PDFWAC 182-512-0880
SSI-related medical—Special income disregards.
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).
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-10-083, § 182-512-0880, filed 4/30/24, effective 7/1/24. Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148), 42 C.F.R. §§ 431, 435, 457 and 45 C.F.R. § 155. WSR 14-07-059, § 182-512-0880, filed 3/14/14, effective 4/14/14. WSR 11-24-018, recodified as § 182-512-0880, filed 11/29/11, effective 12/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 04-09-005, § 388-475-0880, filed 4/7/04, effective 6/1/04.]