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Income overview 1: income eligibility
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 182-512-0600 SSI-related medical -- Definition of income.
Effective June 10, 2019.
- Income is anything a client receives in cash or in-kind that can be used to meet his/her needs for food or shelter. Income can be earned or unearned.
- Some receipts are not income because they do not meet the definition of income above. Some types of receipts that are not income are:
- 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 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;
- Replacement of income already received (see 20 C.F.R. 416.1103 for a more complete list of receipts that are not income); and
- Receipts from extraction of exempt resources for a member of a federally recognized tribe.
- 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 182-512-0840 describes earnings exclusions);
- 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 a client in connection with any publication of their work and any honoraria received for services rendered; and
- In-kind payments made in lieu of cash wages, including the value of food 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;
- Voluntary or court-ordered child support payments, including arrears, received from a noncustodial parent for the benefit of a child are the income of the child;
- Dividends and interest;
- Royalties (except for royalties earned by a client in connection with any publication of their work and any honoraria received for services rendered which would be earned income);
- Capital gains;
- 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;
- Prizes and awards; and
- Amounts received by tribal members from gaming revenues with the exceptions cited in WAC 182-512-0770(3).
- Some items which may be withheld from income, but which the agency 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;
- Child support payments, court ordered or voluntary (WAC 182-512-0900 has an exception for deemors);
- Service fees charged on interest-bearing checking accounts;
- Inheritance taxes; and
- 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 client:
- If it cannot be excluded; and
- After deducting all allowable disregards and deductions.
Items an individual may receive that are not considered income include:
- Weatherization assistance;
- Proceeds from a loan the individual takes out; or
- Bills paid directly to the vendor by another party.
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).
- When recurring income is received in advance or electronically deposited in the individual’s account, the income is considered available for the month it would normally be received.
Example: A Social Security check normally received in February is electronically deposited on January 31st because February 1st is a Saturday, the income is still counted for February.
- Unanticipated nonrecurring lump sums cannot be counted as income in the month received because income must be budgeted prospectively. However, any amount remaining after the month of receipt is 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 182-512-0700 SSI-related medical -- Income eligibility.
Effective July 7, 2019.
- 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):
- Unemployment compensation;
- Retirement; and
- 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.
- 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.
- 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.
- 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.
- Exceptions to the SSI income methodology:
- 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;
- Unspent retroactive lump sum money from SSI or OASDI 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 182-512-0350(10), are unearned income.
- 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:
- To be eligible for SSI-related health care coverage provided under the WAH medically needy (MN) program, a person must:
- Have countable income at or below the effective WAH MN program standard as described in WAC 182-519-0050;
- Satisfy spenddown requirements described in WAC 182-519-0110;
- Meet the requirements for noninstitutional WAH MN coverage while living in an alternate living facility (ALF). See WAC 182-513-1205; or
- Meet eligibility for institutional WAH MN coverage described in WAC 182-513-1315.
Example: An individual reports on April 10th that she will receive a lawsuit settlement that specifies a payment of $5,000 on July 1st. The Agency or it's designee would anticipate the $5,000 payment as income in July. If the individual has $100 of that payment left on August 1st, that $100 is counted as a resource effective August 1st.
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:
- The total amount of income benefits to which a person is entitled is treated as available unearned income even when the benefits are:
- Reduced through the withholding of a portion of the benefit amount to repay a legal obligation;
- 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.
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.