(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).
[Statutory Authority: RCW
41.05.021 and
41.05.160. WSR 23-11-009, § 182-509-0001, filed 5/4/23, effective 6/4/23. Statutory Authority: RCW
41.05.021, Patient Protection and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, 457, and 45 C.F.R. § 155. WSR 14-01-021, § 182-509-0001, filed 12/9/13, effective 1/9/14. WSR 11-23-091, recodified as § 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. WSR 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. WSR 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. WSR 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. WSR 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. WSR 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.]
