WAC 182-509-0300 Modified adjusted gross income (MAGI).

Effective September 18, 2020.

1. The agency uses the modified adjusted gross income (MAGI) methodology to determine eligibility for MAGI-based Washington apple health programs described in WAC 182-509-0305.
2. MAGI methodology is described in WAC 182-509-0300 through 182-509-0375. Generally, MAGI includes adjusted gross income (as determined by the Internal Revenue Code (IRC)) increased by:
   1. Any amount excluded from gross income under Section 911 of the IRC;
   2. Any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax; and
   3. Any amount of Title II Social Security income or Tier 1 Railroad Retirement income which is excluded from gross income under Section 86 of the IRC.
3. When calculating a person's eligibility for the programs listed in WAC 182-509-0305, the agency uses the person's MAGI income with the following exceptions:
   1. Scholarships or fellowship grants described in WAC 182-509-0335 used for education purposes are excluded from income;
   2. Income received by American Indian/Alaskan Native individuals described in WAC 182-509-0340 is excluded from income; and
   3. Any income received as a lump sum as described in WAC 182-509-0375 is counted as income only in the month in which it is received; and
   4. Income received by a child are eighteen or younger or a tax dependent as described in WAC 182-509-0360 is excluded from income.
4. Countable MAGI income is reduced by an amount equal to five percentage points of the federal poverty level (FPL) based on household size to determine net income except that there is no such reduction of countable MAGI income for parents or caretaker relatives with an eligible dependent child whose net countable income is below fifty-four percent of the FPL (as described in WAC 182-509-0305(1)). Net income is compared to the applicable standard described in WAC 182-505-0100.
5. When calculating a person's eligibility for MAGI-based programs listed in WAC 182-509-0305, the agency determines the medical assistance unit for each person according to WAC 182-506-0010.

WAC 182-509-0305 MAGI income -- Persons subject to the modified adjusted gross income (MAGI) methodology.

Effective November 1, 2024.

1. Eligibility for Washington apple health for the following people is determined using the modified adjusted gross income (MAGI) methodology described in WAC 182-509-0300:
   1. Parents or caretaker relatives with an eligible dependent child (described in WAC 182-503-0565) whose net countable income is below 54 percent of the federal poverty level (FPL) as described in WAC 182-505-0240.
   2. Parents or caretaker relatives with an eligible dependent child whose net countable income exceeds the standard described in (a) of this subsection but is at or below 133 percent FPL as described in WAC 182-505-0250 and 182-507-0110.
   3. Adults with no eligible dependent child with net countable income at or below 133 percent FPL as described in WAC 182-505-0250 and 182-507-0110.
   4. Pregnant people whose net countable income, based on a household size that includes any unborn children, is equal to or below 210 percent FPL at the time of application, as described in WAC 182-505-0115.
   5. People within the 12-month postpartum period beginning the month after the pregnancy ends whose net countable income is equal to or below 210 percent FPL at the time of application, as described in WAC 182-505-0115.
   6. Children age 18 or younger in households with net countable income which is equal to or below 210 percent FPL as described in WAC 182-505-0210.
   7. Children age 18 or younger in households with net countable income that is greater than 210 percent but equal to or below 312 percent FPL, as described in WAC 182-505-0215. Children who are eligible under this section are subject to premiums as described in WAC 182-505-0225.
2. Household size for a person who is subject to MAGI income methodologies is determined according to WAC 182-506-0010.

WAC 182-509-0310 MAGI income -- Timing of income.

Effective January 9, 2014.

For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (WAH) (see WAC 182-509-0300):

1. The agency uses a point-in-time estimate to determine a person's countable income.
2. Point-in-time means that the income is received, or is likely to be received, in the month in which the person submits an application or renewal for WAH, or the month in which the agency completes a redetermination of coverage, with the following provisions:
   1. When a person is paid less frequently than on a monthly basis, (for example, they are self-employed), the agency uses an average to calculate the monthly amount. The average is calculated by:
      1. Adding the total income for representative period of time;
      2. Dividing by the number of months in the time frame; and
      3. Using the result as a monthly average.
   2. When a person is paid more frequently than on a monthly basis, the agency uses the following budgeting method to calculate a monthly amount:
      1. If the person is paid weekly, the agency multiplies weekly expected income by 4.3;
      2. If the person is paid every other week, the agency multiplies expected income by 2.15.
   3. If the person's current income does not represent his or her projected income as evidenced by clear indications of future changes in income, the agency permits the person to estimate a monthly amount by averaging income over a representative period of time.
3. If the person normally gets the income:
   1. On a specific day, the agency counts it as available on that date.
   2. Monthly or twice monthly and pay dates change due to a reason beyond the person's control, such as a weekend or holiday, it is counted in the month it would normally be received.
   3. Weekly or every other week and pay dates change due to a reason beyond the person's control, it is counted in the month it would normally be received.
4. For information about how income is verified, see WAC 182-503-0050.
5. If the person reports a change in income as required under WAC 182-504-0105 and the change is expected to last for two months or longer, the agency updates the estimate of income based on this change, unless the person receives categorically needy WAH coverage as a pregnant woman or child.

WAC 182-509-0315 MAGI income -- Ownership of income.

Effective January 9, 2014.

1. For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (WAH) (see WAC 182-509-0300) income is considered available to a person if:
   1. An individual in the person's medical assistance unit receives or can reasonably predict that he or she will receive the income.
   2. The income must be counted based on rules under chapter 182-509 WAC.
   3. The person has control over the income, which means the income is available to them. If the person has a representative payee, protective payee, or other individual who manages the income on the person's behalf, it is considered as if the person has control over this income.
   4. The person can use the income to meet current needs.
2. Income that is included in the person's taxable gross income which is required to be reported to the Internal Revenue Service (IRS) is considered as available even if it is paid to someone else or withheld to pay a garnishment, lien or other obligation. (For example, a person manages a block of apartments and lives in one of the apartments. The employer withholds a portion of the person's monthly wages as rent due for the apartment in which he resides. The income that is counted is the gross amount prior to the deduction for rent.)
3. The agency may conduct post-eligibility reviews of health care applications as described in WAC 182-503-0050. Upon request by the agency, a person must provide proof about a type of income, including submitting clarification on:
   1. Who owns the income;
   2. Who has legal control of the income;
   3. The amount of the income; or
   4. If the income is available.

WAC 182-509-0320 MAGI income -- Noncountable income.

Effective September 18, 2020.

For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (see WAC 182-509-0300):

1. Some types of income are not counted when determining eligibility for MAGI-based apple health. Under the MAGI income methodology described in WAC 182-509-0300, income is not counted if the Internal Revenue Service (IRS) permits it to be excluded or deducted for purposes of determining the tax liability of a person. (See 26 U.S.C. Sections 62(a) and 101-140.)
2. Examples of income that are not counted include, but are not limited to:
   1. Bona fide loans, except certain student loans as specified under WAC 182-509-0335;
   2. Federal income tax refunds and earned income tax credit payments for up to 12 months from the date received;
   3. Child support payments received by any person included in household size under WAC 182-506-0010;
   4. Nontaxable time loss benefits or other compensation received for sickness or injury, such as benefits from the department of labor and industries (L&I) or a private insurance company;
   5. Title IV-E and state foster care and adoption support maintenance payments;
   6. Veteran's benefits including, but not limited to, disability compensation and pension payments for disabilities paid to the veteran or family members; education, training and subsistence; benefits under a dependent-care assistance program for veterans, housebound allowance and aid and attendance benefits;
   7. Money withheld from a benefit to repay an overpayment from the same income source;
   8. One-time payments issued under the Department of State or Department of Justice reception and replacement programs, such as Voluntary Agency (VOLAG) payments;
   9. Nontaxable income from employment and training programs;
   10. Any portion of income used to repay the cost of obtaining that income source;
   11. Insurance proceeds or other income received as a result of being a Holocaust survivor;
   12. Federal economic stimulus payments that are excluded for federal and federally assisted state programs;
   13. Income from a sponsor given to a sponsored immigrant;
   14. Fringe benefits provided on a pretax basis by an employer, such as transportation benefits or moving expenses;
   15. Employer contributions to certain pretax benefits funded by an employee's elective salary reduction, such as amounts for a flexible spending account;
   16. Distribution of pension payments paid by the employee (such as premiums or contributions) that were previously subject to tax;
   17. Gifts as described in IRS Publication 559; Survivors, Executors, and Administrators;
   18. Cash or noncash inheritances, except that the agency counts income produced by an inheritance;
   19. Death benefits from life insurance and certain benefits paid for deaths that occur in the line of duty;
   20. Working families' tax credit payments under RCW 82.08.0206; and
   21. Other payments that are excluded from income under state or federal law.
3. Income received from other agencies or organizations as needs-based assistance is not countable income under this section.
   1. "Needs-based" means eligibility for the program is based on having limited income, or resources, or both. Examples of needs-based assistance are:
      1. Clothing;
      2. Food;
      3. Household supplies;
      4. Medical supplies (nonprescriptions);
      5. Personal care items;
      6. Shelter;
      7. Transportation; and
      8. Utilities (e.g. lights, cooking fuel, the cost of heating or heating fuel).
   2. Needs-based cash programs include, but are not limited to, the following apple health programs:
      1. Diversion cash assistance (DCA);
      2. Temporary assistance for needy families (TANF);
      3. State family assistance (SFA);
      4. Pregnant women's assistance (PWA);
      5. Refugee cash assistance (RCA);
      6. Aged, blind, disabled cash assistance (ABD); and
      7. Supplemental security income (SSI).

WAC 182-509-0325 MAGI income -- Unearned income.

Effective January 9, 2014.

For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (WAH) (see WAC 182-509-0300):

1. Unearned income is income received from a source other than employment or self-employment. Examples of unearned income include, but are not limited to:
   1. Tier 1 Railroad Retirement;
   2. Unemployment compensation, except as described in WAC 182-509-0320;
   3. Title II Social Security benefits (including retirement benefits, disability benefits, and benefits for survivors);
   4. Rental income;
   5. Pensions, IRAs, military retirement and annuity payments, except as described in WAC 182-509-0320;
   6. Dividend payments from stocks or shares held in companies; and
   7. Per capita distributions from gaming made by a tribe (see WAC 182-509-0340).
2. When the unearned income must be counted, the agency counts the gross amount before any taxes or premiums are taken out.
3. See WAC 182-509-0320 for examples of unearned income that are not counted.

WAC 182-509-0330 MAGI income -- Earned income.

Effective January 9, 2014.

For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (WAH) (see WAC 182-509-0300):

1. Earned income is income received from working. This includes, but is not limited to:
   1. Wages;
   2. Salaries;
   3. Tips;
   4. Commissions;
   5. Profits from self-employment activities as described in WAC 182-509-0365; and
   6. One-time payments for work done over a period of time, if the income is received in the month of application.
2. When earned income must be counted, the agency computes the countable amount based on deductions from income allowed by the Internal Revenue Service when determining a person's tax liability.
3. See WAC 182-509-0370 for information on how self-employment income is counted.

WAC 182-509-0335 MAGI income -- Educational benefits.

Effective September 18, 2020.

For purposes of determining eligibility for modified adjusted gross income (MAGI)–based Washington apple health (see WAC 182-509-0300), the agency or its designee does not count educational benefits as income when they are used for education expenses, unless the educational benefits are used for living expenses. Examples include, but are not limited to:

1. Educational assistance in the form of grants or loans issued under Title IV of the Higher Education Amendments (Title IV - HEA) or through a program administered by the Department of Education (DOE), such as:
   1. Pell grants (Title IV);
   2. Stafford loans (Title IV);
   3. Perkins loan program (Title IV);
   4. State need grant program (Title IV); and
   5. Training programs administered by the Department of Education (DOE).
2. Payments received for education, training, or subsistence under any law administered by the department of Veteran's Affairs (VA).
3. Student financial assistance provided under the Bureau of Indian Affairs education programs.
4. Educational assistance in the form of grants or loans under the Carl D. Perkins Vocational and Applied Technology Education Act, P.L. 101-392.
5. Work study income including:
   1. Federal or state work study income; and
   2. WorkFirst work study income.
6. Payments to service academy cadets at a military academy.
7. Payments for the purposes of tuition made on behalf of the individual to an educational organization for the education or training of such individual.