Why can’t HCA provide more clear guidance on accident insurance?

School districts currently offer many types of accident policies, and it is not possible to determine by name alone whether the policies conflict with the SEBB Program’s authority. It appears that accident insurance policies likely conflict with the SEBB Program’s authority, but more information is needed about the exact coverage to make a final determination. 

Examples of accident insurance brought to HCA’s attention have primarily included income replacement, which would conflict with the SEBB Program’s disability insurance benefit authority, or accident coverage that would conflict with the SEBB Program's accidental death and dismemberment benefit authority. Review of accident insurance plan policies is necessary to ensure they don't conflict with the SEBB Program’s authority. This review began on December 1, 2019, and each year thereafter, when SEBB organizations that elect to offer optional benefits submit their reports to HCA describing any optional benefits they are offering to school employees.

 

Can SEBB organizations offer liability insurance?

HCA is aware of RCW 28A.400.370 (mandatory insurance protection for employees) and that some districts provide other work-related liability insurance coverage, such as commercial driver’s insurance for bus drivers. Historically, liability insurance administered by HCA has included at least personal auto and home insurance.

School districts can continue to offer liability insurance (including personal auto and home insurance) until at least September 1, 2020. Over the course of the next year, there could be changes to this guidance as a result of legislative action, SEB Board action, or agency rule-making processes. 

Why can’t a school district offer cancer insurance, critical illness, emergency transportation, and medical indemnity plans when the SEBB Program does not offer these specific insurance types?

The SEB Board has the authority to offer these kinds of insurance products and can consider offering them in the future. However, the portfolio of medical benefits offered by the SEBB Program is comprehensive and includes coverage for conditions such as cancer, critical illness, and emergency transportation. Members can select from an array of plan choices to meet different levels of coverage needs. If school districts offered these types of plans in addition to the SEBB medical plans, it would affect the state’s negotiation position when setting rates and would reduce the ability to secure the best rates possible on behalf of members.

Can a school district allow payroll deductions for nonconflicting optional benefits (long-term care, travel, pet, etc.)?

Yes, school districts may offer payroll deductions for optional benefits as long as the benefits do not conflict with the SEBB Program’s authority. The limitation on payroll deductions applies to benefits that conflict with the SEBB Program’s authority (such as, but not limited to, whole life insurance, short-term disability, limited FSAs, medical indemnity plans, and cancer or other insurance types that overlap with health benefits).

What is considered “offering” a benefit that would conflict with the SEBB Program’s authority?

SEBB organizations cannot endorse or make available any benefits that compete with those authorized as part of the SEBB Program. This includes but is not limited to, inviting a vendor to attend a benefits fair to endorse products that compete with any form of a benefit under the SEBB Program’s authority—even if the vendor’s product would be fully paid by the employee. It also includes providing vendors with employee contact information for marketing purposes or facilitating payroll deductions.

 

What benefits are the School Employees Benefits Board (SEBB) Program authorized to offer?

Under RCW 41.05.740 and 41.05.300 through 41.05.310, the SEBB Program includes authority to offer the following health insurance and other benefits to Washington school district and charter school employees, and union-represented educational service district (ESD) employees:

  • Health care coverage, including all forms of:
    • Medical insurance (including supplemental medical products such as cancer insurance, critical illness insurance, emergency transportation insurance, and indemnity plans)
    • Dental insurance
    • Vision insurance
    • Prescription drug insurance
  • Life insurance (all forms, including but not limited to, whole and term life insurance)
  • Accidental death and dismemberment insurance
  • Liability insurance (all forms, including but not limited to home and auto insurance) *
  • Disability insurance (all forms, including but not limited to short- and long-term disability)
  • Flexible spending arrangement (FSA) (all forms, including but not limited to “general-purpose” and “limited-purpose” FSAs)
  • Dependent Care Assistance Program (DCAP)

All forms of the above insurance benefits are within the exclusive offering authority of the SEBB Program. SEBB organizations cannot offer, endorse, or make available any benefits under the SEBB Program’s authority, even if the SEBB Program does not offer the benefit (or a specific form of the benefit). For example, a SEBB organization cannot offer or endorse short-term disability insurance even though the SEBB Program does not currently offer this benefit

* For transitional relief on liability insurance during the 2019-2020 school year, see Can school districts offer liability insurance?.

Why can’t SEBB organizations offer or endorse certain benefits?

Disallowing competing benefits is in the interest of ensuring HCA has the strongest negotiation position when setting rates with SEBB Program vendors and insurers. These limitations are in place to maintain the purchasing power that comes from consolidating all eligible school employees into one statewide risk pool through the SEBB Program. If an employer helps  school employees access a competing, non-SEBB Program insurance product, it would affect the risk profile of the SEBB Program population, which could affect the premiums or benefit structure of SEBB Program benefits.

Other reasons a SEBB organization cannot offer benefits authorized (but not offered) as part of the SEBB Program include:

  • Policy considerations that maximize the value of all benefits when they are used in combination.
  • Rate development that may have taken into account not offering certain benefit structures.
What is the state law history on SEBB organizations’ authority to offer optional benefits?

When the Legislature created the SEBB Program in 2017, a SEBB organization’s authority to offer any benefits to their employees was removed in its  entirety beginning January 1, 2020. This meant that SEBB organizations had no authority to offer any benefits to their employees once the SEBB Program launched. However, during the 2018 session, the Legislature revised the law to allow school districts (but not educational service districts or charter schools) to offer benefits that do not conflict with the SEB Board’s authority to offer benefits.

Income overview 1: income eligibility

Revised date
Purpose statement

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.

Subtopic: Counting

WAC 182-512-0600 SSI-related medical -- Definition of income.

WAC 182-512-0600 SSI-related medical -- Definition of income.

Effective September 30th, 2024.

  1. Income is anything a client receives in cash or in-kind that can be used to meet the client's needs for shelter. Income can be earned or unearned.
  2. Some receipts are not income because they do not meet the definition of income above. Some types of receipts that are not income are:
    1. Cash or in-kind assistance from federal, state, or local government programs whose purpose is to provide medical care or services;
    2. Some in-kind payments that are not shelter coming from nongovernmental programs whose purposes are to provide medical care or medical services;
    3. Payments for repair or replacement of an exempt resource;
    4. Refunds or rebates for money already paid;
    5. Receipts from sale of a resource;
    6. Replacement of income already received (see 20 C.F.R. 416.1103 for a more complete list of receipts that are not income); and
    7. Receipts from extraction of exempt resources for a member of a federally recognized tribe.
  3. Earned income includes the following types of payments:
    1. Gross wages and salaries, including garnished amounts;
    2. Commissions and bonuses;
    3. Severance pay;
    4. Other special payments received because of employment;
    5. Net earnings from self-employment (WAC 182-512-0840 describes earnings exclusions);
    6. Self-employment income of tribal members unless the income is specifically exempted by treaty;
    7. Payments for services performed in a sheltered workshop or work activities center;
    8. Royalties earned by a client in connection with any publication of their work and any honoraria received for services rendered; and
    9. In-kind payments made in lieu of cash wages, including the value of shelter.
  4. Unearned income is all income that is not earned income. Some types of unearned income are:
    1. Annuities, pensions, and other periodic payments;
    2. Alimony and support payments;
    3. 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;
    4. Dividends and interest;
    5. 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);
    6. Capital gains;
    7. Rents;
    8. 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;
    9. Gifts;
    10. Inheritances;
    11. Prizes and awards; and
    12. Amounts received by tribal members from gaming revenues with the exceptions cited in WAC 182-512-0770(3).
  5. Some items which may be withheld from income, but which the agency considers as received income are:
    1. Federal, state, or local income taxes;
    2. Health or life insurance premiums;
    3. SMI premiums;
    4. Union dues;
    5. Penalty deductions for failure to report changes;
    6. Loan payments;
    7. Garnishments;
    8. Child support payments, court ordered or voluntary (WAC 182-512-0900 has an exception for deemors);
    9. Service fees charged on interest-bearing checking accounts;
    10. Inheritance taxes; and
    11. Guardianship fees if presence of a guardian is not a requirement for receiving the income.
  6. Countable income, for the purposes of this chapter, means all income that is available to the client:
    1. If it cannot be excluded; and
    2. After deducting all allowable disregards and deductions.

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. Rent payments received from roomers or boarders are considered unearned income.
  2. The interest portion of payments on sales or real estate contracts owned by an individual who is resource eligible is counted as unearned income when the combined value of all resources is at or below the resource standard. Count only the portion of the payment that goes toward interest as unearned income.
  3. Puyallup Tribe Settlement Income: Budget interest income from the annuity fund payment or the initial investments as newly acquired income.
  4. Receipt of gaming money by tribal members is considered unearned income in the month received. Gaming money set aside in trust funds by the tribe is not considered available until it may be accessed by the tribal member for whom it is set aside.
    Example: A tribe pays $2,000 per month gaming money to each tribal member. For tribal members under age 18, $1,000 per month is set-aside in a trust fund which can be used by the child on or after their 18th birthday. The $1,000 received each month is considered income in the month received. The $1,000 per month set-aside is not considered until the child reaches 18. The month after the child turns 18, any money remaining from the trust fund is considered an available resource and that month’s $2,000 is considered income.
  5. Home equity conversion plans: a security interest in the home is given in exchange for a lump sum, a periodic cash payment, or a line of credit. The most common home equity conversion plan is a reverse mortgage that allows the homeowner to borrow from the equity in the home with no repayment as long as they live in the home. The funds received under a home equity conversion plan are a loan, and thus do not count as income. However; 
    1. Interest earned on any money received under the home conversion plan is considered unearned income, and
    2. Money retained into the following month is considered a resource as of the first of the month following the month of receipt.

Other Examples: 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 their first home. They 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 already paid.

Example: Debbie sold their 1989 Toyota to use public transportation instead of spending money on car repairs. The money received for selling the car is not income. They exchanged one resource (the car) for another (cash).

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

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.

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.

Example: An individual reports on April 10th they will receive a lawsuit settlement that specifies a payment of $5,000 on July 1st. The Agency or its 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.

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.

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.

For more information:

Income overview 2: income eligibility continued

Income overview 3: exclusions and allocations

Income overview 4: exclusions and allocations continued

Please report broken links or content problems.

Income overview 4: exclusions and allocations continued

Revised date
Purpose statement

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.

Subtopic: Counting

WAC 182-512-0840 SSI-related medical -- Work and agency-related income exclusions.

WAC 182-512-0840 SSI-related medical -- Work and agency-related income exclusions.

Effective April 14, 2014.

The agency excludes the following when determining eligibility for Washington apple health (WAH) SSI-related medical programs:

  1. Work related expenses:
    1. That enable an SSI-related person to work; or
    2. That allows a blind or disabled person to work and that are directly related to the person's impairment.
  2. First sixty-five dollars plus one-half of the remainder of earned income. This is considered a work allowance/incentive. This deduction does not apply to income already excluded.
  3. Any portion of self-employment income normally allowed as an income deduction by the Internal Revenue Service (IRS).
  4. Earned income of a person age twenty-one or younger if that person meets the definition of a student as defined in WAC 182-512-0820.
  5. Veteran's aid and attendance, housebound allowance, unusual/unreimbursed medical expenses (UME) paid by the VA to some disabled veterans, their spouses, widows or parents. For people receiving WAH long-term care services, see chapter 182-513 WAC.
  6. Department of veterans affairs benefits designated for the veteran's dependent as long as the SSI-related applicant is not the dependent receiving the income. If an SSI-related applicant receives a dependent allowance based on the veteran's or veteran's survivor claim, the income is countable as long as it is not paid due to unusual medical expenses (UME).
  7. Payments provided in cash or in-kind, to an ineligible or nonapplying spouse, under any government program that provides social services provided to the person, such as chore services or attendant care.
  8. SSA refunds for medicare buy-in premiums paid by the person when the state also paid the premiums.
  9. Income that causes a person to lose SSI eligibility, due solely to reduction in the SSP.
  10. Tax rebates or special payments excluded under other statutes.
  11. Any public agency refund of taxes paid on real property or on food.

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

Work Incentives

The Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs include a number of employment support provisions commonly referred to as work incentives. Many of these incentives help individuals receiving such benefits maintain their eligibility for health care coverage. For a general description of these work incentives, see the Social Security Red Book.

Veterans Benefits

There are several different types of veteran's benefits issued by the U.S. Department of Veteran's Affairs (VA). The benefit type, who the benefit is for, and what the intention of benefit determines how the Agency treats the income source for SSI-related Apple Health.

The VA publishes its current payment standards in the VA benefits chart which is available from the ADSA website.

Verification of VA income may be obtained by requesting a copy of the VA award letter or by using the information in the PARIS cross match. The VA claim number must be coded in ACES to ensure the crossmatch data is current and accurate.

Listed below are common types of VA income sources. VA income may be needs-based which means other income affects the total VA payment or it may be compensation based on disability or death.

Service-Connected Disability Compensation

Service-connected disability compensation is a benefit paid to a veteran because of a service-related injury or disease. These benefits are countable income for SSI-related Apple Health eligibility. Since these benefits are not needs-based, other income of the veteran or their family is not taken into consideration when determining the amount of the payment. However, the payment may include an amount for the veteran’s dependents (spouse or children). Any portion of the VA payment designated as a dependent’s income must be split out of the total VA compensation amount and coded as that individual’s income. A dependent’s income is not considered the veteran’s income for SSI-related Apple Health purposes.

Example: John receives VA compensation based on 40% disability. John has two children under the age of 18. The total payment John receives is $651.84 per month. The Veterans Compensation Benefits Rate Table shows the VA payment at 40% disability includes:
$620.17 for the veteran (John) + one child; and
$31.67 for each additional child under age 18.
$588.50 is John's countable income and $31.67 is countable income for each child.

Dependency and Indemnity Compensation (DIC)

DIC is a tax-free monetary benefit generally payable to a surviving spouse, child, or parent of service members who died while on active duty, active duty for training, or inactive duty training, or to survivors of veterans who died from their service-connected disabilities. Parents DIC is an income-based benefit for parents who were financially dependent on a service member or veteran who died from a service-related cause. The VA payment was based on a different formula for veterans who died prior to January 1, 1993. After January 1993, the VA switched to a basic rate with add-on amounts for dependent children or aid and attendance expenses.

As with service-connected disability, any amount designated for a dependent child needs to be identified and coded on that dependent’s screen in ACES. Both the widow’s and the child’s income are countable income for SSI-related Apple Health, although any amount designated as aid and attendance is not counted. If there is no surviving spouse, DIC benefits may be paid directly to children through the age of 18 or 21 if a student is still in school. DIC compensation has its own allowances.

Example: Jose is the surviving spouse of a veteran who was killed on active duty in 2009. Jose has one child, age 14. Jose receives a total VA payment of $1538.75:
$1233.23 = basic rate payment. This is Jose's countable VA income.
$305.52 = dependent allowance. This is the child's countable VA income.

Parent’s Dependency and Indemnity Compensation (PDIC)

PDIC is a tax-free income-based monthly benefit for the parent(s) of military Service members who died in the line of duty or veterans whose death resulted from a service-related injury or disease. It is countable income for SSI-related Apple Health. All income received by the household is taken into consideration when determining the amount of the VA payment.

The parent(s) may also be eligible to receive an additional amount to cover aid and attendance (A&A) expenses. Amounts designated for A&A are not countable for SSI-related medical. The VA benefits chart provides a breakdown of the payment amount and any A&A amount. Amounts designated for A&A are not countable for SSI-related Apple Health.

Needs-based Pensions

Disability pensions are benefits paid to wartime veterans with limited income who are no longer able to work. Pensions are available to veterans, surviving spouses, and children if the veteran has qualifying service, there is financial need, and the veteran has a qualifying disability. In addition to the veteran’s pension amount, the VA may increase the payment by a dependent allocation, an aid and attendance or housebound allowance, or monies to reimburse veterans for unusual medical expenses (UME). Any portion of the payment determined to be the pension is countable income to the veteran. Any portion of the payment determined to be the dependent’s income is countable income to that dependent. A&A, housebound allowance and UME are not countable income for the purposes of SSI-related Medicaid.
Currently, the only pension program that the VA accepts applications for is the Improved Pension. However, veterans who applied for a pension prior to 01/01/1979 may be receiving one of the following pension types:

  • Old Law Disability or Death Pension
  • Section 306 Disability or Death Pension; or
  • Improved Pension

Old Law and Section 306 Pensions (approved prior to 1979)

These plans have an income cap. Veterans may have household income up to the cap and still be eligible for the full benefit amount. Veterans continue to be eligible for these pensions as long as they:

  • Remain disabled
  • Don't lose a dependent
  • Don't have assets over the limit set by the VA; or
  • Don't exceed the annual income limit set by the VA

A surviving spouse or child is eligible for this pension as long as they retain surviving spouse or child status.

Improved Pensions

Improved pensions are directly affected by other household income. The VA pays the difference between the household’s annual income from all sources (except SSI) and the VA’s annual income standard. The improved pension amounts listed in Part 1 of the VA benefit chart show the maximum benefit the veteran would be eligible for based on the household having no other income.

Example: Joe receives $600 per month in Social Security Disability Benefits (SSDI) and $385 per month in veteran's pension benefits. In reviewing the VA benefit chart, you see that the maximum VA pension benefit for a veteran with no dependents is $985 (Dec.08 amount). The benefit Joe receives is $985 less the $600 SSDI for a total VA payment amount of $385. Code the $385 as VI income in ACES.

Example: Imagine Joe has a dependent child living at home. Joe would now be entitled to receive a total VA payment of $691. In reviewing the VA benefit chart, you see that the maximum VA pension benefit for a veteran with a single dependent is $1291. Again the VA subtracts the $600 SSDI benefit from the maximum payment. Line 2 on the chart shows you that the dependent's allowance is $306. Code $385 VI income in Joe's UNER screen and $306 VI income on the child's UNER screen.

Note: Subtract the dependent's income in ACES to correctly determine allocations and deeming to dependents for SSI-related purposes. In some situations the VA may pay a dependent allocation for a child that does not live in the home. That income is counted for the veteran if they keep the money and is not counted if they give the income to that dependent.

Aid and Attendance/Housebound Allowances (VT code in ACES)

These are additional benefits paid to veterans, their spouses, surviving spouses, and parents. This allowance is available within all compensation, DIC and pension programs. Aid and Attendance (A&A) is paid based on the need for personal care services from another person or based on a specific disability. The housebound allowance is paid based on certain specific disabilities and is a lesser amount than A&A. Any amount designated as A&A or a housebound allowance is excluded income for SSI-related Apple programs.

Example: Use the same example above of Joe and one dependent child, but Joe has now been approved for A&A. Joe's total income is $1349 VA income plus the $600 SSDI income, for total income of $1949 per month. Of this, $385 is the pension payment (code as VI in ACES), $306 is the child's income (code as VI on the child's screen in ACES) and $658 is A&A (code as VT in ACES), which is exempt income for SSI-related Medicaid. Joe's total countable income is $985 per month.

Unusual Medical Expenses (UME) (VU code in ACES)

Individuals or surviving spouses who receive Improved Pension or Improved Death Pension benefits may be eligible to receive UME which provides a higher VA pension benefit. UME is paid to offset increased medical costs, similar to an income reimbursement. Amounts designated for UME are not countable for SSI-related Apple Health and must be split out from the total VA payment amount.

Example: Joe receives $600 SSDI benefits and a VA Improved Pension benefit of $985 for total monthly income of $1585. Joe doesn't have a dependent in this example and is not getting A&A. We know from the example above that the maximum pension benefit Joe could receive is $385 based on the other income of $600 SSDI, so Joe must be receiving an allowance for unusual medical expenses in the amount of $600. (The VA 'offsets' Joe's SSDI income by the amount Joe is expending on high medical expenses). In ACES $385 is Joe's VA pension (code as VI), $600 is UME (code as VU), and $600 is Joe's SSDI income.

The UME calculator. In some cases, you can tell if an individual is receiving an allowance for UME by checking the PARIS interface data. However, for new applicants there may not be a recent crossmatch available to review and the VA award letter does not give this information. The UME calculator breaks down the amount of benefits that have been restored due to UME for veterans receiving the Improved Pension. You need to know the following information to use the UME calculator:

  • Total VA payment amount,
  • The type of VA pension benefit,
  • Whether the payment includes an amount for A&A, housebound allowance, or a dependent allowance,
  • All other family income amounts.

UME restores benefits in a certain order – A&A/Housebound, then dependent allowance, then the basic pension. The calculator is programmed with this logic and displays the correct amounts and codes to enter into ACES.

Note: The calculator still uses the ACES code VA for the improved pension and not the VI code. Please record this as VI income in ACES).

Example: Maria is a disabled veteran who receives an improved pension and A&A. Maria's total VA income is $1643 per month. Maria also receives $800 in Social Security Disability Benefits (SSDI). Since $1643 is the maximum amount the VA pays for someone with no other income, the VA must be offsetting Maria's SSDI benefits of $800 with unusual medical expenses (UME). If this information is entered into the UME calculator, you can determine that Maria receives $658 in A&A (code as VT in ACES), $800 in UME (code as VU in ACES) and $185 in improved pension benefits (code as VI in ACES). The VA restores the A&A benefit before it restores the improved pension benefit. Total countable income for Maria is $985.

WAC 182-512-0860 SSI-related medical -- Income exclusions under federal statute or other state laws.

WAC 182-512-0860 SSI-related medical -- Income exclusions under federal statute or other state laws.

Effective April 14, 2014.

The Social Security Act and other federal statutes or state laws list income that the agency excludes when determining eligibility for Washington apple health (WAH) SSI-related medical programs. These exclusions include, but are not limited to:

  1. Income tax refunds;
  2. Federal earned income tax credit (EITC) payments for 12 months after the month of receipt;
  3. Compensation provided to volunteers in the Corporation for National and Community Service (CNCS), formerly known as ACTION programs established by the Domestic Volunteer Service Act of 1973. P.L. 93-113;
  4. Assistance to a person (other than wages or salaries) under the Older Americans Act of 1965, as amended by section 102 (h)(1) of Pub. L. 95-478 (92 Stat. 1515, 42 U.S.C. 3020a);
  5. Federal, state and local government payments including assistance provided in cash or in-kind under any government program that provides medical or social services;
  6. Certain cash or in-kind payments a person receives from a governmental or nongovernmental medical or social service agency to pay for medical or social services;
  7. Value of food provided through a federal or nonprofit food program such as WIC, donated food program, school lunch program;
  8. Assistance based on need, including:
    1. Any federal SSI income or state supplement payment (SSP) based on financial need;
    2. Basic Food;
    3. State-funded cash assistance;
    4. CEAP;
    5. TANF; and
    6. Bureau of Indian Affairs (BIA) general assistance.
  9. Housing assistance from a federal program such as HUD if paid under:
    1. United States Housing Act of 1937 (section 1437 et seq. of 42 U.S.C.);
    2. National Housing Act (section 1701 et seq. of 12 U.S.C.);
    3. Section 101 of the Housing and Urban Development Act of 1965 (section 1701s of 12 U.S.C., section 1451 of 42 U.S.C.);
    4. Title V of the Housing Act of 1949 (section 1471 et seq. of 42 U.S.C.);
    5. Section 202(h) of the Housing Act of 1959; or
    6. Weatherization provided to low-income homeowners by programs that consider income in the eligibility determinations.
  10. Energy assistance payments including:
    1. Those to prevent fuel cutoffs; and
    2. Those to promote energy efficiency.
  11. Income from employment and training programs as specified in WAC 182-512-0780.
  12. Foster grandparents program;
  13. Title IV-E and state foster care maintenance payments if the foster child is not included in the assistance unit;
  14. The value of any childcare provided or arranged (or any payment for such care or reimbursement for costs incurred for such care) under the Child Care and Development Block Grant Act, as amended by section 8(b) of P.L. 102-586 (106 Stat. 5035);
  15. Educational assistance as specified in WAC 182-512-0760;
  16. The excluded income described in WAC 182-512-0770 and other income received by American Indians/Alaska Natives that is excluded by federal law;
  17. Payments from Susan Walker v. Bayer Corporation, et al., 96-c-5024 (N.D. Ill) (May 8, 1997) settlement funds;
  18. Payments from Ricky Ray Hemophilia Relief Fund Act of 1998, P.L. 105-369;
  19. Disaster assistance paid under Federal Disaster Relief P.L. 100-387 and Emergency Assistance Act, P.L. 93-288 amended by P.L. 100-707 and for farmers P.L. 100-387;
  20. Payments to certain survivors of the Holocaust as victims of Nazi persecution; payments excluded pursuant to section 1(a) of the Victims of Nazi Persecution Act of 1994, P.L. 103-286 (108 Stat. 1450);
  21. Payments made under section 500 through 506 of the Austrian General Social Insurance Act;
  22. Payments made under the Netherlands' Act on Benefits for Victims of Persecution (WUV);
  23. Restitution payments and interest earned to Japanese Americans or their survivors, and Aleuts interned during World War II, established by P.L. 100-383;
  24. Payments made from the Agent Orange Settlement Funds or any other funds to settle Agent Orange liability claims established by P.L. 101-201;
  25. Payments made under section six of the Radiation Exposure Compensation Act established by P.L. 101-426;
  26. Any interest or dividend is excluded as income, except for the community spouse of an institutionalized person; and
  27. Working families' tax credit payments under RCW 82.08.0206.

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. Assistance based on need that is not counted as income include payments wholly funded by a State or not of its political divisions. For this purpose, an Indian tribe is considered a political subdivision within the geographical boundary of a State. When such payments are provided under a program that uses the amount of an individual's income to determine eligibility, the payments are not counted as income. If the individual's income is used only for determining the amount of a payment, however, and not also for eligibility for the program under which the payment is made, then the payment is counted as unearned income.
  2. Some tribes, such as the Muckleshoot Indian Tribe, provide this type of cash assistance to its elder members. When eligibility for this assistance is based on the individual's income, the payments are not counted when determining eligibility for Apple Health. They are considered needs-based and may include payments for housing or social services. These payments are excluded under 20 CFR § 416.1124(c)(2) – Unearned income we do not count. Also see the tribal income desk aid.
  3. It is important to understand that the Tribal General Welfare Exclusion Act of 2014 amends the Internal Revenue Service (IRS) code. The bill language does not add any new exclusions from Indian income to the SSI program. Its primary purpose is to codify that certain payments, programs, or services provided by tribal governments for the general welfare of their people that meet the requirements under the Tribal Act are excluded from federal income tax, as are TANF and SSI benefits. For more information, go to the Social Security Administration's American Indians and Alaska Natives (AIAN) webpage.
  4. Needs-based stipends such as those issued by the Homeless Worker Stipend Program are excluded as income in the month received.

For more information:

Income overview 1: income eligibility

Income overview 2: income eligibility continued

Income overview 3: exclusions and allocations

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