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.

WAC 182-512-0200 SSI-related medical -- Definition of resources.

Effective December 1, 2011

1. A resource is any cash, other personal property, or real property that an applicant, recipient or other financially responsible person:
   1. Owns;
   2. Has the right, authority, or power to convert to cash (if not already cash); and
   3. Has the legal right to use for his/her support and maintenance.
2. The value of a resource may change. However, the property (personal or real) still remains a resource.
3. Some assets are not resources. Any asset that does not meet the criteria in subsection (1) above is not a resource.
4. When an SSI related client owns a bank account or time deposit jointly with others who are also SSI related clients, we consider the funds as being available to the SSI related individuals in equal shares, unless sufficient evidence to the contrary is provided.
5. When an SSI related client owns a bank account or time deposit jointly with others who are not SSI related, we consider all funds in the joint account as available to the client unless sufficient evidence to the contrary is provided.
6. When an SSI related client jointly owns either real or personal property other than bank accounts or time deposits, the department considers that the client owns and has available only his or her fractional interest in the property unless sufficient evidence to the contrary is provided.
7. A resource is countable toward the resource limit only if it is available and is not excluded.

WAC 182-512-0150 SSI-related medical -- Medically needy (MN) medical eligibility.

Effective June 26, 2022.

1. Washington apple health (WAH) medically needy (MN) health care coverage is available for any of the following:
   1. A person who is SSI-related and not eligible for WAH categorically needy (CN) medical coverage because the person has countable income that is above the WAH CN income level (CNIL) (or for long-term care (LTC) recipients, above the special income limit (SIL)):
      1. The person's countable income is at or below WAH MN standards, leaving no spenddown requirement; or
      2. The person's countable income is above WAH MN standards requiring the person to spenddown their excess income (see subsection (4) of this section). See WAC 182-512-0500 through 182-512-0800 for rules on determining countable income, and WAC 182-519-0050 for program standards or chapter 182-513 WAC for institutional standards.
   2. An SSI-related ineligible spouse of an SSI recipient;
   3. A person who meets SSI program criteria but is not eligible for the SSI cash grant due to immigration status or sponsor deeming. See WAC 182-503-0535 for limits on eligibility for aliens;
   4. A person who meets the WAH MN LTC services requirements of chapter 182-513 WAC;
   5. A person who lives in an alternate living facility and meets the requirements of WAC 182-513-1205; or
   6. A person who meets resource requirements as described in chapter 182-512 WAC, elects and is certified for hospice services per chapter 182-551 WAC.
2. A person whose countable resources are above the SSI resource standards is not eligible for WAH MN noninstitutional health care coverage. See WAC 182-512-0200 through 182-512-0550 to determine countable resources.
3. A person who qualifies for services under WAH long-term care programs has different criteria and may spend down excess resources to become eligible for WAH LTC institutional or waiver health care coverage. Refer to WAC 182-513-1315 and 182-513-1395.
4. A person with income over the effective WAH MN income limit (MNIL) described in WAC 182-519-0050 may become eligible for WAH MN coverage when the person has incurred medical expenses that are equal to the excess income. This is the process of meeting spenddown. Refer to chapter 182-519 WAC for spenddown information.
5. A person may be eligible for health care coverage for any or all of the three months immediately prior to the month of application, if the person has:
   1. Met all eligibility requirements for the months being considered; and
   2. Received medical services covered by medicaid during that time.
6. A person who is eligible for WAH MN without a spenddown is certified for up to 12 months. For a person who must meet a spenddown, refer to WAC 182-519-0110. For a person who is eligible for a WAH long-term care MN program, refer to WAC 182-513-1395 and 182-513-1315.
7. A person must reapply for each certification period. There is no continuous eligibility for WAH MN.

WAC 182-512-0100 SSI-related medical -- Categorically needy (CN) medical eligibility.

Effective April 14, 2014.

1. Washington apple health (WAH) categorically needy (CN) coverage is available for an SSI-related person who meets the criteria in WAC 182-512-0050, SSI-related medical—General information.
2. To be eligible for SSI-related WAH CN medical programs, a person must also have:
   1. Countable income and resources at or below the SSI-related WAH CN medical monthly standard (refer to WAC 182-512-0010) or be eligible for an SSI cash grant but choose not to receive it; or
   2. Countable resources at or below the SSI resource standard and income above the SSI-related WAH CN medical monthly standard, but the countable income falls below that standard after applying special income disregards as described in WAC 182-512-0880; or
   3. Met requirements for long-term care (LTC) WAH CN income and resource requirements that are found in chapters 182-513 and 182-515 WAC if wanting LTC or waiver services.
3. An ineligible spouse of an SSI recipient is not eligible for noninstitutional SSI-related WAH CN health care coverage. If an ineligible spouse of an SSI recipient has dependent children in the home, eligibility may be determined for health care coverage under the WAH medically needy program or for a modified adjusted gross income-based program.

WAC 182-512-0050 SSI-related medical -- General information.

Effective April 14, 2014.

1. The agency (which includes its designee for purposes of this chapter) provides health care coverage under the Washington apple health (WAH) categorically needy (CN) and medically needy (MN) SSI-related programs for SSI-related people, meaning those who meet at least one of the federal SSI program criteria as being:
   1. Age sixty-five or older;
   2. Blind with:
      1. Central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; or
      2. A field of vision limitation so the widest diameter of the visual field subtends an angle no greater than twenty degrees.
   3. Disabled:
      1. "Disabled" means unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, which:
         1. Can be expected to result in death; or
         2. Has lasted or can be expected to last for a continuous period of not less than twelve months; or
         3. In the case of a child seventeen years of age or younger, if the child suffers from any medically determinable physical or mental impairment of comparable severity.
      2. Decisions on SSI-related disability are subject to the authority of:
         1. Federal statutes and regulations codified at 42 U.S.C. Section 1382c and 20 C.F.R., parts 404 and 416, as amended; and
         2. Controlling federal court decisions, which define the OASDI and SSI disability standard and determination process.
2. A denial of Title II or Title XVI federal benefits by SSA solely due to failure to meet the blindness or disability criteria is binding on the agency unless the applicant's:
   1. Denial is under appeal in the reconsideration stage in SSA's administrative hearing process, or SSA's appeals council; or
   2. Medical condition has changed since the SSA denial was issued.
3. The agency considers a person who meets the special requirements for SSI status under Sections 1619(a) or 1619(b) of the Social Security Act as an SSI recipient. Such a person is eligible for WAH CN health care coverage under WAC 182-510-0001.
4. Persons referred to in subsection (1) must also meet appropriate eligibility criteria found in the following WAC and EA-Z Manual sections:
   1. For all programs:
      1. WAC 182-506-0015, Medical assistance units;
      2. WAC 182-504-0015, Categorically needy and WAC 182-504-0020, Medically needy certification periods;
      3. Program specific requirements in chapter 182-512 WAC;
      4. WAC 182-503-0050, Verification;
      5. WAC 182-503-0505, General eligibility requirements for medical programs;
      6. WAC 182-503-0540, Assignment of rights and cooperation;
      7. Chapter 182-516 WAC, Trusts, annuities and life estates.
   2. For LTC programs:
      1. Chapter 182-513 WAC, Long-term care services;
      2. Chapter 182-515 WAC, Waiver services.
   3. For WAH MN, chapter 182-519 WAC, Spenddown;
   4. For WAH HWD, program specific requirements in chapter 182-511 WAC.
5. Aliens who qualify for medicaid coverage, but are determined ineligible because of alien status may be eligible for programs as specified in WAC 182-507-0110.
6. The agency pays for a person's medical care outside of Washington according to WAC 182-501-0180.
7. The agency follows income and resource methodologies of the supplemental security income (SSI) program defined in federal law when determining eligibility for SSI-related medical or medicare savings programs unless the agency adopts rules that are less restrictive than those of the SSI program.
8. Refer to WAC 182-504-0125 for effects of changes on medical assistance for redetermination of eligibility.