WAC 182-512-0790 SSI-related medical -- Exemption from sponsor deeming.

Effective April 14, 2014.

1. A person who meets any of the following conditions is permanently exempt from deeming and the agency does not count the sponsor's income or resources when determining eligibility for Washington apple health (WAH) SSI-related coverage:
   1. The Immigration and Nationality Act (INA) does not require the person to have a sponsor. Immigrants who are not required to have a sponsor include those with the following status with U.S. Citizenship and Immigration Services (USCIS):
      1. Refugee;
      2. Parolee admitted under Section 212(d)(5) of the Immigration and Nationality Act (INA);
      3. Asylee;
      4. Cuban/Haitian entrant under Section 202 of the Immigration Reform and Control Act of 1986 (IRCA);
      5. Amerasians admitted with an I-551 admission code of AM1, AM2, AM3, AM6, AM7, or AM8; and
      6. Special immigrant from Iraq or Afghanistan.
   2. The person meets the blindness or disability requirements described in WAC 182-512-0050(1);
   3. The person was sponsored by an organization or group as opposed to another person;
   4. The person is a nonqualified or undocumented alien as defined in WAC 182-503-0530 (3) and (4);
   5. The person has worked or can get credit for forty qualifying quarters of work under Title II of the Social Security Act. The agency does not count a quarter of work toward this requirement if the person working received TANF, Basic Food, SSI, CHIP, or nonemergency medicaid coverage. A quarter of work earned by the following people is counted toward the forty qualifying quarters:
      1. The person;
      2. The person's parents for the time they worked before the person turned eighteen years old (including the time they worked before the person's birth); and
      3. The person's spouse if still married or if the spouse is deceased.
   6. The person has become a United States (U.S.) citizen;
   7. The sponsor is dead; or
   8. If USCIS or a court decides that the person, their child, or their parent was a victim of domestic violence from the person's sponsor and:
      1. The person no longer lives with the sponsor; and
      2. Leaving the sponsor caused the need for coverage.
2. A person is exempt from the deeming process while in the same assistance unit (AU) as the sponsor.
3. If the person, their child, or their parent was a victim of domestic violence, the person is exempt from the deeming process for twelve months if:
   1. They no longer live with the person who committed the violence; and
   2. Leaving this person caused the need for health coverage.
4. If the person's medical assistance unit (MAU) has income at or below one hundred thirty percent of the federal poverty level (FPL), the person is exempt from the deeming process for twelve months. This is called the "indigence exemption." A person may choose to use this exemption or not to use this exemption in full knowledge of the possible risks involved. See risks in subsection (5) of this section. For this rule, the agency counts the following as income:
   1. Earned and unearned income received by any member of the MAU from any source; and
   2. The value of any noncash items of value such as free rent, commodities, goods, or services received from another person or organization.
5. A person who chooses not to use the indigence exemption must provide verification of the sponsor's income and resources and will be subject to the deeming rules described in WAC 182-512-0795.
6. For federally funded programs, if the person uses the indigence exemption, the agency is required by law to give the U.S. Attorney General the following information:
   1. The names of the sponsored people in the person's AU;
   2. That the person is exempt from deeming due to income;
   3. The sponsor's name; and
   4. The effective date that the twelve-month exemption began.

WAC 182-512-0785 SSI-related medical -- Effect of a sponsor's income.

Effective August 6, 2018.

1. The following definitions apply to this section:
   1. "Sponsor" means a person who agreed to meet the needs of a sponsored immigrant by signing a United States Citizenship and Immigration Services Affidavit of Support form I-864 or I-864A. This includes a sponsor's spouse if the spouse signed the affidavit of support.
   2. "Sponsored immigrant" means a person who must have a sponsor under the Immigration and Nationality Act (INA) to be admitted into the United States for residence.
   3. "Deeming" means the agency counts a part of the sponsor's income and resources as available to the sponsored immigrant.
   4. "Exempt" means the person meets one of the conditions of WAC 182-512-0790.
2. If the person is a sponsored immigrant and is not exempt from deeming, the person must provide the following information to be eligible for Washington apple health (WAH) SSI-related coverage even if the person is not receiving support from their sponsor:
   1. The name and address of the sponsor;
   2. The income and resources of the sponsor; and
   3. Any additional information needed for the agency to determine if:
      1. Income must be deemed to the person's medical assistance unit (MAU); and
      2. The amount of income that must be deemed to the MAU.
3. If the person is not eligible for coverage because the agency does not have the information needed regarding the sponsor, eligibility for other unsponsored household members applying for coverage is not delayed. Although the sponsored immigrant may not be eligible for coverage, the following is counted when determining the eligibility of other household members:
   1. All earned or unearned income of the sponsored immigrant that is not excluded under chapter 182-512 WAC; and
   2. All deductions the sponsored immigrant would be eligible for under chapter 182-512 WAC.
4. If the person refuses to provide the agency with the information needed regarding the sponsor, the other adult members in the MAU must provide the information. If the same person sponsored everyone in the MAU, the entire MAU is not eligible for WAH coverage until someone provides the information that is needed.

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.

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.

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.

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.

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

Effective June 3, 2025

The agency does not count income until the person begins to receive it. Income is budgeted prospectively for all Washington apple health health care programs.

1. 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.
2. The agency follows income and resource methodologies of the supplemental security income (SSI) program defined in federal law when determining eligibility for apple health SSI-related medical or medicare savings programs unless the agency adopts rules that are less restrictive than those of the SSI program.
3. 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.
4. To be eligible for apple health categorically needy (CN) SSI-related health care coverage, a person's countable income cannot exceed the apple health CN program standard described in:
   1. WAC 182-512-0010 for noninstitutional apple health coverage unless living in an alternate living facility; or
   2. WAC 182-513-1205 for noninstitutional apple health CN coverage while living in an alternate living facility; or
   3. WAC 182-513-1315 for institutional and waiver services coverage.
5. 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 apple health 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 apple health MN coverage while living in an alternate living facility (ALF). See WAC 182-513-1205; or
   4. Meet eligibility for institutional apple health MN coverage described in WAC 182-513-1315.

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

Effective June 3, 2025

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(4), 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 30, 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).