Current through Register Vol. 24-18, September 15, 2024
Portions of a person's income the agency otherwise counts are
disregarded when determining eligibility for Washington apple health
SSI-related medical programs.
(1) The
agency disregards cost of living adjustments (COLAs) to Social Security
benefits and provides categorically needy (CN) SSI-related medicaid benefits
under the Pickle Amendment criteria of 42 C.F.R. 435.135 (1)(a) to a person
who:
(a) Is currently receiving Title II
Social Security benefits;
(b) Was
eligible for and received SSI or State Supplement payments (SSP) but became
ineligible for those payments after April, 1977; and
(c) Would still be eligible for SSI or SSP
payments if the amount of Social Security COLA increases paid under section
215(i) of the Social Security Act were deducted from the person's current Title
II Social Security benefits.
(d) To
satisfy this provision, a person must have been eligible for and received SSI
or SSP payments and in the same month was entitled to, but did not necessarily
receive, a Title II Social Security benefit for at least one month since April
1977. This includes a person who receives a Title II Social Security benefit
payment the month after the last SSI or SSP payment is made due to the fact
that Social Security is paid the month after entitlement begins.
(e) For purposes of this section, the agency
also disregards COLAs received by a person, their financially responsible
spouse, and other financially responsible family members, such as a
parent.
(2) In
determining SSI-related CN-WAH coverage, the agency disregards:
(a) Widow(er)'s benefits for a person who:
(i) Was entitled to SSA title II
(widow/widower's) benefits in December 1983;
(ii) Was at least 50 years old, but not yet
60 at that time;
(iii) Received
title II benefits and SSI in January 1984;
(iv) Would continue to be eligible for
SSI/SSP payments if the title II benefits were disregarded; and
(v) Filed an application for medicaid with
the state by July 1, 1988.
(b) Widow, Widower or Surviving Divorced
Spouse (title II) benefits for a person who:
(i) Received SSI/SSP benefits the month prior
to receipt of title II benefits;
(ii) Would continue to be eligible for
SSI/SSP benefits if the title II benefits or the COLA(s) to those benefits were
disregarded; and
(iii) Is not
eligible for medicare Part A. This person is considered an SSI recipient until
becoming entitled to medicare Part A.
(3) A disabled adult child (DAC) who is
ineligible for SSI/SSP solely due to receipt of either Social Security benefits
as a disabled adult child of a person with a Social Security account or due to
receipt of a COLA to the DAC benefits, may be income eligible for Apple Health
categorically needy (CN) health care coverage if disregarding the SSA DAC
benefits and COLA brings countable income below the CN standards, and the
person:
(a) Is 18 years of age or
older;
(b) Remains related to the
SSI program through disability or blindness;
(c) Lost SSI eligibility on or after July 1,
1988, due solely to the receipt of DAC benefits from SSA or a COLA to those
benefits; and
(d) Meets the other
SSI-related CN medical requirements.
(4) A person is eligible for CN coverage if:
(a) In August 1972, the person received:
(i) Old age assistance (OAA);
(ii) Aid to blind (AB);
(iii) Aid to families with dependent children
(AFDC); or
(iv) Aid to the
permanently and totally disabled (APTD).
(b) The person was entitled to or received
retirement, survivors, and disability insurance (RSDI) benefits; or
(c) The person was ineligible for OAA, AB,
AFDC, SSI, or APTD solely because of the 20 percent increase in Social Security
benefits under P.L. 92-336.
(5) People who stop receiving an SSI cash
payment due to earnings, but still meet all of the other SSI eligibility rules
and have income below the higher limit established by the Social Security Act's
Section 1619(b) are eligible for continued WAH CN medicaid.
(6) TANF income methodology is used to
determine countable income for children and pregnant people applying for
medically needy (MN) coverage unless the SSI methodology would be more
beneficial to the person. When using the TANF income methodologies, deduct:
(a) A 50 percent earned income disregard
described in WAC
388-450-0170;
(b) Actual child care and dependent care
expenses related to employment; and
(c) Child support actually paid.
(7) The agency disregards a
person's income over 150 percent of the FPL when determining eligibility for
the community behavioral health support services (CBHS) benefit under chapter
182-561 WAC. This disregard only applies to eligibility for the CHBS benefit
and does not apply to:
(a) Long-term services
and supports eligibility determinations under chapters 182-513 and 182-515 WAC;
or
(b) Post-eligibility treatment
of income (PETI).
11-24-018, recodified as WAC 182-512-0880, filed 11/29/11,
effective 12/1/11. Statutory Authority:
RCW
74.04.050,
74.08.090. 04-09-005, §
388-475-0880, filed 4/7/04, effective
6/1/04.
