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.

WAC 182-512-0650 SSI-related medical -- Available income.

Effective September 30th, 2024.

1. Income is considered available to a person at the earliest of when it is:
   1. Received; or
   2. Credited to a person's account; or
   3. Set aside for the person's use; or
   4. Used or can be used to meet the person's needs for shelter.
2. Anticipated nonrecurring lump sum payments are treated as income in the month received, with the exception of those listed in WAC 182-512-0700(5), and any remainder is considered a resource in the following month.
3. Reoccurring income is considered available in the month of normal receipt, even if the financial institution posts it before or after the month of normal receipt.
4. In-kind income received from anyone other than a legally responsible relative is considered available income only if it is earned 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.

WAC 182-512-0550 SSI-related medical — All other excluded resources.

Effective June 4, 2021.

All resources described in this section are excluded resources for SSI-related medical programs. Unless otherwise stated, interest earned on the resource amount is counted as unearned income.

1. Resources necessary for a person who is blind or disabled to fulfill a self-sufficiency plan approved by the agency.
2. Retroactive payments from SSI or old age, survivors, and disability insurance (OASDI), including benefits a person receives under the interim assistance reimbursement agreement with the Social Security Administration, are excluded for nine months following the month of receipt. This exclusion applies to:
   1. Payments received by the person, the person's spouse, or any other person financially responsible for the person;
   2. SSI payments for benefits due for the month(s) before the month of continuing payment;
   3. OASDI payments for benefits due for a month that is two or more months before the month of continuing payment; and
   4. Proceeds from these payments as long as they are held as cash, or in a checking or savings account. The funds may be commingled with other funds, but must remain identifiable from the other funds for this exclusion to apply. This exclusion does not apply once the payments have been converted to any other type of resource.
3. All resources specifically excluded by federal law, such as those described in subsections (4) through (11) of this section as long as such funds are identifiable.
4. Payments made under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
5. The excluded resources described in WAC 182-512-0770 and other resources of American Indians/Alaska Natives that are excluded by federal law.
6. Restitution payment and any interest earned from this payment to persons of Japanese or Aleut ancestry who were relocated and interned during war time under the Civil Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution Act.
7. Funds received from the Agent Orange Settlement Fund or any other funds established to settle Agent Orange liability claims.
8. Payments or interest accrued on payments received under the Radiation Exposure Compensation Act received by the injured person, the surviving spouse, children, grandchildren, or grandparents.
9. Payments or interest accrued on payments received under the Energy Employees Occupational Illness Compensation Act of 2000 (EEOICA) received by the injured person, the surviving spouse, children, grandchildren, or grandparents.
10. Payments from:
    1. The Dutch government under the Netherlands' Act on Benefits for Victims of Persecution (WUV).
    2. The Victims of Nazi Persecution Act of 1994 to survivors of the Holocaust.
    3. Susan Walker vs. Bayer Corporation, et al., 96-C-5024 (N.D. Ill.) (May 8, 1997) settlement funds.
    4. Ricky Ray Hemophilia Relief Fund Act of 1998 P.L. 105-369.
11. The unspent social insurance payments received due to wage credits granted under sections 500 through 506 of the Austrian General Social Insurance Act.
12. Tax refunds and earned income tax credit refunds and payments are excluded as resources for twelve months after the month of receipt.
13. Payments from a state administered victim's compensation program for a period of nine calendar months after the month of receipt.
14. Cash or in-kind items received as a settlement for the purpose of repairing or replacing a specific excluded resource are excluded:
    1. For nine months. This includes relocation assistance provided by state or local government.
    2. Up to a maximum of thirty months, when:
       1. The person intends to repair or replace the excluded resource; and
       2. Circumstances beyond the control of the settlement recipient prevented the repair or replacement of the excluded resource within the first or second nine months of receipt of the settlement.
    3. For an indefinite period, if the settlement is from federal relocation assistance.
    4. Permanently, if the settlement is assistance received under the Disaster Relief and Emergency Assistance Act or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States, or is comparable assistance received from a state or local government or from a disaster assistance organization. Interest earned on this assistance is also excluded from resources. Any cash or in-kind items received as a settlement and excluded under this subsection are available resources when not used within the allowable time periods.
15. Insurance proceeds or other assets recovered by a Holocaust survivor.
16. Pension funds owned by an ineligible spouse. Pension funds are defined as funds held in a(n):
    1. Individual retirement account (IRA) as described by the IRS code; or
    2. Work-related pension plan (including plans for self-employed persons, known as Keogh plans).
17. Cash payments received from a medical or social service agency to pay for medical or social services are excluded for one calendar month following the month of receipt.
18. SSA- or division of vocational rehabilitation (DVR)-approved plans for achieving self-support (PASS) accounts, allowing blind or disabled persons to set aside resources necessary for the achievement of the plan's goals, are excluded.
19. Food and nutrition programs with federal involvement. This includes Washington Basic Food, school reduced and free meals and milk programs and WIC.
20. Gifts to, or for the benefit of, a person 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, as follows:
    1. In-kind gifts that are not converted to cash; or
    2. Cash gifts up to a total of two thousand dollars in a calendar year.
21. 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.
22. The following are among assets that are not resources and as such are neither excluded nor counted:
    1. Home energy assistance/support and maintenance assistance;
    2. Retroactive in-home supportive services payments to ineligible spouses and parents; and
    3. Gifts of domestic travel tickets.
23. Resources accumulated in a separate account, designated by the client, that result from work activity during the client's enrollment in apple health for workers with disabilities (HWD) program under chapter 182-511 WAC.
24. Limited to clients who have been or continue to be subject to participation as defined in WAC 182-513-1100 during the public health emergency (PHE), resources accumulated due to not increasing participation in response to section 6008(b) of the Families First Coronavirus Response Act (FFCRA) are excluded for:
    1. The duration of the PHE; and
    2. A period of twelve months after the PHE ends.
25. Resources listed in the program operations manual system (POMS), not otherwise excluded under this section, are excluded (see SSA POMS Section SI 01130.050 https://secure.ssa.gov/apps10/poms.nsf/lnx/0501130050).

WAC 182-512-0500 SSI-related medical -- Burial funds, contracts and spaces excluded as resources.

Effective June 11, 2023.

1. For the purposes of this section, burial funds are funds set aside and clearly designated solely for burial and related expenses, and kept separate from all other resources not intended for burial. These include:
   1. Revocable burial contracts;
   2. Revocable burial trusts; or
   3. Other revocable burial arrangements. The designation is effective the first day of the month in which the person intended the funds to be set aside for burial.
2. Burial funds in a revocable burial contract, burial trust, cash accounts, or other financial instruments with a definite cash value are excluded as resources for the person and their spouse, up to $1,500 each, when set aside solely for burial or cremation and related expenses.
3. Interest earned in burial funds and appreciation in the value of excluded burial arrangements in subsection (2) of this section are excluded from resources and are not counted as income if left to accumulate and become part of the separate burial fund.
4. An irrevocable burial account, burial trust, or other irrevocable burial arrangement, set aside solely for burial and related expenses, is not considered a resource. To be excluded, the amount set aside must be reasonably related to the anticipated death-related expenses.
5. The $1,500 exclusion for burial funds described in subsection (2) of this section is reduced by:
   1. The face value of life insurance with CSV excluded in WAC 182-512-0450; and
   2. Amounts that meet the requirements of subsection (4) of this section.
6. A person's burial funds are no longer excluded when they are mixed with other resources that are not related to burial.
7. When excluded burial funds are spent for other purposes, the spent amount is added to other countable resources and any amount exceeding the resource limit is considered available income on the first of the month it is used. The amount remaining in the burial fund remains excluded.
8. Burial space and accessories for the person and any member of the person's immediate family described in subsection (9) of this section are excluded. Burial space and accessories include:
   1. Conventional gravesites;
   2. Crypts, niches, and mausoleums;
   3. Urns, caskets and other repositories customarily used for the remains of deceased persons;
   4. Necessary and reasonable improvements to the burial space including, but not limited to:
      1. Vaults and burial containers;
      2. Headstones, markers and plaques;
      3. Arrangements for the opening and closing of the gravesite; and
      4. Contracts for care and maintenance of the gravesite.
   5. A burial space purchase agreement that is fully or partially paid, and any accrued interest.
9. Immediate family, for the purposes of subsection (8) of this section includes the person's:
   1. Spouse;
   2. Parents and adoptive parents;
   3. Minor and adult children, including adoptive and stepchildren;
   4. Siblings (brothers and sisters), including adoptive and stepsiblings;
   5. Spouses of any of the above.

None of the family members listed above, need to be dependent on or living with the person, to be considered immediate family members.

WAC 182-512-0450 SSI-related medical -- Life insurance excluded as a resource.

Effective April 14, 2014.

1. The agency excludes life insurance policies that do not have or cannot accrue a cash surrender value (CSV) in determining whether owned policies exceed the life insurance exclusion limits for resources and in determining burial fund exclusion limits.
2. Policies owned by each spouse are evaluated and counted separately.
3. If the total face value of all policies with a CSV potential that a person owns on the same insured is equal to or less than fifteen hundred dollars, the resource is excluded.
4. If the total face value of all policies with a CSV potential that a person owns on the same insured is more than fifteen hundred dollars, the total CSV of the policies is counted toward the resource limit, unless the person designates such policies as burial funds. If they are designated as burial funds, they must be evaluated under the burial fund exclusion described in WAC 182-512-0500.

WAC 182-512-0400 SSI-related medical -- Vehicles excluded as resources.

Effective February 20, 2017.

1. For SSI-related medical programs, a vehicle is defined as anything used for transportation. In addition to cars and trucks, a vehicle can include boats, snowmobiles, and animal-drawn vehicles.
2. One vehicle is excluded regardless of its value, if it is used to provide transportation for the SSI-related person or a member of the person's household.
3. A vehicle used as the person's primary residence is excluded as the home, and does not count as the one excluded vehicle under subsection (2) of this section.

WAC 182-512-0350 SSI-related medical -- Property and contracts excluded as resources.

Effective November 14, 2019.

1. The agency excludes the following resources when determining eligibility for SSI-related medical assistance:
   1. A client's household goods and personal effects;
   2. One home (which can be any shelter), including the land on which the dwelling is located, and all contiguous property and related out-buildings in which the client has ownership interest for long-term care programs, see WAC 182-513-1350 for home equity limits, when:
      1. The client uses the home as a primary residence;
      2. The client's spouse lives in the home;
      3. The client does not currently live in the home, but the client or the client's representative has stated the client intends to return to the home; or
      4. A relative, who is financially or medically dependent on the client, lives in the home and either the dependency is documented or a written statement of dependency is provided by the client, the client's authorized representative, or by the client's dependent relative.
   3. The value of ownership interest in jointly owned real property is an excluded resource for as long as sale of the property would cause undue hardship to a co-owner due to loss of housing. Undue hardship would result if the co-owner:
      1. Uses the property as the client's principal place of residence;
      2. Would have to move if the property were sold; and
      3. Has no other readily available housing.
2. Proceeds from the sale of an interest described in subsection (1)(b) of this section, are excluded as a resource if the client uses the proceeds to purchase another home by the end of the third month after receiving the proceeds from the sale.
3. An installment contract from the sale of the home described in subsection (1)(b) above is not a resource as long as the client plans to use the entire down payment and the entire principal portion of a given installment payment to buy another excluded home, and does so within three months after the month of receiving such down payment or installment payment.
4. The value of sales contracts is excluded when the:
   1. Current market value of the contract is zero;
   2. Contract cannot be sold; or
   3. Current market value of the sales contract combined with other resources does not exceed the resource limits.
5. Sales contracts executed before December 1, 1993, are excluded resources as long as they are not transferred to someone other than a spouse.
6. A sales contract for the sale of the client's principal place of residence executed between December 1, 1993, and May 31, 2004, is an excluded resource unless it has been transferred to someone other than a spouse and it:
   1. Provides interest income within the prevailing interest rate at the time of the sale;
   2. Requires the repayment of a principal amount equal to the fair market value of the property; and
   3. The term of the contract does not exceed thirty years.
7. A sales contract executed on or after June 1, 2004, on a home that was the principal place of residence for the client at the time of institutionalization is an excluded resource as long as it is not transferred to someone other than a spouse and it:
   1. Provides interest income within the prevailing interest rate at the time of the sale;
   2. Requires the repayment of a principal amount equal to the fair market value of the property within the anticipated life expectancy of the client; and
   3. The term of the contract does not exceed thirty years.
8. Payments received on sales contracts of the home described in subsection (1)(b) of this section are treated as follows:
   1. The interest portion of the payment is treated as unearned income in the month of receipt of the payment;
   2. The principal portion of the payment is treated as an excluded resource if reinvested in the purchase of a new home within three months after the month of receipt;
   3. If the principal portion of the payment is not reinvested in the purchase of a new home within three months after the month of receipt, that portion of the payment is a liquid resource as of the date of receipt.
9. Payments received on sales contracts described in subsection (4) of this section are treated as follows:
   1. The principal portion of the payment on the contract is treated as a resource and counted toward the resource limit to the extent retained at the first moment of the month following the month of receipt of the payment; and
   2. The interest portion is treated as unearned income the month of receipt of the payment.
10. For sales contracts that meet the criteria in subsection (5), (6), or (7) of this section but do not meet the criteria in subsection (3) or (4) of this section, both the principal and interest portions of the payment are treated as unearned income in the month of receipt.
11. Property essential to self-support (PESS) is excluded as a resource within certain limits. There are three categories of PESS:
    1. Real and personal property used in a trade or business:
       1. That is a resource defined under WAC 182-512-0200;
       2. That is in current use as described under the Social Security Administration's Program Operations Manual System (POMS) SI 01130.504; and
       3. Where the trade or business is a sole proprietorship or simple partnership.
    2. Nonbusiness income-producing property (i.e., property not used in a trade or business), such as:
       1. Houses or apartments for rent; and
       2. Land, other than home property.
    3. Property used to produce goods or services essential to a client's daily activities, such as land used to produce vegetables or livestock, which is used only for personal consumption in the client's household. This includes personal property necessary to perform daily functions including vehicles such as boats for subsistence fishing and garden tractors for subsistence farming, but does not include other vehicles such as those that qualify as automobiles (e.g., cars, trucks).
12. The agency excludes a client's real and personal property used in a trade or business, described under subsection (11)(a) of this section, regardless of value as long as it is in current use (as described under POMS SI 01130.504) in the trade or business and remains used in the trade or business.
13. The agency excludes up to $6,000 of a client's equity in nonbusiness income-producing property, described under subsection (11)(b) of this section, if it produces a net annual income to the client of at least six percent of the excluded equity.
    1. If a client's equity in the property is over $6,000, only the amount over $6,000 is counted toward the resource limit, as long as the net annual income requirement of six percent is met on the excluded equity.
    2. If the six percent requirement is not met due to circumstances beyond the client's control (e.g., illness), and there is a reasonable expectation that the activities will again meet the six percent rule, the same exclusions as in subsection (13)(a) of this section apply.
    3. If a client has more than one piece of real property in this category, each is independently evaluated to see if it meets the six percent return, and the total equities of all those properties are added to see if the total is over $6,000. If the total is over the $6,000 limit, the amount exceeding the limit is counted toward the resource limit.
    4. The equity in each property that does not meet the six percent annual net income limit is counted toward the resource limit, with the exception of property that represents the authority granted by a governmental agency to engage in an income-producing activity if it is:
       1. Used in a trade or business or nonbusiness income-producing activity; or
       2. Not used due to circumstances beyond the client's control (e.g., illness), and there is a reasonable expectation that the use will resume.
14. Property used to produce goods or services essential to a client's daily activities is excluded if the client's equity in the property does not exceed $6,000.
15. Personal property used by a client as an employee for work is not counted toward the resource limit, regardless of value, while in current use (as described under POMS SI 01130.504), or if the required use for work is reasonably expected to resume.
16. Interests in trust or in restricted Indian land owned by a client who is of Indian descent from a federally recognized Indian tribe or held by the spouse or widow/er of that client, is not counted toward the resource limit if permission of the other people, the tribe, or an agency of the federal government must be received in order to dispose of the land.
17. Receipt of money by a member of a federally recognized tribe from exercising federally protected rights or extraction of excluded resources, such as fishing, shell-fishing, or selling timber from protected land, is considered conversion of an excluded resource during the month of receipt. Any amount remaining from the conversion of this excluded resource on the first of the month after the month of receipt will remain excluded if it is used to purchase another excluded resource. Any amount remaining in the form of a countable resource (such as in a checking or savings account) on the first of the month after receipt, will be added to other countable resources for eligibility determinations.

WAC 182-512-0260 SSI-related medical -- How to count a sponsor's resources.

Effective April 14, 2014.

1. The agency counts part of a sponsor's resources as available to an applicant or recipient of Washington apple health (WAH) SSI-related health care coverage if:
   1. The person is a sponsored immigrant as defined in WAC 182-512-0785; and
   2. The person is not exempt from deeming under WAC 182-512-0790.
2. The agency determines the amount of the sponsor's resources to count by:
   1. Totaling the countable resources of the sponsor and the sponsor's spouse (if the spouse signed the affidavit of support);
   2. Subtracting fifteen hundred dollars; and
   3. Counting the remaining amount as a resource that is available to the person.
3. When a sponsor has sponsored other people as well, the agency divides the result by the total number of people sponsored.
4. A sponsor's resources are counted when determining eligibility for WAH coverage until the person becomes exempt from deeming under WAC 182-512-0790.

WAC 182-512-0250 SSI-related medical — Ownership and availability of resources.

Effective April 27, 2020.

1. The agency considers personal and real property to be available to a Washington apple health applicant or recipient if the applicant or recipient:
   1. Owns the property;
   2. Has the authority to convert the property into cash;
   3. Can expect to convert the property to cash within twenty working days; and
   4. May legally use the property for his or her support.
2. The agency counts the resources of financially responsible persons (as defined in WAC 182-506-0015) who live in the home even if those persons do not receive Washington apple health coverage.
3. For long-term care (LTC) services, cash and other resources transferred by a Washington apple health applicant or recipient or his or her spouse to another to pay for the Washington apple health applicant or recipient's LTC services are considered resources available to the applicant or recipient unless otherwise excluded in this chapter, chapter 182-513 WAC, or chapter 182-516 WAC.
4. A resource is considered available on the first day of the month following the month of receipt unless a rule about a specific type of resource provides for a different time period.
5. A resource that ordinarily cannot be converted to cash within twenty working days is considered unavailable as long as a reasonable effort is being made to convert the resource to cash.
6. A person may provide evidence showing that a resource is unavailable. A resource is not counted if the person shows sufficient evidence that the resource is unavailable.
7. We do not count the resources of victims of family violence, as defined in WAC 388-452-0010, when:
   1. The resource is owned jointly with members of the former household;
   2. Availability of the resource depends on an agreement of the joint owner; or
   3. Making the resource available would place the person at risk of harm.
8. The value of a resource is its fair market value minus encumbrances.
9. Refer to WAC 182-512-0260 to consider additional resources when an alien has a sponsor.