(1) For purposes of Washington apple health
(WAH) program eligibility, a person's countable income is income which remains
when:
(a) The income cannot be specifically
excluded; and
(b) All appropriate
deductions and disregards allowed by a specific program have been
applied.
(2) A person's
countable income may not exceed the income standard for the specific WAH
program, unless the program allows for those limits to be exceeded. Specific
program standards are described below:
(a) For
modified adjusted gross income (MAGI)-based programs described in WAC
182-503-0510, see WAC
182-505-0100 for the applicable
program standard based on a percentage of the federal poverty level
(FPL);
(d) For WAH medicare savings programs, see
WAC
182-517-0100;
(e) For WAH noninstitutional medical in an
alternative living facility, see WAC
182-513-1205; and
(3) For the MAGI-based programs listed below,
the agency or its designee determines eligibility based on the countable MAGI
income of the members of the person's medical assistance unit as determined per
WAC
182-506-0010:
(a) WAH for parents and caretaker relatives
program as described in WAC
182-505-0240;
(c) WAH for kids programs as described in WAC
182-505-0210 with the following
exceptions:
(i) Newborn children born to a
woman who is eligible for WAH on the date of the newborn's birth, including a
retroactive eligibility determination;
(ii) Children who are receiving
SSI;
(iii) Children who are in
foster care or receiving subsidized adoption services.
(d) WAH MAGI-based adult medical as described
in WAC
182-505-0250; and
(e) WAH MAGI-based alien emergency medical as
described in WAC
182-507-0110.
(4) For the following SSI-related
WAH programs, unless the state has adopted more liberal rules, income rules for
the SSI program are used to determine a person's countable income:
(a) WAH noninstitutional SSI-related CN or
medically needy (MN) coverage described in chapters
182-511 and
182-512
WAC;
(b) WAH institutional
SSI-related CN or MN long-term care or hospice coverage described in chapters
182-513 and
182-515 WAC;
(c) WAH
alien emergency medical programs based on age 65 or older or disability
described in chapter
182-507 WAC; and
(d) WAH medicare savings programs described
in chapter
182-517 WAC.
(5) Anticipated nonrecurring lump sum
payments received by an applicant or recipient of a WAH SSI-related medical
program are counted as income in the month of receipt, subject to reporting
requirements, with the exception of retroactive supplemental security income
(SSI)/Social Security disability lump sum payments. See WAC
182-512-0300(4)
and
182-512-0700 for more
information.
(6) Countable income
for the WAH refugee medical (RMA) program and WAH MN program for pregnant women
and children is determined as follows:
(a) The
agency or its designee allows the following deductions from a person's gross
earnings:
(i) Fifty percent of gross earned
income;
(ii) Actual work-related
child and dependent care expenses, which are the person's responsibility;
and
(iii) Court or administratively
ordered current or back support paid to meet the needs of legal
dependents.
(b) Only
income actually contributed to an alien client from the alien's sponsor is
countable unless the sponsor signs the affidavit of support I-864 or
I-864A.
(c) Nonrecurring lump sum
payments are counted as income in the month of receipt and as a resource if the
person retains the payment after the month of receipt (resource limits do not
apply to MN coverage for pregnant women and children). For RMA, nonrecurring
lump sum payments are counted as income if received in the month of application
and not considered if received thereafter per WAC
182-507-0130.
(7) Countable income rules for
other WAH programs that are not MAGI-based or SSI-related are described in the
specific program rules listed in WAC
182-503-0510(3)(c).
(8) Some WAH programs are not based on a
person's or household's countable income but are based on a specific status or
entitlement in federal rule. The rules for these deemed eligible WAH programs
are described in WAC
182-503-0510(4).
Notes
Wash. Admin.
Code §
182-509-0001
Amended by
WSR
14-01-021, filed 12/9/13, effective 1/9/2014
Amended by
WSR
23-11-009, Filed 5/4/2023, effective
6/4/2023
11-23-091, recodified as WAC
182-509-0001, filed 11/17/11,
effective 11/21/11. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090,
74.09.530,
74.09.700, and 2007 c 5.
08-05-018, § 388-450-0210, filed 2/12/08, effective 3/14/08. Statutory
Authority:
RCW
74.08.090,
74.09.530, and 74.09.415.
05-23-013, § 388-450-0210, filed 11/4/05, effective 1/1/06. Statutory
Authority:
RCW
74.08.090,
74.08A.100,
74.09.080, and 74.09.415.
02-17-030, § 388-450-0210, filed 8/12/02, effective 9/12/02. Statutory
Authority:
RCW
74.08.090,
74.08A.100, and Title XIX State
Plan amendment 00-008. 02-03-009, § 388-450-0210, filed 1/4/02, effective
2/4/02. Statutory Authority:
RCW
74.04.050,
74.04.055,
74.04.057 and
74.08.090. 98-16-044, §
388-450-0210, filed 7/31/98, effective 9/1/98. Formerly WAC 388-505-0580,
388-505-0590 and 388-519-1910.