Long-term services and supports (LTSS) manual

Available income

Revised Date: 
October 22, 2013

Purpose: This section describes determining available income for an SSI-related single client for long-term care and determining available income for legally married couples for long-term care services.

WAC 182-513-1325 Determining available income for an SSI-related single client for long-term care (LTC) services.

Effective February 20, 2017

This section describes income the agency or its designee determines available when evaluating an SSI-related single client's eligibility for long-term care (LTC) services.

  1. See WAC 182-513-1330 for rules related to available income for legally married couples.
  2. The agency or its designee applies the following rules when determining income eligibility for SSI-related LTC services:
    1. WAC 182-512-0600 SSI-related medical—Definition of income;
    2. WAC 182-512-0650 SSI-related medical—Available income;
    3. WAC 182-512-0700 SSI-related medical—Income eligibility;
    4. WAC 182-512-0750 SSI-related medical—Countable unearned income;
    5. WAC 182-512-0840 (3) self-employment income-allowable expenses
    6. WAC 182-512-0785, 182-512-0790, and 182-512-0795 for sponsored immigrants and how to determine if sponsors' income counts in determining benefits.
  3. In initial categorically needy income eligibility for LTC, the agency does not allow any deductions listed in 1612(b) of the Social Security Act, for example:
    1. Twenty dollars per month income exclusion under WAC 182-512-0800;
    2. The first $65 and the remaining one-half earned income work incentive under WAC 182-512-0840; and
    3. Impairment related work expense or blind work expense under WAC 182-512-0840.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1330 Determining available income for legally married couples for long-term care (LTC) services.

Effective August 26, 2018

This section describes income the agency or its designee determines available when evaluating a legally married person's eligibility for long-term care (LTC) services.

  1. The agency or the agency's designee applies the following rules when determining income eligibility for LTC services:
    1. WAC 182-512-0600 SSI-related medical—Definition of income;
    2. WAC 182-512-0650 SSI-related medical—Available income;
    3. WAC 182-512-0700 SSI-related medical—Income eligibility;
    4. WAC 182-512-0750 SSI-related medical—Countable unearned income;
    5. WAC 182-512-0840(3), self-employment income-allowance expenses;
    6. WAC 182-512-0960 SSI-related medical —Allocating income—Determining eligibility for a spouse when the other spouse receives long-term services and supports (LTSS);
    7. WAC 182-512-0785, 182-512-0790, and 182-512-0795 for sponsored immigrants and how to determine if the sponsors' income counts in determining benefits.
  2. In initial categorically needy income eligibility for LTC, the agency does not allow any deductions listed in 1612(b) of the Social Security Act, for example:
    1. Twenty dollars per month income exclusion under WAC 182-512-0800;
    2. The first $65 and the remaining one-half earned income work incentive under WAC 182-512-0840; and
    3. Impairment related work expense or blind work expense under WAC 182-512-0840.
  3. The following income is available to an institutionalized spouse, unless subsections (5) and (6) apply:
    1. Income received in the institutionalized spouse's name;
    2. Income paid to a representative on the institutionalized spouse's behalf; and
    3. One-half of the income received in the names of both spouses.
  4. The following income is unavailable to an institutionalized spouse:
    1. Separate income received in the name of the community spouse; and
    2. Income established as unavailable through a court order.
  5. For the determination of eligibility only, if available income under subsection (3)(a) through (c) of this section, minus income exclusions under WAC 182-513-1340, exceeds the special income level (SIL), defined under WAC 182-513-1100, the agency or its designee:
    1. Follows Washington state community property law when determining ownership of income;
    2. Presumes all income received after the marriage by either spouse to be community income;
    3. Considers one-half of all community income available to the institutionalized spouse.
  6. If the total of subsection (5)(c) of this section plus the institutionalized spouse's separate income is over the SIL, determine available income using subsection (3) of this section.
  7. A stream of income, not generated by a transferred resource, is available to the institutionalized spouse, even if the institutionalized spouse transfers or assigns the rights to the stream of income to one of the following:
    1. The community spouse; or
    2. A trust for the benefit of the community spouse.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

  1. Available income:
    1. When one member of a married couple applies for LTC services, the department applies the "name on the check" rule (see below) to determine the individual’s available income. If the individual is not income eligible for services under the CN program, the department applies the "community income" rule (see below). If the application of both rules results in income above the CN standard, the department determines the individual’s eligibility for institutional or hospice services under the MN program.
    2. When both spouses are applying at the same time, or when one has already been determined eligible for LTC services, the department establishes eligibility for them as it does for single individuals as described in WAC 182-513-1315 (14) with the following exceptions:
      1. If the two are living together in a NF or alternate care facility, their eligibility can be determined together as a couple, if doing so would be to their advantage.
      2. If one spouse is applying for CN LTC services, the department does not use the community income rule to establish an income amount for each individual as a single person, when doing so would be to their disadvantage. The department uses the "name on the check" rule for each spouse, when doing so allows an otherwise eligible client to be approved for CN services.
      3. The total amount of income benefits which a person is entitled is treated as available unearned income even when benefits are;
        1. Reduced through the withholding of a portion of the benefit amount to repay a legal obligation; or
        2. Garnished to repay a debt, other legal obligation, or make any other payment such as payment of Medicare premiums. See WAC 182-512-0750

    Example A spouse receiving COPES in the home retains income of up to 100% of the FPL before available income is assigned to the other spouse. The higher expenses of living in the community are included in the amount defined by the waivered program as a maintenance needs amount. The department does not reduce that amount when assigning community income between the spouses to determine eligibility or participation in the cost of care.

    Example A spouse who resides in a medical facility is not eligible for COPES when the department applies the "community income" rule to establish an income amount for each spouse. Due to income of the other spouse who is approved for LTC services in a medical facility, one-half of the community income amount exceeds the SIL. In such a case, the department applies the "name on the check" rule, when doing so allows the spouse who is otherwise eligible for COPES to return to a community setting, if the individual wishes to do so.

  2. Income methodologies:
    1. "Name on the check" rule:
      1. This rule presumes that income received in the spouse’s name is his/her separate income
      2. Income paid to one spouse on his/her behalf is presumed to be that spouse’s income
      3. One-half of income paid to both spouses is assigned to each spouse
      4. With no documentation of ownership, one-half of all income is assigned to each spouse
      5. Income received in the name of either or both spouses and another person(s) is assigned according to their proportionate share
    2. "Community income" rule:
      1. This rule presumes that income received in the name of either or both spouses is the income of both, unless it meets the definition of separate income
      2. Consider income, including but not limited to wages or pensions and retirement funds the spouse earned the right to receive during the marriage as community income
    3. Separate income:
      1. SSI payments or income legally established as separate income
      2. Income from a source that required the spouse to earn the right to receive it, including but not limited to, retirement funds the spouse earned the right to receive before the marriage
      3. Income from separate property acquired before the marriage or during the marriage, if purchased with separate income and kept separately
      4. Income that has been commingled is not separate income, unless it can be traced to its separate source
    4. SSI ineligible spouse who is eligible for institutional Medicaid
      1. An ineligible spouse of an SSI recipient is eligible for CN medical benefits if eligible for CN institutional Medicaid.

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Worker Responsibilities

  1. See Available Income in Clarifying Information to establish what income must be counted in the eligibility determination.
  2. See Income Methodologies in Clarifying Information to determine separate and community income.
  3. For an institutionalized individual with a community spouse, first determine eligibility for CN LTC services by using the "name on the check" rule. If the individual is not eligible, then use the "community income" rule.
  4. When both spouses are institutionalized, assign one-half of the community income to each spouse unless doing so results in ineligibility for one spouse who would otherwise meet all CN program requirements as a single individual.