Current through Register Vol. 24-18, September 15, 2024
The agency considers the income of financially responsible
persons to determine if a portion of that income is available to other
household members.
(1) A portion of
the income of a nonapplying spouse is considered available to meet the needs of
a Washington apple health SSI-related applicant. A nonapplying spouse is
defined as someone who is:
(a) Financially
responsible for the SSI-related applicant as described in WAC
182-506-0015 and
182-512-0960. For apple health
institutional and home and community based waiver programs, see WAC
182-513-1315;
(b) Living in the same household with the
SSI-related applicant;
(c) Not
receiving a needs based payment such as temporary assistance to needy families
(TANF) or state-funded cash assistance (SFA); or
(d) Not related to SSI, or is not applying
for apple health coverage including spouses receiving SSI.
(2) An ineligible spouse is the spouse of an
SSI cash recipient and is either not eligible for SSI for themselves or who has
elected to not receive SSI cash so that their spouse may be eligible. An
SSI-related applicant who is the ineligible spouse of an SSI cash recipient is
not eligible for apple health categorically needy (CN) health care coverage and
must be considered for health care coverage under the apple health medically
needy (MN) program or for a modified adjusted gross income-based program if the
person does not receive medicare.
(3) When determining whether a nonapplying
spouse's income is countable, the agency:
(a)
Follows the income rules described in WAC
182-512-0600 through
182-512-0780;
(b) Excludes income described in WAC
182-512-0800 (2) through
(10), and all income excluded under federal
statute or state law as described in WAC
182-512-0860;
(c) Excludes work-related expenses described
in WAC 182-512-0840, with the exception
that the $65 plus one half earned income deduction described in WAC
182-512-0840(2)
does not apply;
(d) Deducts any
court ordered child support which the nonapplying spouse pays for a child
outside of the home (current support or arrears); and
(e) Deducts any applicable child-related
income exclusions described in WAC
182-512-0820.
(4) The agency allocates income of
the nonapplying spouse to non-applying children who reside in the home as
described in WAC
182-512-0820. Allocations to
children are deducted first from the non-applying spouse's unearned income,
then from their earned income.
(a) For apple
health CN medical determinations, allocations to children are not allowed out
of the income of the SSI-related applicant, only from the income of the
nonapplying spouse.
(b) For apple
health MN medical determinations, allocations to children are allowed from the
income of the SSI-related applicant if the applicant is unmarried.
(5) For apple health SSI-related
CN medical determinations, a portion of the countable income of a nonapplying
spouse remaining after the deductions and allocations described in subsections
(3) and (4) of this section may be deemed to the SSI-related applicant. If the
nonapplying spouse's countable income is:
(a)
Less than or equal to one-half of the federal benefit rate (FBR), no income is
deemed to the applicant. Compare the applicant's countable income to the
one-person SSI categorically needy income level (CNIL) described in WAC
182-512-0010.
(b) Greater than one-half of the FBR, then
the entire nonapplying spouse's countable income is deemed to the applicant.
Compare the applicant's income to the two-person SSI CNIL.
(6) When income is not deemed to the
SSI-related applicant from the nonapplying spouse per subsection (5)(a) of this
section, allow all allowable income deductions and exclusions as described in
chapter 182-512 WAC to the SSI-related applicant's income, and compare the net
remaining income to the one-person SSI CNIL.
(7) When income is deemed to the SSI-related
applicant from the nonapplying spouse per subsection (5)(b) of this section:
(a) Combine the applicant's unearned income
with any unearned income deemed from the nonapplying spouse and allow one $20
general income exclusion to the combined amount. If there is less than $20 of
unearned income, the remainder of the $20 general income exclusion is deducted
from earned income.
(b) Combine the
applicant's earned income with any earned income deemed from the nonapplying
spouse and allow the $65 plus one half of the remainder earned income deduction
(described in WAC
182-512-0840(2))
to the combined amount.
(c) Add
together the net unearned and net earned income amounts and compare the total
to the two-person SSI CNIL described in WAC
182-512-0010. If the income is
equal to or below the applicable two-person standard, the applicant is eligible
for apple health CN health care coverage.
(8) An SSI-related applicant who is working,
whose level of work activity and earnings is determined not to be "substantial
gainful activity" in accordance with all applicable Social Security disability
determination rules and standards, but who is not eligible for apple health CN
coverage under the regular apple health SSI-related program, may be considered
for eligibility under the HWD program. For HWD program rules, see chapter
182-511 WAC.
(9) If the SSI-related
applicant's countable income is above the applicable SSI CNIL standard, the
agency or its authorized representative considers eligibility under the apple
health MN program or under the HWD program if the person is working. An
SSI-related applicant who meets the following criteria is not eligible for
apple health MN coverage and eligibility must be determined under HWD or under
a MAGI-based apple health program:
(a) The
applicant is blind or disabled and, for a MAGI-based apple health program,
under the age of 65;
(b) The
applicant's level of work activity and earnings is determined to be
"substantial gainful activity" in accordance with all applicable Social
Security disability determination rules and standards; and
(c) The applicant is not receiving a title II
Social Security cash benefit based on blindness or disability.
(10) For SSI-related apple health
MN medical determinations, a portion of the countable income of a nonapplying
spouse remaining after the deductions and allocations described in subsections
(3) and (4) of this section may be deemed to the SSI-related applicant. If the
nonapplying spouse's countable income is:
(a)
Less than or equal to the effective one-person MNIL described in WAC
182-519-0050, no income is deemed
to the applicant and a portion of the applicant's countable income is allocated
to the nonapplying spouse's income to raise it to the effective MNIL
standard.
(b) Greater than the
effective MNIL, then the amount in excess of the effective one-person MNIL is
deemed to the applicant. Compare the applicant's income to the effective
one-person MNIL.
(11)
When income is not deemed to the SSI-related applicant from the nonapplying
spouse per subsection (10)(a) of this section:
(a) Allocate income from the applicant to
bring the income of the nonapplying spouse up to the effective one-person MNIL
standard;
(b) Allow all allowable
income deductions and exclusions as described in chapter 182-512 WAC to the
SSI-related applicant's remaining income;
(c) Allow a deduction for medical insurance
premium expenses (if applicable); and
(d) Compare the net countable income to the
effective one-person MNIL.
(12) When income is deemed to the SSI-related
applicant from the nonapplying spouse per subsection (10)(b) of this section:
(a) Combine the applicant's unearned income
with any unearned income deemed from the nonapplying spouse and allow one $20
general income exclusion to the combined amount (if there is less than $20 of
unearned income, the remainder of the $20 general income exclusion is deducted
from earned income);
(b) Combine
the applicant's earned income with any earned income deemed from the
nonapplying spouse and allow the $65 plus one half of the remainder earned
income deduction (described in WAC
182-512-0840(2))
to the combined amount;
(c) Add
together the net unearned and net earned income amounts;
(d) Allow a deduction for medical insurance
premium expenses (if applicable) per WAC
182-519-0100(5);
and
(e) Compare the net countable
income to the effective one-person MNIL described in WAC
182-519-0050. If the income is:
(i) Equal to or below the effective
one-person MNIL, the applicant is eligible for apple health MN health care
coverage with no spenddown.
(ii)
Greater than the effective MNIL, the applicant is only eligible for apple
health MN health care coverage after meeting a spend-down liability as
described in WAC
182-519-0110.
(13) The ineligible
spouse of an SSI-cash recipient applying for apple health MN coverage is
eligible to receive the deductions and allocations described in subsection
(10)(a) of this section.
Statutory Authority:
RCW
41.05.021. 12-20-001, §182-512-0920,
filed 9/19/12, effective 10/20/12. 11-24-018, recodified as WAC 182-512-0920,
filed 11/29/11, effective 12/1/11. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090, and
74.09.500. 11-15-023, §
388-475-0920, filed 7/8/11, effective
8/8/11.
