(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):
(a)
Annuities;
(b) Pensions;
(c) Unemployment compensation;
(d) Retirement; and
(e) 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:
(a) 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;
(b) Unspent
retroactive lump sum money from SSI or OASDI is excluded as a resource for nine
months following receipt of the lump sum; and
(c) 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:
(a) WAC
182-512-0010
for noninstitutional WAH coverage unless living in an alternate living
facility; or
(b) WAC
182-513-1205
for noninstitutional WAH CN coverage while living in an alternate living
facility; or
(c) 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:
(a) Have countable income at or below
the effective WAH MN program standard as described in WAC
182-519-0050;
(b) Satisfy spend down requirements described
in WAC
182-519-0110;
(c) Meet the requirements for
noninstitutional WAH MN coverage while living in an alternate living facility
(ALF). See WAC
182-513-1205;
or
(d) Meet eligibility for
institutional WAH MN coverage described in WAC
182-513-1315.
Notes
Wash. Admin.
Code §
182-512-0700
Amended by
WSR
14-07-059, filed 3/14/14, effective
4/14/2014
Amended by
WSR
19-13-010, Filed 6/6/2019, effective
7/7/2019
Statutory Authority:
RCW
41.05.021. 12-20-001, §182-512-0700, filed
9/19/12, effective 10/20/12. 11-24-018, recodified as WAC 182-512-0700, filed
11/29/11, effective 12/1/11. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090, and
74.09.500, and Social Security Act
as amended by P.L.
108-203. 06-04-046, § 388-475-0700, filed 1/26/06,
effective 2/26/06. Statutory Authority:
RCW
74.04.050,
74.08.090. 04-09-004, §
388-475-0700, filed 4/7/04, effective
6/1/04.
