WAC 182-512-0800 SSI-related medical -- General income exclusions.

Effective September 30th 2024.

The agency excludes, or does not consider, the following when determining a person's eligibility for Washington apple health SSI-related medical programs:

1. The first $20 per month of unearned income. If there is less than $20 of unearned income in a month, the remainder is excluded from earned income in that month.
   1. The $20 limit is the same, whether applying it for a couple or for a single person.
   2. 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.
   3. The $20 disregard is applied after all exclusions have been taken from income.
2. 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:
   1. Earned and does not exceed a total of $30 per calendar quarter; or
   2. Unearned and does not exceed a total of $60 per calendar quarter;
   3. An increase in a person's burial funds that were established on or after November 1, 1982, if the increase is the result of:
      1. Interest earned on excluded burial funds; or
      2. Appreciation in the value of an excluded burial arrangement that was left to accumulate and become part of separately identified burial funds.
3. Essential expenses necessary for a person to receive compensation (e.g., necessary legal fees in order to get a settlement).
4. Receipts, which are not considered income, when they are for:
   1. Replacement or repair of an exempt resource;
   2. Prepayment or repayment of medical care paid by a health insurance policy or medical service program; or
   3. Payments made under a credit life or credit disability policy.
5. 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.
6. Funds representing shared household costs.
7. Crime victim's compensation.
8. The value of a common transportation ticket, given as a gift, that is used for transportation and not converted to cash.
9. Gifts that are not for clothing or shelter.
10.  In-kind payments. 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 apple health SSI-related medical programs:
    1. In-kind payments for services paid by a person's employer if:
       1. The service is not provided in the course of an employer's trade or business; or
       2. The service is in the form of food that is on the employer's business premises and for the employer's convenience; or
       3. 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.
    2. In-kind payments made to people in the following categories:
       1. Agricultural employees;
       2. Domestic employees;
       3. Members of the uniformed services; and
       4. Persons who work from home to produce specific products for the employer from materials supplied by the employer.
11. Unearned income withheld, before receipt by the person, for mandatory income tax purposes.

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.

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 182-512-0785 SSI-related medical -- Effect of a sponsor's income.

Effective August 6, 2018.

1. The following definitions apply to this section:
   1. "Sponsor" means a person who agreed to meet the needs of a sponsored immigrant by signing a United States Citizenship and Immigration Services Affidavit of Support form I-864 or I-864A. This includes a sponsor's spouse if the spouse signed the affidavit of support.
   2. "Sponsored immigrant" means a person who must have a sponsor under the Immigration and Nationality Act (INA) to be admitted into the United States for residence.
   3. "Deeming" means the agency counts a part of the sponsor's income and resources as available to the sponsored immigrant.
   4. "Exempt" means the person meets one of the conditions of WAC 182-512-0790.
2. If the person is a sponsored immigrant and is not exempt from deeming, the person must provide the following information to be eligible for Washington apple health (WAH) SSI-related coverage even if the person is not receiving support from their sponsor:
   1. The name and address of the sponsor;
   2. The income and resources of the sponsor; and
   3. Any additional information needed for the agency to determine if:
      1. Income must be deemed to the person's medical assistance unit (MAU); and
      2. The amount of income that must be deemed to the MAU.
3. If the person is not eligible for coverage because the agency does not have the information needed regarding the sponsor, eligibility for other unsponsored household members applying for coverage is not delayed. Although the sponsored immigrant may not be eligible for coverage, the following is counted when determining the eligibility of other household members:
   1. All earned or unearned income of the sponsored immigrant that is not excluded under chapter 182-512 WAC; and
   2. All deductions the sponsored immigrant would be eligible for under chapter 182-512 WAC.
4. If the person refuses to provide the agency with the information needed regarding the sponsor, the other adult members in the MAU must provide the information. If the same person sponsored everyone in the MAU, the entire MAU is not eligible for WAH coverage until someone provides the information that is needed.

WAC 182-512-0780 SSI-related medical -- Employment and training programs.

Effective April 14, 2014.

1. The agency excludes income received from the following programs:
   1. Payments issued under the Workforce Investment Act (WIA);
   2. Payments issued under the National and Community Service Trust Act of 1993. This includes payments made through the AmeriCorps program;
   3. Payments issued under Title I of the Domestic Volunteer Act of 1973, such as VISTA, AmeriCorps VISTA, University Year for Action, and Urban Crime Prevention Program; and
   4. All payments issued under Title II of the Domestic Volunteer Act of 1973. These include:
      1. Retired Senior Volunteer Program (RSVP);
      2. Foster Grandparents Program; and
      3. Senior Companion Program.
2. The agency counts training allowances from vocational and rehabilitative programs as earned income when:
   1. The program is recognized by federal, state, or local governments; and
   2. The allowance is not a reimbursement.
3. The agency excludes support service payments received by or made on behalf of WorkFirst recipients.

WAC 182-512-0770 SSI-related medical -- American Indian or Alaska Native excluded income and resources.

Effective April 16, 2015.

1. The agency excludes the following types of income from being considered when determining eligibility for Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for American Indians or Alaska Natives:
   1. Distributions from Alaska Native corporations and settlement trusts;
   2. Distributions from any property held in trust, subject to federal restrictions, located within the most recent boundaries of a prior federal reservation, or otherwise under the supervision of the Secretary of the Interior;
   3. Distributions and payments from rents, leases, rights of way, royalties, usage rights, or natural resource extraction and harvest from:
      1. Rights of ownership or possession in any lands described in (b) of this subsection; or
      2. Federally protected rights regarding off-reservation hunting, fishing, gathering, or usage of natural resources.
   4. Distributions resulting from real property ownership interests related to natural resources and improvements that are:
      1. Located on or near a reservation or within the most recent boundaries of a prior federal reservation; or
      2. Resulting from the exercise of federally protected rights related to such real property ownership interests.
   5. Payments resulting from:
      1. Ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance; or
      2. Rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.
   6. Student financial assistance provided under the Bureau of Indian Affairs education programs; and
   7. Any other applicable income exclusion as provided by federal law, regulation, or rule.
2. The agency excludes the following types of resources from being considered when determining eligibility for WAH-CN and WAH-MN SSI-related programs for American Indians or Alaska Natives:
   1. Property, including real property and improvements, that is:
      1. Held in trust, subject to federal restrictions, or otherwise under the supervision of the Secretary of the Interior; and
      2. Located on a reservation, including any federally recognized Indian tribe's reservation, pueblo, or colony, including:
         1. Former reservations in Oklahoma;
         2. Alaska Native regions established by the Alaska Native Claims Settlement Act; and
         3. Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior.
   2. Property located within the most recent boundaries of a prior federal reservation for any federally recognized tribe not described in (a) of this subsection;
   3. Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including, but not limited to, extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish and shellfish) resulting from the exercise of federally protected rights; and
   4. Ownership interests in or usage rights to items not covered in (a), (b), or (c) of this subsection that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.
3. When determining eligibility for WAH-CN and WAH-MN SSI-related programs for American Indians or Alaska Natives, the agency counts or excludes amounts received by tribal members from exercise of gaming revenues (per capita distributions) that are retained after the month of receipt based on the type of resource in which the money is retained.  If the amounts are retained in a countable resource (for example, cash, checking account, or savings account), the agency treats the amounts as a countable resource.  If the amounts are converted to an excluded resource (for example, personal property like a refrigerator), the agency treats the amounts as excluded resources.

WAC 182-512-0760 SSI-related medical -- Education assistance.

Effective April 14, 2014.

1. The agency does not count:
   1. Educational assistance in the form of grants, loans or work study, issued from Title IV of the Higher Education Amendments (Title IV – HEA) and Bureau of Indian Affairs (BIA) education assistance programs. Examples of Title IV – HEA and BIA educational assistance include, but are not limited to:
      1. College work study (federal and state);
      2. Pell grants; and
      3. BIA higher education grants.
   2. Educational assistance in the form of grants, loans or work study made available under any program administered by the department of education (DOE) to an undergraduate student. Examples of programs administered by DOE include, but are not limited to:
      1. Christa McAuliffe Fellowship Program;
      2. Jacob K. Javits Fellowship Program; and
      3. Library Career Training Program.
2. For assistance in the form of grants, loans or work study under the Carl D. Perkins Vocational and Applied Technology Education Act, P.L. 101-391:
   1. If the person attends school half-time or more, the agency subtracts the following expenses:
      1. Tuition;
      2. Fees;
      3. Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study;
      4. Books;
      5. Supplies;
      6. Transportation;
      7. Dependent care; and
      8. Miscellaneous personal expenses.
   2. If the person attends school less than half-time, the agency subtracts the following expenses:
      1. Tuition;
      2. Fees; and
      3. Costs for purchase or rental of equipment, materials, or supplies required of all students in the same course of study.
3. WorkFirst work-study income is not counted.
4. Income received from work study program that is not excluded under subsection (1) of this section is counted as earned income and is subject to earned income disregards as described in WAC 182-512-0840(2).
5. If the person receives Veteran's Administration Educational Assistance:
   1. All applicable attendance costs are subtracted; and
   2. The remaining income is budgeted as unearned income.

WAC 182-512-0750 SSI-related medical -- Countable unearned income.

Effective April 14, 2014.

The agency counts unearned income for Washington apple health (WAH) SSI-related medical programs as follows:

1. The total amount of income benefits to which a person is entitled is treated as available unearned income even when the benefits are:
   1. Reduced through the withholding of a portion of the benefit amount to repay a legal obligation;
   2. Garnished to repay a debt, other legal obligation, or make any other payment such as payment of medicare premiums.
2. Payments received on a loan:
   1. Interest paid on the loan amount is considered unearned income; and
   2. Payments on the loan principal are not considered income. However, any amounts retained on the first of the following month are considered a resource.
3. 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.
4. 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:
   1. Advertising for tenants;
   2. Property taxes;
   3. Property insurance;
   4. Repairs and maintenance on the property; and
   5. Interest and escrow portions of a mortgage.

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

WAC 182-512-0700 SSI-related medical -- Income eligibility.

Effective July 7, 2019.

1. In order to be eligible, a person is required to do everything necessary to obtain any income to which he or she is entitled including (but not limited to):
   1. Annuities;
   2. Pensions;
   3. Unemployment compensation;
   4. Retirement; and
   5. Disability benefits; even if their receipt makes the person ineligible for agency services, unless the person can provide evidence showing good reason for not obtaining the benefits.
2. The agency does not count this income until the person begins to receive it. Income is budgeted prospectively for all Washington apple health (WAH) health care programs.
3. Anticipated nonrecurring lump sum payments other than retroactive SSI/SSDI payments are considered income in the month received, subject to reporting requirements in WAC 182-504-0110. Any unspent portion is considered a resource the first of the following month.
4. The agency follows income and resource methodologies of the supplemental security income (SSI) program defined in federal law when determining eligibility for WAH SSI-related medical or medicare savings programs unless the agency adopts rules that are less restrictive than those of the SSI program.
5. Exceptions to the SSI income methodology:
   1. Lump sum payments from a retroactive old age, survivors, and disability insurance (OASDI) benefit, when reduced by the amount of SSI received during the period covered by the payment, are not counted as income;
   2. Unspent retroactive lump sum money from SSI or OASDI is excluded as a resource for nine months following receipt of the lump sum; and
   3. Both the principal and interest portions of payments from a sales contract, that meet the definition in WAC 182-512-0350(10), are unearned income.
6. To be eligible for WAH categorically needy (CN) SSI-related health care coverage, a person's countable income cannot exceed the WAH CN program standard described in:
   1. WAC 182-512-0010 for noninstitutional WAH coverage unless living in an alternate living facility; or
   2. WAC 182-513-1205 for noninstitutional WAH CN coverage while living in an alternate living facility; or
   3. WAC 182-513-1315 for institutional and waiver services coverage.
7. To be eligible for SSI-related health care coverage provided under the WAH medically needy (MN) program, a person must:
   1. Have countable income at or below the effective WAH MN program standard as described in WAC 182-519-0050;
   2. Satisfy spenddown requirements described in WAC 182-519-0110;
   3. Meet the requirements for noninstitutional WAH MN coverage while living in an alternate living facility (ALF). See WAC 182-513-1205; or
   4. Meet eligibility for institutional WAH MN coverage described in WAC 182-513-1315.

WAC 182-512-0650 SSI-related medical -- Available income.

Effective September 30th, 2024.

1. Income is considered available to a person at the earliest of when it is:
   1. Received; or
   2. Credited to a person's account; or
   3. Set aside for the person's use; or
   4. Used or can be used to meet the person's needs for shelter.
2. Anticipated nonrecurring lump sum payments are treated as income in the month received, with the exception of those listed in WAC 182-512-0700(5), and any remainder is considered a resource in the following month.
3. Reoccurring 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.
4. In-kind income received from anyone other than a legally responsible relative is considered available income only if it is earned income.