Income special disregards

Revised Date: 
January 15, 2015

WAC 182-512-0880 SSI-related medical -- Special income disregards.

WAC 182-512-0880 SSI-related medical -- Special income disregards.

Effective April 14, 2014.

Portions of a person's income the agency otherwise counts are disregarded when determining eligibility for Washington apple health (WAH) SSI-related medical programs.

  1. The agency disregards cost of living adjustments (COLAs) to Social Security benefits and provides categorically needy (CN) SSI-related medicaid benefits under the Pickle Amendment criteria of 42 C.F.R. 435.135(1)(a) to a person who:
    1. Is currently receiving Title II Social Security benefits;
    2. Was eligible for and received SSI or State Supplement payments (SSP) but became ineligible for those payments after April, 1977; and
    3. Would still be eligible for SSI or SSP payments if the amount of Social Security COLA increases paid under section 215(i) of the Social Security Act were deducted from his or her current Title II Social Security benefits.
    4. To satisfy this provision, a person must have been eligible for and received SSI or SSP payments and in the same month was entitled to, but did not necessarily receive, a Title II Social Security benefit for at least one month since April 1977. This includes a person who receives a Title II Social Security benefit payment the month after the last SSI or SSP payment is made due to the fact that Social Security is paid the month after entitlement begins.
    5. For purposes of this section, the agency also disregards COLAs received by a person, his or her financially responsible spouse, and other financially responsible family members, such as a parent.
  2. In determining SSI-related CN-WAH coverage, the agency disregards:
    1. Widow(er)'s benefits for a person who:
      1. Was entitled to SSA title II (widow/widower's) benefits in December 1983;
      2. Was at least fifty years old, but not yet sixty at that time;
      3. Received title II benefits and SSI in January 1984;
      4. Would continue to be eligible for SSI/SSP payments if the title II benefits were disregarded; and
      5. Filed an application for medicaid with the state by July 1, 1988.
    2. Widow, Widower or Surviving Divorced Spouse (title II) benefits for a person who:
      1. Received SSI/SSP benefits the month prior to receipt of title II benefits;
      2. Would continue to be eligible for SSI/SSP benefits if the title II benefits or the COLA(s) to those benefits were disregarded; and
      3. Is not eligible for medicare Part A. This person is considered an SSI recipient until becoming entitled to medicare Part A.
  3. A disabled adult child (DAC) who is ineligible for SSI/SSP solely due to receipt of either Social Security benefits as a disabled adult child of a person with a Social Security account or due to receipt of a COLA to the DAC benefits, may be income eligible for WAH categorically needy (CN) health care coverage if disregarding the SSA DAC benefits and COLA brings countable income below the CN standards, and the person:
    1. Is eighteen years of age or older;
    2. Remains related to the SSI program through disability or blindness;
    3. Lost SSI eligibility on or after July 1, 1988, due solely to the receipt of DAC benefits from SSA or a COLA to those benefits; and
    4. Meets the other WAH SSI-related CN medical requirements.
  4. A person is eligible for WAH CN coverage if:
    1. In August 1972, the person received:
      1. Old age assistance (OAA);
      2. Aid to blind (AB);
      3. Aid to families with dependent children (AFDC); or
      4. Aid to the permanently and totally disabled (APTD).
    2. The person was entitled to or received retirement, survivors, and disability insurance (RSDI) benefits; or
    3. The person was ineligible for OAA, AB, AFDC, SSI, or APTD solely because of the twenty percent increase in Social Security benefits under P.L. 92-336.
  5. Persons who stop receiving an SSI cash payment due to earnings, but still meet all of the other SSI eligibility rules and have income below the higher limit established by the Social Security Act's Section 1619(b) are eligible for continued WAH CN medicaid.
  6. TANF income methodology is used to determine countable income for children and pregnant women applying for WAH medically needy (MN) coverage unless the SSI methodology would be more beneficial to the person. When using the TANF income methodologies, deduct:
    1. A fifty percent earned income disregard described in WAC 388-450-0170;
    2. Actual child care and dependent care expenses related to employment; and
    3. Child support actually paid.

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

SSI-Related Special Income Disregards

When SSI cash assistance closes because the individual begins to receive Title II Social Security Income, ACES does several automated checks to determine if the individual would continue to qualify for CN Apple Health due to one or more of the special income disregards below:

  • Use the Application/Benefit field on the bottom of the UNER screen is used to identify the reason and date an individual was terminated from SSI.
    Note: ACES automatically populates the "Ever Received SSI?" field with a "Y" (Yes) and adds the SSI closure date when an SDX record is received showing the individual is no longer in pay status for SSI. Do not change this designation.
  • SSI closure codes are available to help identify individuals who are eligible for an SSI-related special income disregard. These codes are:
    • H - Receipt of DAC Benefits, or a COLA to DAC benefits
    • I - Receipt of Widows Benefits (Group 1)
    • J - Receipt of or COLA to Widow/Widowers/Surviving Spouse Benefits (Group 2)
    • K - SSI terminated for any other reason and the individual received Title II benefits at the time of termination or by the time ACES rechecks for Title II benefits 60 days after termination. (Pickle disregard)
    • T - SSI terminated for any other reason and the individual did NOT receive Title II benefits at the time of termination or within 60 days of the termination.
    • U - Unable to determine the reason for the SSI termination. This is a system generated code and must be updated to the correct value at the next review or application.
    • C - Old code prior to October 2009.
  • When ACES identifies that SSI closed because of a cost of living increase (COLA), Disabled Adult Child (DAC) benefit, or widow(er) income, it updates the reason code to the bottom of the UNER screen.
  • If ACES is unable to determine the reason for the SSI closure, you need to manually update the closure codes with the correct information while completing the eligibility review required for the redetermination process. See Worker Responsibilities.

Cost of Living Adjustment (COLA) and the Pickle Disregard

The Pickle disregard applies to individuals who lose SSI eligibility due to their beginning to receive Title II Social Security benefits or a Cost of Living Adjustment (COLA) to the Title II benefits. An individual must have been entitled to both SSI and the Title II benefits within the same month for the Pickle disregard to apply. This does not mean that the individual must have received an SSI check and a Title II check in the same month. An individual who loses SSI in one month and receives Title II income in the following month meets the criteria for the Pickle disregard. Individuals who become ineligible for SSI/SSP because of a COLA may be eligible for CN Apple Health through the disregard of COLA. The COLA disregard is allowed only for CN Apple Health. The disregard does not apply to other Apple Health programs.

Disabled Adult Child (DAC) Disregard

The DAC disregard applies to individuals who lose eligibility for SSI because they begin to receive DAC benefits or a COLA to DAC benefits. The DAC disregard is allowed only for CN Apple Health. To receive DAC income, an individual must have been found disabled prior to their twenty-second birthday. Requirements to receive the DAC disregard include:

  • Individual is 18 years of age or older.
  • Individual meets the aged, blind or disabled criteria.
  • Individual has an SSI closure date that is 7/1/88 or later.
  • Net countable income after applying the disregard is below the categorically needy income level (CNIL).
  • Individual meets all other SSI-related CN eligibility requirements.

Widow(er) Group 1 Disregard - Additional Reduction Factor

The widow(er) Group 1 disregard applies to a small group of individuals who meet specific age criteria. When Social Security changed how it calculates Title II benefits for widow(er)s in 1983, SSI ended for some in this group because of an increase in their Title II benefit. These individuals were grandfathered into continued CN eligibility.

Widow(er) Group 2 Disregard - Early Medicare

The widow(er) Group 2 disregard applies to individuals who lose SSI eligibility because of their having to apply for Title II widow(er) benefits or a COLA to those benefits. The disregard protects CN eligibility for these individuals until they are entitled to receive Medicare. Individuals who meet these criteria automatically meet the criteria for the Pickle disregard if they have income from another Title II source.

Worker Responsibilities

Special Income Disregards

Note: If the bottom of the UNER screen does not show any SSI closure information, review the SDX or SOLQ for SSI information. If an individual received SSI in another state and it ended before the individual moved to Washington, SDX records are not available. If the SSI information is questionable or not available, ask the individual for verification.

  • Use the following codes to identify which special income disregard applies:
    • H - Receipt of DAC Benefits, or a COLA to DAC benefits
    • I - Receipt of Widows Benefits (Group 1)
    • J - Receipt of or COLA to Widow/Widowers/Surviving Spouse Benefits (Group 2)
    • K - SSI terminated for any other reason and the individual received Title II benefits at the time of termination or by the time ACES rechecks for Title II benefits 60 days after termination. (Pickle disregard)
    • T - SSI terminated for any other reason and individual did NOT receive Title II benefits at the time of termination or within 60 days of the termination.
    • U - Unable to determine the reason for the SSI termination. This is a system generated code and must be updated to the correct value at the next review or application.
    • C - Old code prior to October 2009.

Cost of Living Adjustment (COLA) and the Pickle Disregard

When ACES receives an SDX record showing SSI income has terminated, there may or may not already be Title II income in the record. The BENDEX interface, which updates the Title II Social Security income, may be received after the original SDX record.

  • If there is Title II income type "SD" or "SS" already coded in ACES, then ACES automatically updates the SSI closure information in the Application/Benefit field on the UNER screen and enters the "K" Pickle indicator code.
  • If there is no Title II income in the record, ACES updates the status code to a "U" Unknown and waits for the BENDEX record to come in. ACES will check the record again in 60 days to see if Title II income was added to the case record.
  • At the time of the 60 day check, if no Title II income was added, or if the existing income has been removed, ACES automatically changes the Application/Benefit Status field to a "T" Terminated and applies no disregards.
  • If another source of Title II income is added to the case prior to the 60 day check, then ACES changes the "U" or "K" code to "H" if the income type that was added is "SC" or to a "J" if the income type that was added is "SW" or "SB".
  1. When the individual provides the eligibility review sent at the time of SSI closure, screen in an S02 medical AU and process, allowing the S01 AU to close. Review the coding on the bottom of the UNER screen to determine if the correct disregards are being applied.

    If the individual is eligible only for the Pickle disregard, then just the COLAs received since SSI was terminated will be excluded in the CN income calculation. You can determine if the disregard was applied by reviewing the MAFI screen. If the Pickle disregard is allowed, ACES indicates this by displaying a "P" in the Disregard Applied field.

    For ACES to apply the Pickle disregard, the following criteria must be met:

    • The individual must receive Title II income either in the same month as they received SSI or in the month immediately after they stopped receiving SSI. In ACES, this means there must be unearned income type SD, SS, SC, SW or SB in an amount greater than zero.
    • The SSI closure date is after 04/30/1977.
    • Individual meets the aged, blind, or disabled criteria.
    • The Application/Benefit status field on the UNER is coded with an "H", "I", "J", or "K".
    • Net countable income after applying the disregard is below the SSI Categorically Needy Income Level.
    • The individual meets all other SSI-related CN medical requirements.

    Note: Individuals may not be CN eligible under Pickle criteria at the time of the SSI closure, but may become eligible for the disregard in subsequent years depending on income. Always review MN spenddown cases for the correct coding before establishing a spenddown liability.

  2. If the disregard makes the individual eligible for CN and the individual:
    • Is receiving CN, continue the certification. Make a note to allow the disregard at the next review.
    • Is receiving MN, change the balance of the certification period to CN. Do not recompute spenddown for the period before the change.
    • Is pending spenddown (in "M" status), recalculate eligibility for the period after the change using the disregard. The period before the change remains the same.
  3. If coded correctly, ACES calculates whether the individual is given the Pickle Disregard and is eligible for CN Apple Health. To calculate it manually, follow these steps:
    • Determine the individual's total income.
    • Determine the month and year the SSI benefits stopped. Use this date to select the Pickle multiplier found in ACES in the parameters.
    • To get to the parameters, go to ACES mainframe.
      • From WMEN screen choose option "F" (parameters).
      • Then choose option "A" (eligibility parameters).
      • From that screen, choose option "O" (CA-MA Tables 3 Inquiry).
      • Then choose the most recent benefit year you are interested in. Current eligibility uses the most recent multiplier.
    • Multiply the current SSA benefit by the multiplier you selected to determine the COLA disregarded amount. Round to the nearest dollar.
    • Subtract the COLA disregard and other income exemptions and disregards from the individual's total income.
    • Add any income allocated from a spouse or parents.
    • Compare the result to the SSI CNIL.
      • If income is below the CNIL, authorize CN.
      • Do not allow the COLA disregard for programs other than CN.

    Example: Laura received SSA and SSI beginning in 1988, but was terminated from SSI after the most recent COLA. In redetermining her eligibility for health care coverage, the worker notes that her income is above the CNIL after the $20 disregard, but she is eligible for the Pickle (COLA) disregards. After checking the ACES parameters table, using the multiplier for the current year (which effectively disregards the yearly COLAs Laura received), her income is below the CNIL and she is eligible for a CN Apple Health (S02) instead of MN with spenddown (S99).

Disabled Adult Child (DAC)

When ACES receives an SDX record where the Medical Eligibility code is "D" and there is Title II income type "SC", ACES automatically updates the SSI closure information on the UNER screen and enters the "H" code. When the individual returns the eligibility review sent at the time of the SSI closure, screen in an S02 medical AU and process, allowing the S01 AU to close.

  1. Review the coding on the bottom of the UNER screen to determine if the correct disregards are being applied. If the individual is eligible for the disregard, the entire amount of the DAC income is excluded in the CN income calculation. You can determine if the disregard was applied by reviewing the MAFI screen. If DAC income was disregarded, ACES will indicate this by displaying a "D" in the Disregard Applied field. If both the DAC and the Pickle disregards are applied, ACES indicates this by displaying an "E" in that field.

    For ACES to apply the DAC disregard, the following criteria must be met:

    • Individual has unearned income type "SC" in an amount greater than zero.
    • Individual is 18 years of age or older.
    • Individual meets the aged, blind, or disabled criteria.
    • Individual has an SSI closure date that is equal to or later than 7/1/88.
    • The Application/Benefit status field on the UNER screen is coded with an "H".
    • Net countable income after applying the disregard is below the SSI categorically needy income level.
    • Individual meets all other SSI-related CN medical requirements.
  2. To verify receipt of DAC benefits, use either:
    • An SDX record that shows this Medicaid Eligibility code and message: D - DISABLED ADULT CHILD: CONT SSI MED; or
    • An SSA inquiry, BDX record or award letter that shows the individual has a BIC code (the 2-letter/number suffix to the Social Security claim number) beginning with a C.

    Note: An individual receiving DAC benefits, who marries anyone other than another DAC or Title II beneficiary will lose their DAC designation and benefits.

  3. To determine manually if the individual receiving DAC benefits would be CN income eligible but for receiving DAC benefits or a COLA to those benefits:
    • Determine the individual's total income;
    • Subtract any appropriate deductions, such as exclusions under federal statute;
    • Determine and subtract the COLA increase on SSA income other than DAC;
    • Subtract the total DAC amount;
    • Compare the results to the CNIL.
      • If income is below the CNIL, authorize CN Apple Health. Continue the DAC disregard as long as the individual is CN eligible with the disregard and continues to meet all other program requirements.
      • If income is above the CNIL, the individual is NOT eligible for the DAC disregard. Determine eligibility for other Apple Health coverage.
  4. Review eligibility for the DAC income disregard:
    • At application and renewal for Apple Health coverage;
    • When you receive an SDX record that shows the Medicaid Eligibility code and message: D - DISABLED ADULT CHILD: CONT SSI MED;
    • At each MN certification

Widow/Widower's Benefit (DWB)

Group 1

If the individual is eligible for the disregard, the entire amount of the widow(er) income is excluded in the CN income calculation. You can determine whether the disregard was applied by reviewing the MAFI screen. If widow(er)s income was disregarded, ACES will indicate this by displaying a "W" in the Disregard Applied field. If both the widow(er) Group 1 and the Pickle disregard are applied, ACES displays an "X" on the MAFI screen.

Note: SSA no longer sends information about these individuals on the SDX records, so automatic updates do not happen for this group. SSA sends a letter to these individuals, which tells them to contact the CSO when their SSI terminates. These individuals receive SSA benefits under the SSN of the deceased spouse, not their own.

For ACES to apply the Widow(er) Group 1 disregard, the following criteria must be met:

  • Individual has unearned income type "SW" in an amount greater than zero.
  • Individual's date of birth is after December 31, 1923 and before January 1, 1934.
  • Individual meets the aged, blind or disabled criteria.
  • Individual has an SSI closure date on the UNER screen that is in January 1984.
  • The Application/Benefit status field on the UNER screen is coded with an "I".
  • Net countable income after applying the disregard is below the categorically needy income level.
  • The individual meets all other SSI-related CN medical requirements.
  1. Use the SSA letter to verify SSA terminated the individual's SSI because the individual began to receive Title II Social Security.
  2. Use an SSA inquiry, SDX screen or the BENDEX screen to verify the benefits as DWB and the amount. Widow/er benefits or Surviving Divorced Spouse benefits are listed as source code SB or SW on the UNER help screen in ACES.
  3. Find the source code SB and SW on the help screen and compare the BIC code for the individual with all possible BICs for these source codes. If the individual's BIC is the same as one of the SB or SW source codes, the individual is eligible for this disregard.
  4. To determine if the individual receiving DWB benefits would be CN income eligible except for the DWB benefits or COLA to these benefits, determine the individual's total countable income;
  • Subtract other income exemptions and disregards from the total income;
  • Subtract the COLA increase on SSA income other than DWB the individual has received from the date SSI ended (using the Pickle multiplier in ACES);
  • Subtract the total DWB amount;
    • If the remaining income is below the CNIL, authorize CN;
    • Continue the DWB disregard as long as the individual is CN eligible with the disregard, and continues to meet the requirements described in this section;
    • If the remaining income is above the CNIL, the individual is not eligible for the DWB disregard. Determine eligibility for other Apple Health coverage. Do not allow the DWB disregard for programs other than CN.

Group 2

When ACES receives an SDX record where the medical eligibility code is "W" and there is Title II income type "SW" or "SB", ACES automatically updates the SSI closure information on the UNER screen and enters the "J" code.

The widow(er) Group 2 disregard applies to individuals who lose SSI eligibility because of their having to apply for Title II widow(er) benefits or a COLA to those benefits. The disregard protects CN eligibility for these individuals until they are entitled to receive Medicare. Individuals who meet these criteria automatically meet the criteria for the Pickle disregard, if they have income from another Title II source.

  • Widow/er benefits and Surviving Divorced Spouse benefits recipients have an SS claim number other than their own SSN and have BIC codes as listed on the ACES help screen in UNER (source codes SW, SB). These individuals' most common BIC codes (the letters at the end of the SS claim number) begin with D, E or W.
  • Ineligibility for SSI due to reasons such as excess resources, other income, etc., does not qualify the individual for this income protection. Widow/er benefit disregards are only for those meeting the requirements in WAC.
  • SSA sends a letter to the individual that tells them to contact the CSO when their SSI terminates.

If the individual returns the eligibility review sent at the time of the SSI closure, screen in an S02 and process and allow the S01 AU to close.

If the individual is eligible for the disregard, the entire amount of the widow(er) income is excluded in the CN income calculation. You will be able to determine if the disregard was applied by reviewing the MAFI screen. If widow(er) income was disregarded, ACES will indicate this by displaying an "S" in the Disregard Applied field. If both widow(er) and the Pickle disregard are applied, ACES displays an "R" on the MAFI screen.

For ACES to apply the Widow(er) Group 2 disregard, the following criteria must be met:

  • Individual has unearned income type "SW" or "SB" in an amount greater than zero.
  • Individual is currently at least 50, but not yet 65.
  • Individual meets the blind or disabled criteria.
  • Individual has an SSI closure date on the UNER screen that is January 1, 1991 or later.
  • Individual is not eligible for Medicare Part A.
  • The Application/Benefit status field on the UNER screen is coded with a "J".
  • Net countable income after applying the disregard is below the categorically needy income level.
  • The individual meets all other SSI-related CN Apple Health requirements.

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