is: On the employer’s business premises, For the employer’s convenience, and If shelter, acceptance by the employee is a condition of employment; In-kind payments made to people in the following categories: Agricultural employees; Domestic employees; Members of the Uniformed Services; Persons who work from home to produce specific products for the employer from materials supplied by the employer. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information An example of what the department excludes from income is: A payment the client received from their health insurance provider to repay the client for an amount spent to get prescriptions that are covered by the insurance; A payment to repair damage to the home ; or Replacement of the contents of a home due to a fire or flood. Home produce used for personal consumption and gifts that are not used for food, clothing or shelter are not counted because they are not defined as income by the Social Security Act.

WAC 388-475-0820 Effective February 26, 2006 WAC 388-475-0820 SSI-related medical -- Child-related income exclusions The department excludes an allowance from a person’s earned and /or unearned income for a child living in the home when: The minor child lives with an SSI-related parent; and  The minor child is not receiving a needs-based cash payment such as TANF or SSI; and The SSI-related parent is single; or The SSI-related parent lives with a spouse who has no income; and The individual applying for or receiving SSI-related medical benefits is the adult parent. The maximum allowance is one-half the Federal Benefit Rate (FBR) for each child. The child’s countable income, if any, is subtracted from the maximum child’s allowance before determining this allowance. Foster care payments received for a child who is not SSI-eligible and who is living in the household, placed there by a licensed, non-profit or public child placement or childcare agency are excluded from income regardless of whether the person requesting or receiving SSI-related medical is the adult foster parent or the child who was placed. Adoption support payments, received by an adult for a child in the household that are designated for the child’s needs, are excluded as income. Adoption support payments that are not specifically designated for the child’s needs are not excluded and are considered unearned income to the adult. Earned income of a person under age twenty-two is excluded if that person is a student . Child support payments received from an absent parent for a child living in the home are considered the income of the child. One-third of child support payments received for a child are excluded from the child’s income. Any portion of a grant, scholarship, fellowship, or gift used for tuition, fees and/or other necessary educational expenses at any educational institution is excluded from income for nine months after the month of receipt. Gifts to, or for the benefit of, a person under 18 years old who has a life-threatening condition, from an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501 (a) of that Code, is excluded as follows: In-kind gifts that are not converted to cash; or Cash gifts up to a total of $2,000 in a calendar year. Veteran’s payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children are excluded from income. Unless it is specifically contributed to the client, all earned income of an ineligible or non-applying person under the age of twenty-one who is a student: Attending a school, college, or university; or Pursuing a vocational or technical training program designed to prepare the student for gainful employment. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information 1 POMS SI 0820.510 lists the amount of a a child’s earned income exemption (#4 in WAC 388-475-0820).

WAC 388-475-0840 Effective June 1, 2004 WAC 388-475-0840 SSI-related medical -Work- and agency-related income exclusions. The department excludes the following when determining eligibility for SSI-related medical programs: Work related expenses: Including child care, that enable an SSI-related client to work;  That allow a blind or disabled client to work and that are directly related to the person's impairment. First sixty-five dollars plus one-half of the remainder of earned income. This is considered a work allowance/incentive. This deduction does not apply to income already excluded. Any portion of self-employment income normally allowed as an income deduction by the Internal Revenue Service (IRS). Veteran’s Aid and Attendance, Housebound allowance, Unusual/ Unreimbursed Medical Expenses (UME) paid by the VA to some disabled veterans, their spouses, widows or parents. For people receiving long-term care services, see Chapter 388-513 WAC. Payments provided in cash or in kind, to an ineligible or non-applying spouse, under any government program that provides social services to the client, such as chore services or attendant care. SSA refunds for Medicare buy-in premiums paid by the client when the state also paid the premiums. Income that causes a client to lose SSI eligibility, due solely to reduction in the SSP. Department of Veteran’s Affairs benefits designated for the veteran's dependent. It is considered income of that dependent. Tax rebates or special payments excluded under other statutes; Any public agency refund of taxes paid on real property or on food. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION Reductions in the SSP will not affect the CNIL for SSI-related medical coverage. Fluctuations in the SSP will not be used to decrease the CNIL. Veteran’s Aid and Attendance (A&A) and some Unusual Medical Expenses (UME) payments are not considered income, so are not excluded as such. These payments act as reimbursement for services (usually long term care) received by eligible Veterans, and as such are a Third Party resource. VA A&A is counted in determining the amount of participation a client owes in post-eligibility calculations for long term care services. See Chapter 388-513 WAC for long term care rules.

WAC 388-475-0860 Effective February 26, 2006 WAC 388-475-0860 SSI-related medical -- Income exclusions under federal statute or other state laws. The Social Security Act and other federal statutes or state laws list income that the department excludes when determining eligibility for SSI-related medical programs. These exclusions include, but are not limited to:  Income tax refunds; Federal earned income tax credit (EITC) payments for nine months after the month of receipt; 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; 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); Federal, State and Local Government payments including assistance provided in cash or in-kind under any government program that provides medical or social services; Certain cash or in-kind payments a client receives from a governmental or non-governmental medical or social service agency to pay for medical or social services; Value of food provided through a federal or non-profit food program such as WIC, donated food program, school lunch program; Assistance based on need, including: Any federal SSI income or state supplement payment (SSP) based on financial need; Food stamps; GA-U; CEAP; TANF; and Bureau of Indian Affairs (BIA) General Assistance; Housing assistance from a federal program such as HUD if paid under: United States Housing Act of 1937 (section 1437 et seq. Of 42 U.S.C.); National Housing Act (section 1701 et seq. Of 12 U.S.C.); Section 101 of the Housing and Urban Development Act of 1965 (section 1701s of 12 U.S.C., section 1451 of 42 U.S.C.); Title V of the Housing Act of 1949 (section 1471 et seq. Of 42 U.S.C.); or Section 202(h) of the Housing Act of 1959. Weatherization provided to low-income homeowners by programs that consider income in the eligibility determinations; Energy assistance payments including; Those to prevent fuel cutoffs, and To promote energy efficiency. Income from employment and training programs as specified in WAC 388-450-0045. Foster Grandparents program; Title IV-E and state foster care maintenance payments if the foster child is not included in the assistance unit; The value of any childcare provided or arranged (or any payment for such care or reimbursement for costs incurred for such care) under the Child Care and Development Block Grant Act, as amended by section 8(b) of P.L. 102-586 (106 Stat. 5035). Educational assistance as specified in WAC 388-450-0035. Up to two thousand dollars per year derived from an individual’s interest in Indian trust or restricted land. Native American benefits and payments as specified in WAC 388-450-0040 and other Native American payments excluded by federal statute. For a complete list of these payments, see 20 CFR 416, Subpart K, Appendix, IV. Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill) (May 8, 1997) settlement funds; Payments from Ricky Ray Hemophilia Relief Fund Act of 1998, P.L. 105-369; Disaster assistance paid under Federal Disaster Relief P.L. 100-387 and Emergency Assistance Act, P.L.93-288 amended by P.L. 100-707 and for farmers P.L.100-387; Payments made to certain survivors of the Holocaust of Germany’s as victims of Nazi persecution; payments excluded pursuant to section 1(a) of the Victims of Nazi Persecution Act of 1994, Public Law 103-286 (108 Stat. 1450); Payments made under section 500 through 506 of the Austrian General Social Insurance Act. Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV); Restitution payments and interest earned to Japanese Americans or their survivors, and Aleuts interned during World War II, established by P.L. 100-383; Payments made from the Agent Orange Settlement Funds or any other funds to settle Agent Orange liability claims established by P.L. 101-201; Payments made under section six of the Radiation Exposure Compensation Act established by P. L. 101-426; Any interest or dividend is excluded as income, except for the community spouse of an institutionalized individual. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 388-475-0880 Effective June 1, 2004 WAC 388-475-0880 Special Income disregards for SSI-related medical programs Portions of your income the department otherwise counts are disregarded when determining eligibility for SSI-related medical programs.  The department disregards the following for SSI-related medical programs: The Cost of Living Adjustment(s) (COLA) for a client who: Is currently receiving a Social Security payment; Was eligible for and received both SSA and SSI/State Supplement payments (SSP) in the same month for at least one month since April, 1977; and Would continue to receive SSI/SSP payments but for the COLA increase(s) to their SSA benefits. This is commonly known as the adjustment for “Pickle people”. Widow(er)’s benefits for a client who: Was entitled to SSA title II (widow/widower’s) benefits in December 1983; Was at least 50 years old, but not yet 60 at that time; Received title II benefits and SSI in January 1984; Would continue to be eligible for SSI/SSP payments if the title II benefits were disregarded; and Filed an application for Medicaid with the state by July 1, 1988. Widow, Widower or Surviving Divorced Spouse (title II) benefits for a client who: Received SSI/SSP benefits the month prior to receipt of title II benefits; Would continue to be eligible for SSI/SSP benefits if the title II benefits or the COLA(s) to those benefits were disregarded; Is not eligible for Medicare Part A. This client is considered an SSI recipient until becoming entitled to Medicare Part A. A Disabled Adult Child (DAC) who is ineligible for SSI/SSP solely due to receipt of either Social Security benefits as a disabled adult child of a person with a Social Security account or due to receipt of a COLA to the DAC benefits, may be income eligible for CN medical if disregarding the SSA DAC benefits and COLA brings countable income below the CN standards, and the client: Is 18 years of age or older; Remains related to the SSI program through disability or blindness; Lost SSI eligibility on or after July 1, 1988 due solely to the receipt of DAC benefits from SSA or a COLA to those benefits; and Meets the other SSI-related CN medical requirements. Clients who stop receiving an SSI cash payment due to earnings, but still meet all of the other SSI eligibility rules and have income below the higher limit established by the Social Security Act’s Section 1619 (b) are eligible for continued CN Medicaid. TANF income methodology is used to determine counable income for children and pregnant women applying for MN unless the SSI methodology would be more beneficial to the client. For cases using TANF methodology, follow the Family Medical rules and allow the: Fifty percent earned income disregard; Child care and dependent care expenses related to employment; and Child support actually paid. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION Special Income Disregards COLA Clients who became ineligible for SSI/SSP because of an SSA Cost of Living Adjustment (COLA) may be income eligible for CN through the disregard of the SSA COLA. The COLA disregard is allowed only for the CN medical program. This income disregard applies to persons living in their own home, an Alternate Care Facility, Assisted Living Facility, Adult Residential Rehabilitation Center (ARRC) or a Developmental Disability Division (DDD) group home. Clients in alternate living arrangements described above and receiving CN Medicaid are considered receiving a State Supplemental Payment (SSP). A client whose income is below the CNIL after the COLA disregard and other SSI-related income exclusions and disregards are deducted is eligible for CN. Eligibility for other medical programs is determined if the client’s income is above the CNIL. Pickle An adult not meeting the CN income and resource standards is eligible for CN medical coverage if the person is a current beneficiary of Title II of the Social Security Act (SSA) benefits who: Simultaneously received both Social Security (SSA and/or OASDI) and SSI; in any month after April 1977; Is currently eligible for and receiving Social Security; Is ineligible for SSI benefits and/or SSP payments; and Would be eligible for SSI benefits if the COLA increases received since becoming ineligible for SSI are deducted from the client’s current Social Security benefit amount. Countable Social Security income under the Pickle calculation must be added to any other countable income the person may have. If the total income after the special disregard is under the SSI standard, the person is income eligible for CN Medicaid. Resource eligibility must also be met. The Pickle multiplier used to determine the Title II benefit amount is found in ACES parameters, table CMS 3. Widow/Widower’s Benefits (DWB) The disregards for disabled widow/widowers age 50 through 59 became effective July 1, 1988. The current disregard for widow/widowers (other than those in #1 above) became effective January 1, 1991. Widow/er benefits and Surviving Divorced Spouse benefits recipients have an SS claim number other than their own SSN and have BIC codes as listed on the ACES help screen in UNER (source codes SW, SB). These clients’ most common BIC codes (the letters at the end of the SS claim number) begin with D, E or W. Ineligibility for SSI due to reasons such as excess resources, other income etc., does not qualify the client for this income protection. Widow/er benefit disregards are only for those meeting the requirements in WAC. SSA sends a letter to the client that tells them to contact the CSO when their SSI terminates. Disabled Adult Children (DAC) The income disregard for DACs became effective July 1, 1988. To be eligible for DAC the client must be 18 years of age or older. The onset date of disability must be earlier than the client’s 22nd birthday. The DAC must meet all other SSI-related CN eligibility requirements, such as the resource standard. A client may receive DAC benefits but not meet the requirements listed in 1-4, which are necessary to disregard the income. Ineligibility for SSI for other reasons such as excess resources, or other income does not qualify the client for this disregard. SSP Income Disregard The 1995 State Legislature authorized using the Total Expenditure Method for computing the state-funded State Supplemental Payment (SSP). The SSP is the amount DSHS adds to the Federal SSI benefit rate. The Total Expenditure Method caps SSP payments at the calendar year 1994 expenditure level for 1995 and beyond. This reduction in SSP is not reflected in an SSI-related CNIL lower than the amount in effect on January 1, 2002. Beginning July 2002, the Social Security Administration no longer sent State Supplemental Payments out to people with income over the SSI standards in effect at the time: Area 1 ($570.90 for a single person, $836.90 for a couple, both eligible) and Area 2 ($550.45 for a single person, $817.00 for a couple, both eligible). The department disregards income between the FBR in effect at that time ($545) and the SSI standard for CN Medicaid eligibility.

WORKER RESPONSIBILITIES Income Disregards: Disregard the first $65 of the remaining monthly earned income after you apply income exclusions. Apply this disregard to earned income only. If income is less than $65, the remainder of the disregard cannot be carried forward to the next month. Disregard one-half of the remaining earned income after applying the $65 disregard. Allow this disregard on the earned income of a non-applying or non-relatable spouse only after the income is allocated to the SSI-related client. Refer to Treatment of Income section in the EA-Z Manual, Clarifying Information after WAC 388-450-0030, for a chart of how income is counted, excluded and disregarded income. Special Income Disregard: 1. COLA – Determination of eligibility for COLA and CN. This is automatically done in ACES. The procedure to do it by hand is as follows: Determine the client’s total income. Determine the month and year the SSI benefits stopped. Use this date to select the Pickle multiplier found in ACES in the parameters.  To get to the parameters, go to ACES mainframe. From WMEN screen choose option “F” (parameters).  Then choose option “A” (eligibility parameters).  From that screen, choose option “O” (CA-MA Tables 3 Inquiry). Then choose the most recent benefit year you are interested in. Current eligibility uses the most recent multiplier. Multiply the current SSA benefit by the multiplier you selected to determine the COLA disregarded amount. Round to the nearest dollar. Subtract the COLA disregard and other income exemptions and disregards from the client’s total income. Add any income allocated from a spouse or parents. Compare the result to the SSI CNIL. If income is below the CNIL, authorize CN. Do not allow the COLA disregard for programs other than CN.

EXAMPLE Laura received SSA and SSI beginning in 1988, but was terminated from SSI after the most recent COLA. In redetermining her medical program eligibility, the worker notes that her income is above the CNIL after the $20 disregard, but she is eligible for the Pickle (COLA) disregards. After checking the ACES parameters table, using the multiplier for the current year (which effectively disregards the yearly COLAs Laura received) her income is below the CNIL and she is eligible for a CN medical program (S02) instead of MN with spenddown (S99).

A client eligible for the COLA disregard is listed in his or her own assistance unit. Do not count the client as a member of any other AU. Consider the COLA eligible client’s income, including the COLA amounts, minus a one person MNIL standard, as available income to the spouse when the spouse applies for SSI related medical; Use the COLA eligible client’s non-covered medical expenses to meet the spouse’s spenddown liability, if any. Review eligibility for the COLA income disregard when: Terminating any cash or other medical program; When a nursing facility client returns to a non -Institutional living arrangement; At application and reapplication for medical care; At each recertification. If the disregard makes the client eligible for CN and the client: i. Is receiving CN, continue the certification. Make a note to allow the disregard at the next certification. ii. Is receiving MN, change the balance of the certification period to CN. Do not recompute spenddown for the period before the change. iii. Is in pending spenddown (“M”) status, recompute eligibility for the period after the change using the disregard. The period before the change remains the same. Widow/widowers Benefits (DWB) SSA sends a letter to these clients, which tells them to contact the CSO when their SSI terminates. These clients receive SSA benefits under the SSN of the deceased spouse, not their own. Use this SSA letter to verify SSA terminated the client’s SSI due to receipt of SSA. Use an SSA inquiry, SDX screen or the Bendex screen to verify the benefits as DWB and the amount. Clients who get Widow/er benefits or Surviving Divorced Spouse benefits are listed as source code SB or SW when looking at the UNER help screen in ACES. Find the source code SB and SW on the help screen and compare the BIC code for the client with all possible BICs for these source codes. IF the client’s BIC is the same as one of the SB or SW source codes, the client is eligible for this disregard. To determine if the client receiving DWB benefits would be CN income eligible except for the DWB benefits or COLA to these benefits, determine the client’s total countable income; Subtract other income exemptions and disregards from the client’s total income; Determine and subtract the COLA increase on SSA income other than DWB the client has received from the date of SSI termination (using the Pickle multiplier in ACES); Subtract the total DWB amount; Compare the results to the current SSI CNIL; If the resulting income is below the CNIL, authorize CN; If the resulting income is above the CNIL, the client is not eligible for the DWB disregard. Determine eligibility for other medical care programs. Do not allow the DWB disregard for programs other than CN. Continue the DWB disregard as long as the client is CN eligible with the disregard, and continues to meet the criteria described in this section.

EXAMPLE A disabled widow, age 60 was terminated from SSI in January 1990. She became disabled in November 1989 and started getting both SSI and SSA benefits. Her husband died in December 1989 and she now gets DWB benefits. She currently receives $302 DWB and $221 SSA. Computation is done as follows: Total income  $523.00 Less general disregard  - 20.00 Less DWB disregard - 302.00 Less COLA disregard (1993 Multiplier)  - 24.00 Total countable income $177.00 The client is CN eligible because $177 is below the CNIL.

Review eligibility for the DWB income disregard: At application and reapplication for medical care and at each MN certification. If the disregard makes the client eligible for CN and the client: Is receiving CN, continue CN. Make a note to allow the disregard at the next certification. Is receiving MN, change the certification to CN. Do not recompute spenddown for any period before the change in circumstance. Is not currently receiving medical care pending spenddown (“M” status), recompute eligibility for the period after the change using the disregard. The period before the change remains the same. Disabled Adult Child (DAC) Client must have received SSI benefits that were terminated due solely to the receipt of the DAC benefits; or, if the client was already receiving SSI as well as DAC benefits, the termination of the SSI must be due solely to the receipt of a COLA to the DAC benefits. A client is not eligible for this disregard if they never received SSI. Ineligibility for SSI due to other reasons (such as excess resources or receipt of other income) does not qualify an individual for this disregard. Persons who are eligible for Medicare because of a disability are considered to have already met the disability criteria for SSI. DAC benefits are not countable income when determining eligibility for an SSI-related medical program. If the income disregard brings the client’s income below the CN income limit, open CN medical. If the client is receiving long term care services, the DAC disregard will affect post-eligibility income determinations such as participation. A client may lose their DAC benefits if they are no longer disabled. A DAC client who marries anyone other than another DAC or Title II recipient will lose their DAC designation and benefits. To verify receipt of DAC benefits use either; An SDX, which will show this Medicaid Eligibility code and message “ DISABLED ADULT CHILD: CONT SSI MED”; or An SSA inquiry, Bendex or award letter that shows the client has a BIC code (the 2 letter/number suffix to the Social Security claim number) beginning with a C; or Contact SSA by phone. To determine if the client receiving DAC benefits would be CN income eligible but for receiving DAC benefits or a COLA to those benefits; Determine the client’s total income; Subtract other income exclusions and disregards from the client’s total income; Determine and subtract the COLA increase on SSA income other than DAC; Subtract the total DAC amount; Compare the results to the SSI CNIL: If income is below the CNIL, authorize CN. Continue the DAC disregard so long as the client is CN eligible with the disregard and continues to meet the criteria described in this section. If the income is above the CNIL, the client is not eligible for the DAC disregard. Determine eligibility for other medical care programs.

EXAMPLE A 33-year-old woman was terminated from SSI in September 1989 because she started receiving DAC benefits. She currently receives $820 in DAC benefits and $221 in unearned income. She is otherwise program and resource eligible. Total income $1041.00 Less general disregard  - 20.00 Less DAC disregard  - 820.00 Less COLA to the DAC benefits disregard (1993 Multiplier)  - 24.00 Total countable income $201.00 The countable income ($201) is below the CNIL; the client is CN eligible.

Review eligibility for the DAC income disregard: At application and reapplication for medical care; When you receive an SDX with a Medicaid Eligibility code “D – DISABLED ADULT CHILD: CONT SSI MED;” At each MN certification. If the disregard makes the client eligible for CN and the client: Is receiving CN, continue the certification. Make a note to allow the disregard at the next certification; Is receiving MN, change the balance of the certification period to CN. Do not recalculate spenddown for the period before the change; Is not currently receiving medical care pending spenddown, recalculate eligibility for the period after the change using the disregard. The period before the change remains the same. State Supplemental Payment (SSP) C income disregard Client lost SSI eligibility due solely to the reduction in the SSP: Disregard the income which caused the client to lose SSI eligibility, and Authorize SSI-related CN medical coverage. Continue this income disregard as long as the client is CN eligible with this disregard and continues to meet the criteria described in this section. Clients who are eligible for the SSP income disregard may also be eligible for the COLA income disregard. If the client is: Eligible for CN with the COLA income disregard, it is not necessary to allow the SSP disregard. Not eligible for CN with the COLA disregard, determine eligibility for the SSP income disregard and SSI-related CN. ALLOCATING INCOME Purpose: SSI-related medical rules and procedures for: Allocating the income of ineligible or non-applying unit members to an assistance unit; Allocating the income of assistance unit members to non-members, non-applying spouse, and non-applying children; Allocating the income of alien sponsors to an assistance unit.

WAC 388-475-0900 Effective June 1, 2004 WAC 388-475-0900 SSI-related medical -- Allocating income. The department considers income of financially responsible persons to determine if a portion of that income must be regarded as available to other household members.   When income is allocated from an SSI-related person to other household members, that income is considered as the other members' income. A portion of the income of a spouse or parent is allocated to the needs of an SSI-related applicant when the spouse or parent is: Financially responsible for the SSI-related person as described in WAC 388-408-0055 and 388-506-0620. For long-term care programs, see WAC 388-513-1315, 388-513-1330, 388-513-1350; for waiver programs see WAC 388-515-1505 through 388-515-1530; Living in the same household; Not receiving SSI; and Either not related to SSI or is not applying for medical assistance. Allocations to children are deducted from the nonapplying spouse's unearned income, then from their earned income, before they are deducted from the applicant's income. See 388-475-0820. If the conditions in subsection (2) are met, the income to be allocated from a parent to an SSI-related minor child applying for medical benefits is the amount remaining after deducting: All allowable income exclusions and disregards as described in 388-475-0750  through 388-475-0880; One-half of the federal benefit rate (FBR) for each SSI ineligible sibling of the SSI related child living in the household, minus any countable income of that child. See WAC 388-478-0055 for FBR amount; The parent's allowance, either the one person FBR for a single parent or two person FBR for a two-parent household. A portion of the countable income of a nonapplying spouse remaining after the deductions in subsection (4) may be allocated to the SSI-related spouse as follows for CN medical determinations: If the income is less than or equal to one-half of the FBR after allowing the income exclusions in subsection (4) of this section, no income is allocated to the client. If the income is equal to or more than one-half of the FBR after allowing the income exclusions in subsection (4) of this section, all income other than the excluded amounts is allocated to the applying spouse. Deductions from the income of the nonapplying spouse of an SSI-related applicant for CN medical determinations are: Income exclusions as described in 388-475-0750 through WAC 388-475-0880; One-half of the federal benefit rate (FBR) as described in 388-478-0055 for each eligible child in the household, minus the child's countable income. In determining MN medical eligibility for SSI-related applicants: If the income of the nonapplying spouse is less than the MNIL (see 388-478-0070) after applying any child allocation, a portion of the applying spouse's countable income is added to the nonapplying spouse's income to raise it to the MNIL for MN; If the income of the nonapplying spouse is more than the MNIL after applying any child allocation, the entire amount exceeding the MNIL is allocated to the applying spouse. Only income and resources actually contributed to an alien applicant from their sponsor are counted as income. For allocation of income from an alien sponsor, refer to 388-450-0155. This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION: The terms used to describe the spouse of an SSI or SSI-related client are as follows: IS (Ineligible Spouse) – the husband or wife of an SSI recipient who lives with the client and: Is not relatable to SSI; or Has not applied for SSI; or Elects to be considered an ineligible spouse by SSI to make his/her spouse eligible for SSI. NAS (Non-Applying Spouse) – the husband or wife of an SSI-related client who lives with the client and who may (or may not) be SSI-related, but who is not applying for medical assistance. Even though the SSI recipient with an IS receives a larger SSI payment which includes an allowance for the IS, the income belongs to the SSI recipient, not the IS. Do not allocate SSI income to the IS when that spouse applies for SSI-related medical. When determining which member of a couple owns income, use the “name on the check” rule first for allocating income, and then use the Washington State community property rules. When community income and separate income are commingled, the separate income is no longer separate, making all of those funds community income. When both spouses are SSI-related and both are applying for medical assistance, consider income and resources jointly. When one person has been authorized SSI-related medical and another member of that person’s family applies for SSI-related medical, redetermine eligibility for them together as a household.

EXAMPLE Gina has been authorized SSI-related medical and is receiving monthly medical ID cards. Her husband, Joe, and 14 year old daughter, Amy, are now also applying for SSI-related medical. We redetermine their eligibility together as a family using the 3 person MNIL standard.

An IS cannot receive CN Medicaid, even with income and resources below CN standards unless in need of long-term care services. Child support paid out is allowed as a deduction from the non-applying spouse’s income but it is not an allowed deduction from the applicant’s income. If both husband and wife are applying there is no allowance for child support paid out. SSA reduces the SSI client’s benefit by income owned by or deemed available from the IS. If one spouse is an SSI client, the other spouse can not be CN eligible, but may be eligible for MN (with or without spenddown.) The IS must complete an application before eligibility for medical coverage can be determined. Since an IS who is SSI-related cannot receive CN, even with income and resources below CN standards unless in need of long-term care services, consider SSI-related MN. An IS who is pregnant or has minor children in the home should be considered for the appropriate Family Medical or Pregnant Woman program or SSI-related MN, whichever program is more advantageous to the client. SSA has already made a resource eligibility determination. No further action is needed determine resource eligibility. Do not include the income of the SSI client when determining the IS’s income eligibility for medical coverage. If there is no allocated income from the non applying spouse (NAS): Use only the SSI-related client’s countable income and a one person SSI CNIL to determine CN eligibility. Allow income exclusions and disregards. If the SSI-related client’s countable income is: At or below the one person SSI CNIL, the client is eligible for CN medical. Above the one person SSI CNIL, the client is not eligible for CN and MN income allocation procedures apply. CN INCOME ALLOCATION PROCEDURES: Determining NAS income and allocation Give the NAS the income exemptions and exclusions and disregards in WAC 388-450. (those available for all clients) Deduct a child’s allowance (1/2 FBR, less any income of the child) for each non-applying child in the home, from the NAP’s unearned income. Deduct any remaining child’s allowance from the NAP’s earned income. If no income remains there is no income to allocate to the SSI-related child. If income remains, deduct: The $20 general disregard from the NAP’s remaining unearned income, Any remaining balance of the general disregard and the $65 plus one half earned income disregard from the NAP’s remaining earned income. Combine the NAP’s remaining earned and unearned income and deduct a parent’s allowance. A single parent allowance is the “one person” SSI standard; A two parent allowance is the “couple, both eligible” SSI standard. Allocate any remaining income to the SSI-related child. If there is more than one SSI-related child divide the remaining income equally among the eligible children. Determining the SSI-Related Child’s CN/MN eligibility Allow the SSI-related income exemptions and disregards, including the $20 general disregard and $65 and one half earned income disregard from the child’s earnings. Total the child’s countable income and the income allocated from the parents and compare the total with the one person SSI CNIL and/or the one person MNIL. If the SSI-related child’s total countable income is: