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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.

For more information:

Income overview 1: income eligibility

Income overview 2: exclusions and allocations

Income overview 4: exclusions and allocations continued

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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 goal of Cascade Select is to help residents get quality, affordable health care coverage in every county in Washington state. You can enroll through Washington Healthplanfinder (also known as the Washington State Health Benefit Exchange).

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. Learn more about Cascade Care and Cascade Care Select on the Washington Healthplanfinder website.

If you qualify for the Cascade Care Savings Special Enrollment Period, you can enroll in a Cascade Care plan throughout the year. Learn more about Cascade Care Savings 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.

News and updates

Date

Title
October 16, 2024

Cascade Select will be available across Washington in 2025
March 18, 2024 HCA to extend Cascade Select carrier contracts
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How do I…

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.

How do school districts have a voice in the bargaining process?

Engaging with school district administrators is key to understanding their concerns. The Office of Financial Management (OFM) engages school districts and local ESDs to solicit feedback through a bargaining resource team, comprising school district leaders, to inform proposals and concepts exchanged at the bargaining table.

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