Income overview 3: exclusions and allocations

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

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.

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. Funds that do not count as income include:
    1. Payments made replacing income that has been lost, stolen or destroyed;
    2. Interest left to accumulate on funds set aside for burial.
  2. Life insurance policy benefits, which an SSI-related individual receives as a beneficiary, are counted as unearned income, except for any of the money spent on the insured’s (deceased person’s) last illness and burial expenses.
  3. Money paid by a person who is “sharing” the cost of food or housing (rent, utilities, etc.) is not considered income. Housing costs are adjusted according to how they are “shared”.
    Example: If the apartment rent is $800 per month and a husband, wife and child are sharing the costs with an unrelated person, only the costs that each AU pays is allowed for that shelter expense. If the family pays $500 and the other person, $300, then the shelter cost for the family is $500. If that family only pays ½ of the rent for the apartment ($400), then $400 is considered their shelter cost.
  4. When it is necessary to place a value on them, in-kind payments are valued at current market value. In-kind income in the form of shelter that is provided by an employer is countable earned income unless:
    1. It is provided on the employer’s premises;
    2. It is provided for the employer’s convenience; and
    3. It is acceptance by the employee is a condition of employment.
  5. An example of excluded income is:
    1. Prescription reimbursement from a health insurer;
    2. A payment to repair damage to the home; or
    3. Replacement of the contents of a home due to a fire or flood.
      Example: A migrant farm worker’s housing, provided by the employer, is not considered income for SSI-related Apple Health purposes.

WAC 182-512-0820 SSI-related medical -- Child-related income exclusions and allocations.

WAC 182-512-0820 SSI-related medical -- Child-related income exclusions and allocations.

Effective June 10, 2019.

  1. For the purposes of Washington apple health SSI-related medical eligibility determinations under chapter 182-512 WAC, a child is defined as a person who is:
    1. Unmarried;
    2. Living in the household of the SSI-related applicant;
    3. The natural, adopted or stepchild of the SSI-related applicant or the applicant's spouse;
    4. Not receiving a needs-based cash payment such as TANF or SSI; and
    5. Either:
      1. Age seventeen or younger; or
      2. Age twenty-one or younger and meets the SSI-related definition of a student described in subsection (6) of this section.
  2. The agency allows an allocation for the support of a child when determining the countable income of an SSI-related applicant. The allocation is calculated as follows:
    1. For apple health categorically needy (CN) health care coverage, the allocation is deducted from the countable income of a nonapplying spouse before determining the amount of the nonapplying spouse's income to be deemed to the SSI-related applicant. Allocations to children are not deducted from the income of an unmarried SSI-related applicant.
    2. For apple health medically needy (MN) medical coverage, the allocation is first deducted from the income of the nonapplying spouse as described in subsection (2)(a) of this section when the SSI-related applicant is married, and from the income of the applicant when the applicant is not married.
  3. The child's countable income, if any, is subtracted from the maximum child's allowance before determining the amount of allocation.
  4. Foster care payments received for a child who is not SSI-eligible and who is living in the household, placed there by a licensed, nonprofit or public child placement or childcare agency are excluded from income regardless of whether the client requesting or receiving SSI-related medical is the adult foster parent or the child who was placed.
  5. Adoption support payments, received by an adult for a child in the household that are designated for the child's needs, are excluded as income. Adoption support payments that are not specifically designated for the child's needs are not excluded and are considered unearned income to the adult.
  6. The agency excludes the earned income of a client age twenty-one or younger if that client is a student. In order to allow the student earned income exclusion, a student must:
    1. Attend a school, college, or university a minimum of eight hours a week; or
    2. Pursue a vocational or technical training program designed to prepare the student for gainful employment a minimum of twelve hours per week; or
    3. Attend school or be home schooled in grades seven through twelve at least twelve hours per week.
  7. Any portion of a grant, scholarship, fellowship, or gift used for tuition, fees and/or other necessary educational expenses at any educational institution is excluded from income and not counted as a resource for nine months after the month of receipt.
  8. One-third of child support payments received for a child who is an applicant for SSI-related medical is excluded from the child's income. Child support payments that are subject to the one-third deduction may be voluntary or court-ordered payments for current support or arrears.
  9. The following gifts to, or for the benefit of, a client under eighteen years old who has a life-threatening condition, from an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of that code, are excluded:
    1. In-kind gifts that are not converted to cash; and
    2. Cash gifts up to a total of two thousand dollars in a calendar year.
  10. Veteran's payments made to, or on behalf of, natural children of Vietnam veterans regardless of their age or marital status, for any disability resulting from spina bifida suffered by these children are excluded from income. Any portion of a veteran's payment that is designed as the dependent's income is countable income to the dependent and not the applicant (assuming the applicant is not the dependent).

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.

Child support paid by the individual is not an allowable exclusion for SSI-related medical eligibility (20 CFR 416.1123(b) (i) POMS00830.115) Child support paid by the nonapplying spouse of an SSI-related applicant is an allowable deduction for the spouse.

Income overview 2: income eligibility 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 182-512-0760 SSI-related medical -- Education assistance.

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.

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

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.

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. Payments made under the Cobell Statement Agreement for the Land Buy-Back for Tribal Nations are excluded when determining countable income. When determining countable resources, they are excluded for twelve months from the date of receipt. See the Claims Resolution Act of 2010, P.L. 111-291, Section 101 (f) for more information.

  2. Assistance based on need that is not counted as income includes 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.

  3. 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.

  4. 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. 

  5. For information about tribal payments made to members that are based on income and need, see Clarifying Information under WAC 182-512-0860 SSI-related medical - Income exclusions under federal statute or other state laws.

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

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.

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.

Cascade Select (public option)

Cascade Select is Washington’s public option plan offered under Cascade Care. Cascade Care is a multi-agency effort involving Health Benefit Exchange (HBE), Health Care Authority (HCA), and Office of the Insurance Commissioner (OIC). HBE manages Cascade Care and HCA is responsible for procuring Cascade Select plans. Learn more

History

HCA initiated a procurement and successfully contracted with five public option carriers, as authorized under Senate Bill 5526 in 2019. Procurement for Cascade Care plans began in February 2020 and Cascade Select plans (public option) were first offered through Washington Healthplanfinder in 2021.

Senate Bill 5377, which passed during the 2021 legislative session, provides additional guidance for Cascade Care.

Goals

The goals of Cascade Select are to increase the availability of quality, affordable health care coverage in the individual market, and ensure residents in every Washington county have a choice of qualified health plans.

Progress towards goals

For plan year 2024,

  • Average premium increases for Cascade Select plans are nearly 50 percent lower than non-Cascade plans. This includes an average rate increase of just 3 percent, instead of 9 percent for other plans.
  • Public option rates are the lowest-premium silver plans in 31 counties, up from 13 in 2023.
  • Public option plans are available in 37 counties, up from 34 counties in 2023 and 19 in 2021.
  • Ninety-nine (99) percent of current Washington Healthplanfinder customers have access to a public option plan.

Difference between Cascade Care and Cascade Select plans

A Cascade Care plan has a standard benefit design that emphasizes lower deductibles and providing access to services before having to pay the deductible. Customers can make “apples to apples” comparisons across different insurance carriers because the benefits are the same.

Cascade Care offers health insurance coverage options on the individual market through Washington’s Healthplanfinder (offered by HBE).

A Cascade Select plan is Washington’s public option and has the same standard benefit design, along with additional requirements, such as:

  • Incorporating community quality standards
  • Value-based purchasing
  • Ensuring aggregate limits on provider reimbursement

These standards help increase access to high-value care at a lower cost.

Enroll in Cascade Care or Cascade Care Select

You can enroll in health care coverage through Washington Healthplanfinder during open enrollment, beginning November 1, 2024, through January 15, 2025. You can enroll in a Cascade Care plan throughout the year if you qualify for the Cascade Care Savings Special Enrollment Period. Learn more on the Washington Healthplanfinder website.

Want to enroll in a Cascade Care or Cascade Select plan?

You can enroll in health care coverage through Washington Healthplanfinder.

Who is responsible for verifying family members’ eligibility for coverage under the SEBB Program?

Employees are required to provide evidence of a dependent’s eligibility within the SEBB Program’s timelines. Benefits administrators verify dependents’ eligibility for coverage.

I have specific questions about continuation coverage (COBRA or unpaid leave). How do I get answers?

Benefits administrators from school districts, charter schools, and ESDs can sign up for our secure messaging application, HCA Support. Your questions about continuation coverage and other topics will go directly to our Outreach and Training staff. 

What happens if the Legislature decides not to fund a tentative agreement?

The Legislature can only approve or reject the tentative agreement in its entirety. If the Legislature decides not to fund a tentative agreement, the parties are left with no ratified agreement, and both the state and the union coalition would need to return to the bargaining table.

What happens if a tentative agreement is not reached by the October 1 deadline?

State law requires that bargaining with the union coalition be completed before October 1 to allow for a fiscal analysis of the impact of any tentative agreement. That analysis is necessary to inform the budgetary process that is the responsibility of the Governor and Legislature. In the past, with very few exceptions, this deadline has been met. For future years, the agreement stays in place if no successive  agreement is reached.

When does collective bargaining take place?

In even-numbered years, between July 1 and October 1. Bargaining took place in 2022, effective for the 2024 and 2025 calendar years. In 2024, negotiations will take place for 2026 and 2027.

How will districts know how bargaining is going?

Collective bargaining law requires that the state negotiate in good faith with the union coalition. There are limits on what details can be shared away from the bargaining table. For the 2018 negotiations, OFM created a bargaining resource team to share news of the negotiations with school administrators.