WAC 182-512-0900 SSI-related medical -- Deeming and allocation of income.

Effective April 14, 2014.

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:
   1. From a nonapplying spouse who lives with the SSI-related applicant; or
   2. From a parent(s) residing with an SSI-related applicant child.
2. An allocation is an amount deducted from income counted in the eligibility determination and considered to be set aside for the support of a person other than the SSI-related applicant. When income is allocated to other household members from the SSI-related applicant(s) or from the applicant's spouse, that income is not counted as income of the SSI-related applicant.
3. An SSI-related person applying for WAH categorically needy (CN) health care coverage must have countable income at or below the SSI categorically needy income level (CNIL) described in WAC 182-512-0010 unless the person is working and meets all requirements for the health care for workers with disabilities (HWD) program described in WAC 182-511-1000 through 182-511-1250.
4. For WAH institutional or home and community based waiver programs, use rules described in WAC 182-513-1315.
5. The agency follows rules described in WAC 182-512-0600 through 182-512-0880 to determine the countable income of an SSI-related applicant or SSI-related couple.
6. If countable income of the applicant exceeds the one-person SSI CNIL prior to considering the income of a nonapplying spouse or children, the applicant is not eligible for WAH CN health care coverage and the agency determines eligibility for the WAH medically needy (MN) program. If the countable income does not exceed the SSI CNIL, see WAC 182-512-0920 to determine if income is to be deemed to the applicant from the nonapplying spouse.
7. If countable income (after allowable deductions) of an SSI-related couple both applying for medical coverage exceeds the two-person SSI CNIL, the couple is not eligible for WAH CN health care coverage and the agency determines eligibility for the WAH medically needy (MN) program.
8. For WAH CN health care coverage, allocations to children are deducted from the nonapplying spouse's unearned income, then from their earned income before income is deemed to the SSI-related applicant. See WAC 182-512-0820.
9. For MN medical coverage, allocations to children are deducted from the income of the SSI-related applicant or SSI-related applicant couple. See subsection (10) of this section to determine the amount of the allocation.
10. An SSI-related person or couple applying for WAH MN health care coverage is allowed an allocation to a nonapplying spouse, their SSI recipient spouse or their dependent child(ren) to reduce countable income before comparing income to the effective medically needy income level (MNIL) described in WAC 182-519-0050. The agency allocates income:
    1. Up to the effective one-person MNIL to a nonapplying spouse or SSI recipient spouse minus the spouse's countable income; and
    2. Up to one-half of the federal benefit rate (FBR) to each dependent minus each dependent's countable income. See WAC 182-512-0820 for child exclusions.
11. A portion of a nonapplying spouse's income may be deemed to the SSI-related applicant:
    1. See WAC 182-512-0920(5) to determine how much income is deemed from a nonapplying spouse to the SSI-related applicant when determining WAH CN eligibility; and
    2. See WAC 182-512-0920(10) to determine how much income is deemed from a nonapplying spouse to the SSI-related applicant when determining WAH MN eligibility.
12. A portion of the income of an ineligible parent or parents is allocated to the needs of an SSI-related applicant child. See WAC 182-512-0940 (4) through (7) to determine how much income is allocated from ineligible parent(s).
13. When income must be deemed from the sponsor or sponsors of a noncitizen applicant or recipient, see WAC 182-512-0795 to determine the amount that must be counted as income of the noncitizen applicant or recipient.

WAC 182-512-0920 SSI-related medical -- Deeming/allocation of income from nonapplying spouse.

Effective April 1, 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:
   1. 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;
   2. Living in the same household with the SSI-related applicant;
   3. Not receiving a needs based payment such as temporary assistance to needy families (TANF) or state-funded cash assistance (SFA); or
   4. Not related to SSI, or is not applying for apple health coverage including spouses receiving SSI.
2. An ineligible spouse is the spouse of an SSI cash recipient and is either not eligible for SSI for themselves or who has elected to not receive SSI cash so that their spouse may be eligible. An SSI-related applicant who is the ineligible spouse of an SSI cash recipient is not eligible for apple health categorically needy (CN) health care coverage and must be considered for health care coverage under the apple health medically needy (MN) program or for a modified adjusted gross income-based program if the person does not receive medicare.
3. When determining whether a nonapplying spouse's income is countable, the agency:
   1. Follows the income rules described in WAC 182-512-0600 through 182-512-0780;
   2. Excludes income described in WAC 182-512-0800 (2) through (10), and all income excluded under federal statute or state law as described in WAC 182-512-0860;
   3. Excludes work-related expenses described in WAC 182-512-0840, with the exception that the $65 plus one half earned income deduction described in WAC 182-512-0840(2) does not apply;
   4. Deducts any court ordered child support which the nonapplying spouse pays for a child outside of the home (current support or arrears); and
   5. Deducts any applicable child-related income exclusions described in WAC 182-512-0820.
4. The agency allocates income of the nonapplying spouse to nonapplying children who reside in the home as described in WAC 182-512-0820. Allocations to children are deducted first from the nonapplying spouse's unearned income, then from their earned income.
   1. For apple health CN medical determinations, allocations to children are not allowed out of the income of the SSI-related applicant, only from the income of the nonapplying spouse.
   2. For apple health MN medical determinations, allocations to children are allowed from the income of the SSI-related applicant if the applicant is unmarried.
5. For apple health SSI-related CN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:
   1. Less than or equal to one-half of the federal benefit rate (FBR), no income is deemed to the applicant. Compare the applicant's countable income to the one-person SSI categorically needy income level (CNIL) described in WAC 182-512-0010.
   2. Greater than one-half of the FBR, then the entire nonapplying spouse's countable income is deemed to the applicant. Compare the applicant's income to the two-person SSI CNIL.
6. When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(a) of this section, allow all allowable income deductions and exclusions as described in chapter 182-512 WAC to the SSI-related applicant's income, and compare the net remaining income to the one-person SSI CNIL.
7. When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (5)(b) of this section:
   1. Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one $20 general income exclusion to the combined amount. If there is less than $20 of unearned income, the remainder of the twenty dollar general income exclusion is deducted from earned income.
   2. Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the $65 plus one half of the remainder earned income deduction (described in WAC 182-512-0840(2)) to the combined amount.
   3. Add together the net unearned and net earned income amounts and compare the total to the two-person SSI CNIL described in WAC 182-512-0010. If the income is equal to or below the applicable two-person standard, the applicant is eligible for apple health CN health care coverage.
8. An SSI-related applicant who is working, whose level of work activity and earnings is determined not to be "substantial gainful activity" in accordance with all applicable Social Security disability determination rules and standards, but who is not eligible for apple health CN coverage under the regular apple health SSI-related program, may be considered for eligibility under the HWD program. For HWD program rules, see chapter 182-511 WAC.
9. If the SSI-related applicant's countable income is above the applicable SSI CNIL standard, the agency or its authorized representative considers eligibility under the apple health MN program or under the HWD program if the person is under the age of sixty-five and working. An SSI-related applicant who meets the following criteria is not eligible for apple health MN coverage and eligibility must be determined under HWD or under a MAGI-based apple health program:
   1. The applicant is blind or disabled and, for a MAGI-based apple health program, under the age of 65;
   2. The applicant's level of work activity and earnings is determined to be "substantial gainful activity" in accordance with all applicable Social Security disability determination rules and standards; and
   3. The applicant is not receiving a title II Social Security cash benefit based on blindness or disability.
10. For SSI-related apple health MN medical determinations, a portion of the countable income of a nonapplying spouse remaining after the deductions and allocations described in subsections (3) and (4) of this section may be deemed to the SSI-related applicant. If the nonapplying spouse's countable income is:
    1. Less than or equal to the effective one-person MNIL described in WAC 182-519-0050, no income is deemed to the applicant and a portion of the applicant's countable income is allocated to the nonapplying spouse's income to raise it to the effective MNIL standard.
    2. Greater than the effective MNIL, then the amount in excess of the effective one-person MNIL is deemed to the applicant. Compare the applicant's income to the effective one-person MNIL.
11. When income is not deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(a) of this section:
    1. Allocate income from the applicant to bring the income of the nonapplying spouse up to the effective one-person MNIL standard;
    2. Allow all allowable income deductions and exclusions as described in chapter 182-512 WAC to the SSI-related applicant's remaining income;
    3. Allow a deduction for medical insurance premium expenses (if applicable); and
    4. Compare the net countable income to the effective one-person MNIL.
12. When income is deemed to the SSI-related applicant from the nonapplying spouse per subsection (10)(b) of this section:
    1. Combine the applicant's unearned income with any unearned income deemed from the nonapplying spouse and allow one $20 general income exclusion to the combined amount (if there is less than $20 of unearned income, the remainder of the twenty dollar general income exclusion is deducted from earned income);
    2. Combine the applicant's earned income with any earned income deemed from the nonapplying spouse and allow the $65 plus one half of the remainder earned income deduction (described in WAC 182-512-0840(2)) to the combined amount;
    3. Add together the net unearned and net earned income amounts;
    4. Allow a deduction for medical insurance premium expenses (if applicable) per WAC 182-519-0100(5); and
    5. Compare the net countable income to the effective one-person MNIL described in WAC 182-519-0050. If the income is:
       1. Equal to or below the effective one-person MNIL, the applicant is eligible for apple health MN health care coverage with no spenddown.
       2. Greater than the effective MNIL, the applicant is only eligible for apple health MN health care coverage after meeting a spenddown liability as described in WAC 182-519-0110.
13. The ineligible spouse of an SSI-cash recipient applying for apple health MN coverage is eligible to receive the deductions and allocations described in subsection (10)(a) of this section.

WAC 182-512-0940 SSI-related medical -- Deeming income from an ineligible parent(s) to a child applying for SSI-related medical.

Effective April 14, 2014.

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. A portion of the income of a parent(s) is considered available to the SSI-related applicant child when the child is age seventeen or younger and the parent(s) is:
   1. Financially responsible for the SSI-related child as described in WAC 182-506-0015;
   2. The natural, adoptive, or step-parent of the child;
   3. Living in the same household with the child;
   4. Not receiving a needs-based payment such as TANF, SFA or SSI; and
   5. Not related to SSI or not applying for medical assistance.
2. If an SSI-related applicant between the ages of eighteen to twenty-one lives with their parents, only consider the parent's income available to the applicant if it is actually contributed to the applicant. If income is not contributed, count only the applicant's own separate income.
3. Income that is deemed to the child is considered as that child's income.
4. When determining whether a parent's income is countable, the agency:
   1. Follows the income rules described in WAC 182-512-0600 through 182-512-0780; and
   2. Excludes income described in WAC 182-512-0800 and 182-512-0840, and all income excluded under a federal statute or state law as described in WAC 182-512-0860.
5. When determining the amount of income to be deemed from a parent(s) to an SSI-related minor child for Washington apple health (WAH) categorically needy (CN) and medically needy (MN) coverage, the agency reduces the parent(s) countable income in the following order:
   1. Court ordered child support paid out for a child not in the home;
   2. An amount equal to one half of the federal benefit rate (FBR) for each SSI-eligible sibling living in the household, minus any countable income of that child. See WAC 182-512-0010 for FBR amount;
   3. A twenty dollar general income exclusion;
   4. A deduction equal to sixty-five dollars plus one-half of the remainder from any remaining earned income of the parent(s);
   5. An amount equal to the one-person SSI CNIL for a single parent or the two-person SSI CNIL for a two parent household;
   6. Any income remaining after these deductions is considered countable income to the SSI-related child and is added to the child's own income. If there is more than one child applying for SSI-related health care coverage, the deemed parental income is divided equally between the applicant children; and
   7. The deductions described in this section are deducted first from unearned income then from earned income unless they are specific to earned income.
6. The SSI-related applicant child is also allowed all applicable income exclusions and disregards described in chapter 182-512 WAC from their own income. After determining the child's nonexcluded income, the agency:
   1. Allows the twenty dollar general income exclusion from any unearned income;
   2. Deducts sixty-five dollars plus one half of the remainder from any earned income which has not already been excluded under the student earned income exclusion (see WAC 182-512-0820); and
   3. Adds the child's countable income to the amount deemed from their parent(s). If the combination of the child's countable income plus deemed parental income is equal to or less than the SSI CNIL, the child is eligible for SSI-related WAH CN health care coverage.
7. If the combination of the child's countable income plus deemed parental income is greater than the SSI CNIL, the agency considers the child for SSI-related WAH medically needy (MN) coverage. Any amount exceeding the effective medically needy income level (MNIL) is used to calculate the amount of the child's spenddown liability as described in WAC 182-519-0110. See WAC 182-519-0050 for the current MNIL standards.

WAC 182-512-0960 SSI-related medical -- Allocating income -- Determining eligibility for a spouse when the other spouse receives long-term services and supports.

Effective February 20, 2017.

1. General Information.
   1. This section describes how the agency determines household income and resources when the household contains both institutional and noninstitutional household members.
   2. A separate medical assistance unit is always established for persons who meet institutional status under WAC 182-513-1320. See WAC 182-506-0015 for rules on how to determine medical assistance units for households that include people related to the supplemental security income (SSI) program.
   3. Throughout this section, "home" means "own home" as defined in WAC 388-106-0010.
   4. The income and resources of each spouse are available to the other through the end of the month in which the spouses stopped living together, unless subsection (3) of this section applies.
   5. The agency determines income and resources separately starting the first day of the month following the month of separation if spouses stop living together in the same home.
   6. When one, or both members of a couple live in an alternative living facility (ALF), the agency considers the couple to be living:
      1. Apart when:
         1. Only one spouse enters the ALF;
         2. Both spouses enter the same ALF but have separate rooms; or
         3. Both spouses enter separate ALFs.
      2. Together when both spouses share a room in an ALF.
2. The agency counts income and resources under this chapter when both members of a couple live in the same house and the community spouse or spousal impoverishment protections community (SIPC) spouse applies for coverage and his or her spouse receives:
   1. Home and community-based (HCB) waiver;
   2. Program for all inclusive care to the elderly (PACE);
   3. Roads to community living (RCL);
   4. Hospice; or
   5. Community first choice (CFC).
3. When one member of a couple lives apart from their spouse and the community spouse or SIPC spouse applies for coverage, and the spouse who receives long-term services and supports lives:
   1. In an institution:
      1. The agency counts income under this chapter, plus any allocation the institutionalized spouse has made available to the community spouse; and
      2. The agency counts resources under this chapter, plus any resources allocated to the community spouse when eligibility for the institutionalized spouse was determined, that remain in the name of the institutionalized spouse and are available to the community spouse under WAC 182-512-0250.
   2. In an ALF and receives HCB waiver, PACE, RCL, or hospice:
      1. The agency counts income under this chapter, plus any allocation the institutionalized spouse has made available to the community spouse; and
      2. The agency counts resources under this chapter, plus any resources allocated to the community spouse when eligibility for the institutionalized spouse was determined, that remain in the name of the institutionalized spouse, and are available to the community spouse under WAC 182-512-0250; and
   3. In an ALF and receives CFC:
      1. The agency counts income under this chapter; and
      2. The agency counts resources under this chapter, plus any resources allocated to the SIPC spouse when eligibility for the spousal impoverishment protections institutionalized (SIPI) spouse was determined, that remain in the name of the SIPI spouse and are available to the community spouse under WAC 182-512-0250.
4. Determining household income when the spouse of an HCB waiver recipient is not eligible for categorically needy (CN) coverage.
   1. When the community spouse is not eligible for categorically needy (CN) coverage under subsection (2) of this section, the agency determines eligibility under the medically needy program;
   2. The agency counts income and resources as described under subsection (2) of this section;
   3. The agency allocates income to the institutionalized spouse before comparing the community spouse's income to the medically needy income level (MNIL) if:
      1. The community spouse lives in the same household as the institutionalized spouse;
      2. The institutionalized spouse is receiving home and community-based waiver services under WAC 182-515-1505 or institutional hospice services under WAC 182-513-1240; and
      3. The institutionalized spouse has gross income under the MNIL.
   4. The allocation in (c) of this subsection cannot exceed the one-person effective MNIL minus the institutionalized spouse's income.

WAC 182-512-0790 SSI-related medical -- Exemption from sponsor deeming.

Effective April 14, 2014.

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:
   1. 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):
      1. Refugee;
      2. Parolee admitted under Section 212(d)(5) of the Immigration and Nationality Act (INA);
      3. Asylee;
      4. Cuban/Haitian entrant under Section 202 of the Immigration Reform and Control Act of 1986 (IRCA);
      5. Amerasians admitted with an I-551 admission code of AM1, AM2, AM3, AM6, AM7, or AM8; and
      6. Special immigrant from Iraq or Afghanistan.
   2. The person meets the blindness or disability requirements described in WAC 182-512-0050(1);
   3. The person was sponsored by an organization or group as opposed to another person;
   4. The person is a nonqualified or undocumented alien as defined in WAC 182-503-0530 (3) and (4);
   5. The person has worked or can get credit for forty qualifying quarters of work under Title II of the Social Security Act. The agency does not count a quarter of work toward this requirement if the person working received TANF, Basic Food, SSI, CHIP, or nonemergency medicaid coverage. A quarter of work earned by the following people is counted toward the forty qualifying quarters:
      1. The person;
      2. The person's parents for the time they worked before the person turned eighteen years old (including the time they worked before the person's birth); and
      3. The person's spouse if still married or if the spouse is deceased.
   6. The person has become a United States (U.S.) citizen;
   7. The sponsor is dead; or
   8. If USCIS or a court decides that the person, their child, or their parent was a victim of domestic violence from the person's sponsor and:
      1. The person no longer lives with the sponsor; and
      2. Leaving the sponsor caused the need for coverage.
2. A person is exempt from the deeming process while in the same assistance unit (AU) as the sponsor.
3. If the person, their child, or their parent was a victim of domestic violence, the person is exempt from the deeming process for twelve months if:
   1. They no longer live with the person who committed the violence; and
   2. Leaving this person caused the need for health coverage.
4. If the person's medical assistance unit (MAU) has income at or below one hundred thirty percent of the federal poverty level (FPL), the person is exempt from the deeming process for twelve months. This is called the "indigence exemption." A person may choose to use this exemption or not to use this exemption in full knowledge of the possible risks involved. See risks in subsection (5) of this section. For this rule, the agency counts the following as income:
   1. Earned and unearned income received by any member of the MAU from any source; and
   2. The value of any noncash items of value such as free rent, commodities, goods, or services received from another person or organization.
5. A person who chooses not to use the indigence exemption must provide verification of the sponsor's income and resources and will be subject to the deeming rules described in WAC 182-512-0795.
6. For federally funded programs, if the person uses the indigence exemption, the agency is required by law to give the U.S. Attorney General the following information:
   1. The names of the sponsored people in the person's AU;
   2. That the person is exempt from deeming due to income;
   3. The sponsor's name; and
   4. The effective date that the twelve-month exemption began.

WAC 182-512-0795 SSI-related medical -- Budgeting a sponsor's income.

Effective January 2, 2015.

1. The agency counts some of the income of a person's sponsor as unearned income to the medical assistance unit (MAU) if:
   1. The sponsor signed the U.S. Citizenship and Immigration Services (USCIS) Affidavit of Support form I-864 or I-864A; and
   2. The person is not exempt from the deeming process in WAC 182-512-0790.
2. The agency determines the amount of income that must be deemed from the sponsor by taking the following steps:
   1. Add together all of the sponsor's earned and unearned income that is not excluded under WAC 182-512-0860;
   2. Add all of the spouse's earned and unearned income that is not excluded under WAC 182-512-0860;
   3. Subtract an allocation for the sponsor equal to the one-person federal benefit rate (FBR);
   4. Subtract an allocation for the sponsor's spouse as follows:
      1. If the spouse is also a cosponsor of the noncitizen, allow an allocation equal to the one-person FBR; or
      2. If the spouse is not a cosponsor but lived in the same household as the sponsor, allow an allocation equal to one-half of the FBR.
   5. Subtract an allocation equal to one-half FBR for each dependent of the sponsor. The dependent's income is not subtracted from the sponsor's dependent's allocation; and
   6. The income remaining is deemed as unearned income to the noncitizen and is added to the noncitizen's own income.
3. If the sponsor has sponsored other noncitizens, all of the sponsor's income is deemed to each person that they sponsored and is not divided between them.