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Income overview 3: exclusions and allocations
Purpose: To describe how various types and amounts of income affect an individual’s eligibility for Categorically Needy (CN) or Medically Needy (MN) health care coverage.
WAC 182-512-0800 SSI-related medical -- General income exclusions.
Effective April 14, 2014.
The agency excludes, or does not consider, the following when determining a person's eligibility for Washington apple health (WAH) SSI-related medical programs:
- 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.
- 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 twenty dollars 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;
- An increase in a person's burial funds that were established on or after November 1, 1982, if the increase is 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 person 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 person 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 agency does not consider in-kind income received from someone other than a person legally responsible for the person unless it is earned. Therefore, the following in-kind payments are not counted when determining eligibility for WAH SSI-related medical programs:
- In-kind payments for services paid by a person's employer if:
- The service is not provided in the course of an employer's trade or business; or
- The service is in the form of food that is on the employer's business premises and for the employer's convenience; or
- The service is in the form of shelter that is on the employer's business premises, for the employer's convenience, and required to be accepted by the employee as a condition of employment.
- In-kind payments made to people in the following categories:
- Agricultural employees;
- Domestic employees;
- Members of the uniformed services; and
- Persons who work from home to produce specific products for the employer from materials supplied by the employer.
- In-kind payments for services paid by a person's employer if:
- Funds that do not count as income include:
- Payments made replacing income that has been lost, stolen or destroyed;
- Interest left to accumulate on funds set aside for burial.
- Life insurance policy benefits, which an SSI-related individual 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.
- Money paid by a person who is “sharing” the cost of food or housing (rent, utilities, etc.) is not considered income. Housing costs are adjusted according to how they are “shared”.
Example: If the apartment rent is $800 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, $300, then the shelter cost for the family is $500. If that family only pays ½ of the rent for the apartment ($400), then $400 is considered their shelter cost.
- 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.
- An example of excluded income is:
- Prescription reimbursement from a health insurer;
- A payment to repair damage to the home; or
- Replacement of the contents of a home due to a fire or flood.
Example: A migrant farm worker’s housing, provided by the employer, is not considered income for SSI-related Apple Health purposes.
WAC 182-512-0820 SSI-related medical -- Child-related income exclusions and allocations.
Effective June 10, 2019.
- 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:
- Living in the household of the SSI-related applicant;
- The natural, adopted or stepchild of the SSI-related applicant or the applicant's spouse;
- Not receiving a needs-based cash payment such as TANF or SSI; and
- Age seventeen or younger; or
- Age twenty-one or younger and meets the SSI-related definition of a student described in subsection (6) of this section.
- The agency allows an allocation for the support of a child when determining the countable income of an SSI-related applicant. The allocation is calculated as follows:
- For apple health categorically needy (CN) health care coverage, the allocation is deducted from the countable income of a nonapplying spouse before determining the amount of the nonapplying spouse's income to be deemed to the SSI-related applicant. Allocations to children are not deducted from the income of an unmarried SSI-related applicant.
- For apple health medically needy (MN) medical coverage, the allocation is first deducted from the income of the nonapplying spouse as described in subsection (2)(a) of this section when the SSI-related applicant is married, and from the income of the applicant when the applicant is not married.
- The child's countable income, if any, is subtracted from the maximum child's allowance before determining the amount of allocation.
- Foster care payments received for a child who is not SSI-eligible and who is living in the household, placed there by a licensed, nonprofit or public child placement or childcare agency are excluded from income regardless of whether the client 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.
- The agency excludes the earned income of a client age twenty-one or younger if that client is a student. In order to allow the student earned income exclusion, a student must:
- Attend a school, college, or university a minimum of eight hours a week; or
- Pursue a vocational or technical training program designed to prepare the student for gainful employment a minimum of twelve hours per week; or
- Attend school or be home schooled in grades seven through twelve at least twelve hours per week.
- 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 and not counted as a resource for nine months after the month of receipt.
- One-third of child support payments received for a child who is an applicant for SSI-related medical is excluded from the child's income. Child support payments that are subject to the one-third deduction may be voluntary or court-ordered payments for current support or arrears.
- The following gifts to, or for the benefit of, a client under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that code, are excluded:
- In-kind gifts that are not converted to cash; and
- Cash gifts up to a total of two thousand dollars 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. Any portion of a veteran's payment that is designed as the dependent's income is countable income to the dependent and not the applicant (assuming the applicant is not the dependent).