Income
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Income


Revised October 22, 2014


Effect of income on Eligibility and Benefit Level


Purpose: This section contains rules and procedures for determining countable income for cash, medical, and Basic Food.

WAC 182-509-0001Countable income for Washington apple health programs.
WAC 388-450-0162How does the department count my income to determine if my assistance unit is eligible and how does the department calculate the amount of my cash and Basic Food benefits?
WAC 388-450-0165Gross earned income limit for TANF / SFA.
WAC 388-450-0170Does the department provide an earned income deduction as an incentive for persons who receive TANF/SFA to work?
WAC 388-450-0185What income deductions does the department allow when determining if I am eligible for food benefits and the amount of my monthly benefits?
WAC 388-450-0190How does the department figure my shelter cost income deduction for Basic Food?
WAC 388-450-0195Does the department use my utility costs when calculating my Basic Food or WASHCAP benefits?
WAC 388-450-0200Will the medical expenses of elderly persons or individuals with disabilities in my assistance unit be used as an income deduction for Basic Food?

WAC 182-509-0001

WAC 182-509-0001

Effective October 1, 2013

WAC 182-509-0001 Countable income for Washington apple health programs.



(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);

(b) For WAH SSI-related CN coverage, see WAC 182-512-0010;

(c) For WAH MN coverage, see WAC 182-519-0050;

(d) For WAH for workers with disabilities, see WAC 182-511-1060;

(e) For WAH medicare savings programs, see WAC 182-517-0100;

(f) For WAH noninstitutional medical in an alternative living facility, see WAC 182-513-1305; and

(g) For WAH long-term care programs, see WAC 182-513-1315 and 182-513-1395.

(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;

(b) WAH pregnancy program as described in WAC 182-505-0115;

(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 sixty-five 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).

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 388-450-0162

WAC 388-450-0162

Effective October 1, 2013

WAC 388-450-0162 How does the department count my income to determine if my assistance unit is eligible and how does the department calculate the amount of my cash and Basic Food benefits?

1.    Countable income is all income your assistance unit (AU) or your child-only means-testing AU has after we subtract the following:

a.    Excluded or disregarded income under WAC 388-450-0015

b.    For cash assistance, earned income incentives and deductions allowed for specific programs under WAC 388-450-0170 and 388-450-0175;

c.    For Basic Food, deductions allowed under WAC 388-450-0185; and

d.    Income we allocate to someone outside of the assistance unit under WAC 388-450-0095 through WAC 388-450-0160.

2.    Countable income includes all income that we must deem or allocate from financially responsible persons who are not members of your AU under WAC 388-450-0095 through 388-450-0160.

3.    Starting November 1, 2011, we may apply child-only means-testing to determine eligibility and your payment standard amount.

a.    Child-only means-testing applies when you are a nonparental relative or unrelated caregiver applying for or receiving a nonneedy TANF/SFA grant for a child or children only, unless at least one child was placed by a state or tribal child welfare agency and it is an open child welfare case.

b.    For the purposes of child-only means-testing only, we include yourself, your spouse, your dependents, and other persons who are financially responsible for yourself or the child as defined in WAC 388-450-0100 in your assistance unit (AU). We call this your child-only means-testing AU.

c.    As shown in the chart below, we compare your child-only means-testing AU's total countable income to the current federal poverty level (FPL) for your household size to determine your child-only means-testing payment standard. Your child-only means-tested payment standard is a percentage of the payment standards in WAC 388-478-0020.

If your countable child-only means-testing AU income is:

 Your child-only means-tested payment standard is equal to the following percentage of the payment standards in WAC 388-478-0020:

 200% FPL or less

 100%

Between 201% and 225% of FPL

 80%

Between 226% and 250% of FPL

 60%

Between 251% and 275% FPL

40%

Between 276% and 300% FPL

 20%

 Over 300% of the FPL

 The children in your care are not eligible for a TANF/SFA grant.

 

d.    If the children in your care qualify for a TANF/SFA grant once the child-only means-test is applied, the child's income is budgeted against the child-only means-tested payment standard amount.

 

4.    For cash assistance:

a.     We compare your countable income to the payment standards in WAC 388-478-0020 and WAC 388-478-0033 or, for child-only means-tested cases, to the payment standard amount in subsection (3).

b.     You are not eligible for benefits when your AU's countable income is equal to or greater than the payment standard plus any authorized additional requirements.

c.      Your benefit level is the payment standard and authorized additional requirements minus your AU's countable income.

5.   For Basic Food, if you meet all other eligibility requirements for the program under WAC 388-400-0040, we determine if you meet the income requirements for benefits and calculate your AU's monthly benefits as specified under Title 7 Part 273 of code of federal regulations for the supplemental nutrition assistance program (SNAP). The process is described in brief below:

a.    How we determine if your AU is income eligible for Basic Food:

i.      We compare your AU's total monthly income to the gross monthly income standard under WAC 388-478-0060. We don't use income that isn't counted under WAC 388-450-0015 as a part of your gross monthly income.

ii.    We then compare your AU's countable monthly income to the net income standard under WAC 388-478-0060.

A.    If your AU is categorically eligible for Basic Food under WAC 388-414-0001, your AU can have income over the gross or net income standard and still be eligible for benefits.

B.    If your AU includes a person who is sixty years of age or older or has a disability, your AU can have income over the gross income standard, but must have income under the net income standard to be eligible for benefits.

C.   All other AUs must have income at or below the gross and net income standards as required under WAC 388-478-0060 to be eligible for Basic Food.

b.     How we calculate your AU's monthly Basic Food benefits:

i.      We start with the maximum allotment for your AU under WAC 388-478-0060.

ii.    We then subtract thirty percent of your AU's countable income from the maximum allotment and round the benefit down to the next whole dollar to determine your monthly benefit.

iii.   If your AU is eligible for benefits and has one or two persons, your AU will receive at least the minimum allotment as described under WAC 388-412-0015, even if the monthly benefit we calculate is lower than the minimum allotment.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Utility Chart
Medical Expense Deduction for Basic Food Chart

CLARIFYING INFORMATION

1.   We reduce the cash or Basic Food benefit amount by any sanction penalties or overpayment deductions before issuing a benefit.

2.   For information on how the cash benefit amount is calculated for the first month of eligibility, see WAC 388-450-0225.

3.   For cash assistance, when an AU contains eight or more people we calculate the benefit level by subtracting the countable income from the appropriate payment standard.  The grant payment cannot  exceed the maximum monthly payment of $941.00.  See WAC 388-478-0020  for cash assistance payment standards.


EXAMPLE

Nine-person TANF AU with countable income of $75.

 

Payment standard

$1033

Less net countable income

     -75

Benefit level

$958

Grant Payment

$941  (maximum payment)


4.   The following guidelines apply to means testing of non-parental child-only grants:

a.    To determine eligibility and benefit amount, we define who to include in the AU as the applicant or recipient TANF child(ren), the caregiver, the caregiver’s spouse, all of the caregiver’s dependents, and any other persons financially responsible for the caregiver or for the TANF child(ren).

b.    A means test based on the Federal Poverty Level will be applied to the TANF/SFA payment standards. The means test will be applied after the countable income of the entire household, including the TANF child’s income, is determined, and before the TANF child’s income is budgeted against the appropriate payment standard.

c.    Caregivers of children placed by a state or tribal welfare agency with an open case are exempt from the means test. Even if only one of the TANF children in the household meets the criteria for the child welfare exemption, the whole household is exempt from means testing.

d.    SSNs will be requested for all child-only means-testing AU members. SSNs will not be required for members who have another way to verify their income.

 


EXAMPLE

An aunt and uncle are caring for their 10 year old niece. They have two minor children of their own. They apply for TANF for the niece. For means testing purposes, the AU consists of the aunt and uncle, their two children, and their niece, for a family size of five. None of the children have income but the aunt is employed part-time and the uncle is retired. The aunt earns $1,000 per month and the uncle receives $2,500 per month in retirement income. We apply the 50% disregard to both the aunt's earned income and the uncl's unearned income so the total countable income is $1,750. Since 200% of the 2014 Federal Poverty Level (FPL) for a family of five is $4,652, the niece qualifies for a full TANF grant.


EXAMPLE

Similar scenario as above but the aunt and uncle have no minor children of their own, so the family size is three. This time both aunt and uncle are retired with a combined unearned income of $7,000 per month, which means countable income of $3,500 after the 50% disregard The niece has no income. Since the household income falls between 201% ($3,315) and 225% ($3,710) of FPL for a family of three, the niece's TANF grant is based on a payment standard reduced by 20%.


NOTE:

The Federal Poverty Level and payment standard calculations described above will all be done by ACES. The worker’s responsibility will be to determine the appropriate means testing household composition, verify household’ income, and enter this information into ACES (see Worker Responsibilities below).


How to Calculate Basic Food benefits

 

Staff must understand how to calculate Basic Food benefits in order to explain how a client's income and circumstances affect their benefits.  Use the following procedures to determine an AU's Basic Food benefits.

 

Gross income:

  1. Determine total countable gross income for all AUs as follows:
    1. Include all dollar and cent amounts when calculating;
    2. Add all non-excluded earned income from all sources;
    3. Add all non-excluded unearned income from all sources; and
    4. Add all deemed and allocated income.
  2. Compare total countable gross income to the gross income standard.
  3. Deny the application or terminate benefits for AUs with income above the gross income standard under WAC 388-478-0060 unless the AU:

§         Includes an elderly or disabled person; or

§         Is categorically eligible (CE) under WAC 388-414-0001.  

   4.    Determine net income for AUs that meet the gross income standard and for AUs containing

          an elderly or disabled member.

Net income:  

Start with all dollar and cent amounts for income that is not excluded for Basic Food and all allowable expenses.

  1. Subtract the following from the AU’s gross income:
    1. The appropriate standard deduction based on AU size;
    2. The earned income deduction, if appropriate, which is 20% of gross earned income;
    3. Out-of-pocket dependent care expenses;
    4. Allowable non-reimbursable medical expenses over $35 for persons in the AU who are elderly or disabled.
    5. Legally obligated child support payments made by an AU member to or for a person who is not a member of the AU. 
  2. Calculate the shelter cost income deduction:
    1. Start with the AU’s allowable monthly shelter costs including the utility deduction;
    2. Subtract ½ of the result from step 1. above.

§     If the AU includes a person who is elderly or has a disability, we use the result from step b above as the shelter cost income deduction.

§     If the AU does not include an elderly or disabled person, we use the lesser amount of the result from step b or the maximum shelter deduction for these households under WAC 388-450-0190.  

  1. Take the result from step 1.  Subtract the result from step 2 to calculate the AU’s net income.  Round this value to the nearest whole dollar (Round up from $.50 and down from $.49.)
  2. Compare net income from step 3 to the net income standard.

Eligibility: 

Deny or terminate benefits if they are not CE under 388-414-0001 and they have net income over the net income limit under WAC 388-478-0060.

 

Benefit level:

 

For eligible AUs, determine their monthly benefit level by using the allotment formula or basis of issuance tables:

 

Allotment formula:

  • Multiply the AU's net income by 30%;
  • Round this amount up to the next whole dollar; and
  • Subtract the result from the Maximum Allotment for the number of eligible AU members.

Basis of Issuance:   

Use the AU’s net income and household size to look up their monthly benefit amount using the Basis of Issuance Table - DSHS 12-006.


WORKER RESPONSIBILITIES

In an emergency situation when ACES is not available, calculate benefits for an AU eligible for Basic Food benefits by using Steps 1 - 3 above.

 

ACES is programmed to determine benefits for AUs appropriately based on the circumstances of the household including citizenship and alien status.  For households with non-citizens members, ensure that you code the (ALAS) screen in ACES correctly and update an immigrant’s information at recertification.


How to Calculate Cash Assistance (Means Testing) for Non-parental Child-Only Caregivers starting November 1, 2011:

 

  1. Determine if any TANF child in the household is exempt from income means testing based on a state or tribal child welfare placement and an “open” child welfare case. Ask the caregiver if the child in their care was placed by a state or tribal child welfare agency.

a.    State child welfare cases are coded with an “R” or “F” in the Relative Placement field on the child’s DEM1 screen in ACES.

b.    Tribal-placed child-only cases may not be coded in ACES and may have to be identified  by phone contact with individual tribes. Follow your local protocol for communication with tribes, such as contacting your local tribal liaison.  If you are unsuccessful in confirming a placement through a tribal liaison, please contact Kerry Judge (360-725-4630 or Judgeka@dshs.wa.gov) or Tom Berry (360-725-4617 or berrytj@dshs.wa.gov) at CSD headquarters.

c.    If you successfully determine an open child welfare placement, the child is exempt from means testing and you should continue to process and finalize the TANF grant

2.    If the child is not exempt from means testing, determine who is in the child-only means-testing  household based on TANF household composition rules and enter this information into ACES.

  1. Verify the countable income of all members of the child-only means testing household, based on TANF rules for what income is countable. Enter this information into ACES under the appropriate household member.
  2. ACES will determine eligibility for the TANF child(ren) and the appropriate TANF payment standard if the child-only means-tested AU income is 300% of the Federal Poverty Level or less. If the means tested income is over 300% ACES will automatically close the child-only TANF grant.
  3. If the household passes the means test the ACES system will budget only the TANF child’s countable income against the appropriate payment standard and determine the actual benefit amount.

WAC 388-450-0165
WAC 388-450-0165

Effective March 8, 2004

WAC 388-450-0165 Gross earned income limit for TANF / SFA.

When applying the gross earned income limit as required under WAC 388-478-0035

  1. "Family" means:

    1. All adults and children who would otherwise be included in the assistance unit under WAC 388-408-0015, but who do not meet TANF / SFA eligibility requirements;

    2. The unborn child of a woman in her third trimester of pregnancy; and

    3. The husband of a woman in her third trimester of pregnancy, when residing together.

  2. "Gross earned income" does not include excluded income, as provided in WAC 388-450-0015.

  3. The following amounts are disregarded when determining a family's gross earned income:

    1. Court or administratively ordered current or back support paid to meet the needs of legal dependents, up to:

      1. The amount actually paid; or

      2. A one-person need standard for each legal dependent.

    2. Authorized ongoing additional requirement payment as defined in chapter 388-473 WAC .

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

To find the gross earned income limit for TANF/SFA, see  WAC 388-478-0035, Maximum earned income limits for TANF and SFA.


WAC 388-450-0170
WAC 388-450-0170

Effective October 1, 2013

WAC 388-450-0170 Does the department provide an earned income deduction as an incentive for persons who receive TANF/SFA to work?

This section applies to TANF / SFA, RCA, and PWA.  

  1. If a client works, the department only counts some of the income to determine eligibility and benefit level.

  2. We only count fifty percent of your monthly gross earned income.  We do this to encourage you to work.

  3. If you pay for dependent care before we approve your benefits, we subtract the amount you pay for those dependent children or incapacitated adults who get cash assistance with you.

    1. The amount we subtract is:

      1. Prorated according to the date you are eligible for benefits;

      2. Cannot be more than your gross monthly income; and

      3. Cannot exceed the following for each depending child or incapacitated adult:

Dependent Care Maximum Deductions
Hours Worked Per Month Child Two Years of Age & Under Child Over Two Years of Age or Incapacitated Adult

0 - 40

$ 50.00

$ 43.75

41 - 80

$ 100.00

$ 87.50

81 - 120

$ 150.00

$131.25

121 or More

$ 200.00

$175.00

b.  In order to get this deduction:

i.  The person providing the care must be someone other than the parent or stepparent of  the child or incapacitated adult; and

ii.  You must verify the expense.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. If a client does not report income timely and we later discover this income, we recalculate the client's benefits as if they had reported timely and determine if there is a benefit error.  Clients still receive the 50% earned income incentive. 
  2. ABD  clients receive an earned income incentive and as described in WAC 388-450-0175, ABD earned income incentive .

  3. When we determine the dependent care maximum deduction, we use a child's age on the first day of the month as the child's age for that month (e.g., If a child turns two on August 15, we consider the child as under two for August and two years of age in September).


WAC 388-450-0175
Error processing SSI file

WAC 388-450-0185

WAC 388-450-0185

Effective October 1, 2014

WAC 388-450-0185 What income deductions does the department allow when determining if I am eligible for food benefits and the amount of my monthly benefits?



We determine if your assistance unit (AU) is eligible for Basic Food and calculate your monthly benefits according to requirements of the Food and Nutrition Act of 2008 and federal regulations related to the supplemental nutrition assistance program (SNAP).

These federal laws allow us to subtract only the following amounts from your AU's total monthly income to determine your countable monthly income under WAC 388-450-0162:

  1. A standard deduction based on the number of eligible people in your AU under WAC 388-408-0035: 

Eligible AU members

Standard deduction

1

$155

2

$155

3

$155

4

$165

5

$193

6 or more

$221

  1. Twenty percent of your AU's gross earned income (earned income deduction);
  2. Your AU's expected monthly dependent care expense needed for an AU member to:
    1. Keep work, look for work, or accept work;
    2. Attend training or education to prepare for employment; or
    3. Meet employment and training requirements under chapter 388-444 WAC.
  3. Medical expenses over thirty-five dollars a month owed or anticipated by an elderly or disabled person in your AU as allowed under WAC 388-450-0200.
  4. A portion of your shelter costs as described in WAC 388-450-0190.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

For information on the shelter deductions, see WAC 388-450-0190.

For information on utility allowances, see WAC 388-450-0195.

For information on medical deductions, see WAC 388-450-0200.

The following topics related to the above WAC are discussed below.

Standard Deduction

  1. The Federal government sets the standard deduction each October by comparing 8.31% of the current federal poverty rate for the number of AU members to $134. The standard deduction is the larger of the two figures.
  2. For the standard deduction, we count eligible AU members only.  We do not count ineligible members such as someone disqualified as an ineligible alien, or for an intentional program violation (IPV), and non-members such as ineligible students or someone who lives in the residence but is not an AU member under WAC 388-408-0035.

 Child Support Payments

  1. We exempt court-ordered child support payments from gross income prior to administering the gross income test.
  2. We exempt the lesser of the amount paid or the amount legally obligated.  We do not exempt an amount that is voluntarily paid over the legal obligation.

 


NOTE:

We allow an amount over the monthly support order if it is to repay back child support the client is legally obligated to pay.


  1. We do not exempt payments that are not legally obligated.  Examples of payments that do not qualify for this exemption are voluntary payments and contributions for a child's needs not specified in the court order.
  2. Clients do not have to report changes in the amount of child support they pay. We do not consider failure to pay child support as a change of circumstance.  We are required to act on a change if clients report an increase or decrease in child support.
  3. In addition to support paid for children outside the home, we allow the exemption when clients pay support for children now in the AU when the support is:
    1. Legally obligated; and
    2. For a period of time the child was outside the support payer's home.
  1. If someone outside the AU consistently pays the child support obligation, we allow the child support exemption only if the AU member must repay the amount under a bona fide loan agreement. 
  2. If a child support order requires the client to make an in-kind child support payment instead of, or in addition to a cash payment, we allow the amount the client pays for this expense as a child support exemption. Examples of these in-kind orders include requirements for the non-custodial parent to pay a portion of child care or medical costs.

Dependent Care Deductions

  1. We allow all of the out-of-pocket cost for dependent care for the dependent care deduction.  This deduction is no longer limited based on the age of the person receiving care.
  2. Dependent care expenses don’t need to be verified unless they are questionable.
  3. Out-of-pocket travel expenses incurred when transporting dependents to and from a child care provider are allowable as part of the Basic Food dependent care deduction.

     

    1. When determining the mileage incurred for dependent care transportation don’t include the normal commute mileage by the Basic Food assistance unit (AU).
    2. Only allow the dependent care transportation expense for the additional mileage incurred by the AU member.  Use the current business IRS mileage rate to estimate the allowable deduction.
    3. Costs for other means of transporting dependents to and from the child care facility such as public transportation, paying a friend or relative outside the AU, or paying an additional amount for the daycare provider to transport dependents, are also allowable deductions.
    4. If client is claiming an amount over the IRS mileage rate estimate then the claimed expenses should be considered questionable and must be verified.

EXAMPLE

The day care center is located on the route the AU member drives to work. When the stop at the day care center is added, the mileage does not change.  The AU is not eligible for a dependent care transportation deduction as no additional expense occurs.


EXAMPLE

The AU member takes her child to a day care center not located on her route to work. When the stop at the day care center is added, she drives an additional 10 miles in the morning and an additional 10 miles in the afternoon 5 days per week.  The AU is eligible for a dependent care transportation deduction. The actual related transportation expense is the 20 miles per day associated with the travel to the day care center.


NOTE:

Accept a client’s statement of dependent care transportation mileage unless it is questionable.  MapQuest or Google Maps can be used if the mileage is unknown or questionable.


  1. When a portion of the client's dependent care expenses are paid by Working Connections Child Care (WCCC) or any other source, the client may claim the dependent care deduction for the portion not paid by someone else. 
  2. Some clients have both subsidized and private-pay child care expenses.  Clients can receive the deduction for both, as long as the requirements of WAC 388-450-0185 are met.
  3. Child care expenses for educational purposes:
    1. If we disregard a client's educational benefits under WAC 388-450-0035, we can only allow a deduction for the anticipated child care expense above the amount "earmarked" for dependent care expenses.
    2. We prorate earmarked funds over the period that the clients are intended to use the educational benefits.

EXAMPLE

Client receives $1200.00 Educational Benefits through the Perkins Act for January-March.  $400.00 is identified as being for childcare expenses.  Client pays $195.00 monthly for the care of her five-year old daughter.

$195.00

Monthly cost of childcare

-133.33

$400 Earmarked expense ÷ 3 months

$61.67

Allowable dependent care deduction


NOTE:

There is no federal definition for "training or education to prepare for employment."  This could be a short-term course or a four-year college, as long as it would be reasonable to expect that it would help the client become employed.


7.   Dependent care deduction when the person with income is an ineligible AU member:

If the ineligible member has income and dependent care expense billed to or paid by the ineligible member(s), we determine the deduction by:

·         Dividing the expenses evenly among all the AU's eligible and ineligible members; and

·         Assigning the prorated share of such expenses to the eligible members.

8.      WCCC co-payment waived by the provider:

 

We allow the dependent care deduction for a client's WCCC co-pay even if the provider waives the fee on a regular basis.


NOTE:

A household can only deduct expenses if the service is provided by someone outside of the assistance unit (AU) and the household makes a money payment for the service. For example, a dependent care deduction is not allowed if another household member provides the care, or compensation for the care is provided in the form of an in-kind benefit, such as food.


DEDUCTIONS FOR AUs with SPECIAL CIRCUMSTANCES

1.  Drug and Alcohol Treatment Facilities:

We allow the following deductions for clients who are paying a part of the cost of  their own care:

a.      Standard deduction;

b.      The amount the client pays as a medical cost if treatment is prescribed by a physician; and

c.      The amount the client pays that we do not use as a deduction in (ii) above as a shelter expense up to the shelter maximum.

Clients that do not pay a part of the cost of their own care receive the standard deduction only.


NOTE:

The deductions described above for D&A treatment facilities applies only when a client has been in the facility for more than 30 days.


2.      Group living arrangements:

For clients who live in group-homes, we follow normal eligibility procedures other than shelter costs.  We determine the shelter costs for clients that pay room and board by deducting the maximum allotment for one person from the amount paid to the home. 

See WAC 388-478-0060 for maximum allotment.


WAC 388-450-0190
WAC 388-450-0190

Effective October 1, 2014

WAC 388-450-0190 How does the department figure my shelter cost income deduction for Basic Food?

 

 The department calculates your shelter cost income deduction as follows: 

1.    First, we add up the amounts your assistance unit (AU) must pay each month for shelter. We do not count any overdue amounts, late fees, penalties or mortgage you make ahead of time as an allowable cost. We count the following expenses as an allowable shelter cost in the month the expense is due:

a.    Monthly rent, lease, and mortgage payments;

b.    Property taxes;

c.    Homeowner's association or condo fees;

d.    Homeowner's insurance for the building only;

e.    Utility allowance your AU is eligible for under WAC 388-450-0195;

f.     Out-of-pocket repairs for the home if it was substantially damaged or destroyed due to a natural disaster such as a fire or flood;

g.    Expense of a temporarily unoccupied home because of employment, training away from the home, illness, or abandonment caused by a natural disaster or casualty loss if your:

                                      i.        AU intends to return to the home;

                                    ii.        AU has current occupants who are not claiming the shelter costs for Basic Food purposes; and

                                   iii.        AU's home is not being leased or rented during your AU's absence.

2.    Second, we subtract all deductions your AU is eligible for under WAC 388-450-0185 (1) through (4) from your AU's countable income. The result is your AU's net income.

3.    Finally, we subtract one-half of your AU's countable income from your AU's total shelter costs. The result is your excess shelter costs. Your AU's shelter cost deduction is the excess shelter costs:

a.    Up to a maximum of four hundred ninety dollars if no one in your AU is elderly or disabled; or

b.    The entire amount if an eligible person in your AU is elderly or disabled, even if the amount is over four hundred ninety dollars.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

Allowable shelter costs:

We allow the following ongoing and current shelter costs when calculating the shelter deductions for an assistance unit (AU):

  1. We allow monthly rent cost including mandatory lease agreement fees for extra non-food expenses (e.g., cable, furniture, garage, and storage).

  • We count non-food expenses only when the lease or contract requires the client to pay the fees.  For example, if a client's rent includes cable and the cable expense is not optional, then the expense is considered mandatory and is allowable;

  • We do not count a mandatory fee for daily meals or toiletries as a shelter cost.

  • We use the cost a client must pay if the rent is paid on time as the rent cost.  We do not change the allowable shelter costs due to discounts for early payment or fees for late payment.

  • For AUs receiving HUD, FHA, or other rental subsidies, we allow only the out-of-pocket rent expense for the AU.

  • We allow money paid by one AU to another AU living in the same residence for a share of the total rent.

  • We allow rent paid in advance as an expense for the month the rent is due.


NOTE:

Shelter costs should be entered on the SHEL screen of any ineligible AU member that has income to ensure correct proration of shelter costs.


EXAMPLE

Larry receives a severance package of $1,500 from a former employer. Because Larry knows that hours where he works vary by season, he decides to pay his $250.00 rent for September through February in July.


2.    For group home residents who pay a flat fee for room and board, we calculate allowable shelter costs by subtracting the one-person maximum allotment for Basic Food from the amount paid to the home.

3.    AU members that own or are buying a home can use the following home-ownership expenses as a shelter cost:

·         Payments on first and / or second mortgages (including home equity loans & home equity lines of credit);

·         Real estate contract payments, loan payments including interest, leading to ownership of the house or mobile home;

·         Property taxes.  When an AU has their property taxes deferred to a later date, we allow only the deductions for the taxes at the point the tax would be due without a deferral.  We do not allow taxes as a shelter cost if the taxes have been waived;

·         State and local assessments;

·         The entire amount of condo fees;

·         Mandatory homeowner's association fees;

·         Structural insurance only. We allow the total cost of structural and furnishings insurance only when the structural insurance cannot be separated from coverage for furniture and belongings;

·         Cost of an unoccupied home as allowed in WAC 388-450-0190;

·         Cost of home repairs resulting from a natural disaster such as fire or flood. We do not allow costs covered by insurance or other public or private sources; and

·         Costs for more than one residence in a single month when an AU moves mid-month.

 Non-allowable shelter costs:

We do not allow the following costs as a part of the shelter deduction:

·         The unpaid value of shelter a client receives free or at a reduced cost in exchange for work;

·         In-kind or non-cash payments instead of paying rent (e.g., client purchases $300 worth of household supplies instead of paying $300 to a roommate or landlord.)

·         Payments on a mortgage in excess of monthly minimum payment (pre-paying mortgage);

·         Down payments on a mortgage;

·         Balloon payments on a mortgage;

·         A payment toward the purchase of a home that is made after the last contract payment for the home;

·         A payment on a foreclosed home if the client is no longer legally obligated to pay the mortgage;

·         An HUD add-on to contract rental charges to recover previously undercharged rent.

·         Security or rental deposits;

·         Pre-payment of future rent in the month rent is prepaid (the expense is allowed in the month the payment is due);

·         Payments made directly to landlord or mortgage company by non-AU members;

·         Mandatory fees for meals specified in lease agreements.

·         Late fees;

·         Payments on mortgage or rental costs for a previous time period;

·         Costs for an unoccupied home unless it is allowed in WAC 388-450-0190.

·         Shelter expenses that are consistently paid by someone outside the AU.  If a parent, friend, or agency pays the client's shelter costs only on occasion, the AU is still eligible for the full shelter expense deduction.  HUD or FHA or other subsidies are not allowed as shelter costs.

·         Shelter deductions above the maximum shelter cost for an AU without an elderly or disabled person or where the only elderly or disabled AU member is an ineligible AU member.


NOTE:

A landlord statement or receipt may not reflect any add-on expenses to recover previously undercharged rent.


4.  Shared living / roomers:

AU owns or is buying home -

When an AU owns or is buying a residence and shares the residence with another AU, we consider the AU that owns the home to have a roomer. 

a.    The rent paid to the homeowner is counted as self-employment earned income.  See Calculating Net Self-Employment Income in Special Situations to determine income from a roomer.

b.    The roomer receives the shelter deduction for;

                                        i.       The rent paid to the owner; and

                                      ii.       A standard utility allowance (SUA).

c.    The owner receives the shelter deduction for the standard utility allowance (SUA) and either:

                                        i.        The portion of shelter costs not used as a self-employment expense based on number of bedrooms in the residence and the number of bedrooms rented out; or

                                       ii.        All expenses the landlord must pay for the housing costs.


EXAMPLE

Landlord rents out one of the three bedrooms. Total cost of mortgage, taxes, and insurance is $900.00 monthly.  The owner can use either of the two options below for her expenses.

Option 1

$600 (+ SUA) Shelter expense (2/3 of $900)
$300 Self-employment expense

Option 2

$900 (+ SUA) Shelter expense


      Renting out areas other than rooms in AU's home-

When clients rent out an area of their home other than a bedroom, we count this area as another bedroom and determine self-employment expenses as described in ‘AU owns or is buying home '.  (above)

      AU rents residence -

AUs that rent a residence are considered to have roomers when:

a.    They rent out a portion of the residence to someone outside of the AU; and

b.    The rent they receive is more that the total rent obligation for the AU as shown on the rental agreement or lease.

                                    i.    The rent paid to the AU is counted as self-employment earned income.  See Calculating Net Self-Employment Income in Special Situations to determine income from a roomer.

                                  ii.    The roomer receives the shelter deduction for:

·         The rent paid to the AU; and

·         A standard utility allowance (SUA).

c.    The AU receives the shelter deduction for the standard utility allowance (SUA) and either:

                                    i.      The portion of shelter costs not used as a self-employment expense based on number of rooms in the residence and the number of rooms rented out; or

                                  ii.      All costs the AU must pay for the housing. See Clarifying Information of WAC 388-450-0195 for information on utilities.

d.    Clients that share a residence are not considered to have roomers if they:

                                i.          Do not own the residence;

                              ii.          Are not buying the residence; and

                             iii.          Do not charge their roommates an amount above the total rent as shown on the lease.

 


WAC 388-450-0195
WAC 388-450-0195

Effective March 10, 2014

WAC 388-450-0195 Does the department use my utility costs when calculating my Basic Food or WASHCAP benefits?

1.      The department uses utility allowances instead of the actual utility costs your assistance unit (AU) pays when we determine your:

a.      Monthly benefits under WAC 388-492-0070 if you receive WASHCAP;or

b.       Shelter cost income deduction under WAC 388-450-0190 for Basic Food.

2.      For Basic Food, "utilities" include the following:

a.      Heating or cooling fuel;

b.      Electricity or gas;

c.      Water and sewer;

d.      Well or septic tank installation/maintenance;

e.      Garbage/trash collection; and

f.        Telephone service.

3.      We use the amounts below if you have utility costs separate from your rent or mortgage payment:

a.       If your AU has heating or cooling costs or receives more than twenty dollars in Low Income Home Energy Assistance Act (LIHEAA) benefits each year, you get a standard utility allowance (SUA) of four hundred nine dollars.

b.      If your AU does not qualify for the SUA and you have any two utility costs listed in subsection (2) of this section, you get a limited utility allowance (LUA) of three hundred thirty dollars.

c.       If your AU has only telephone costs and no other utility costs, you get a telephone utility allowance (TUA) of sixty-five dollars.

4.       If your AU receives Basic Food on March 9, 2014, you receive the SUA through August 2014 regardless of your household's utility expenses unless you have a lapse in your Basic Food benefits.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1.        The Standard Utility Allowance (SUA)

             

             a.  How can an AU qualify for SUA? 

      An AU qualifies for SUA if the AU:

                                    i.        Is responsible to pay out-of-pocket heating or cooling costs separate from rent or mortgage costs;

                                  ii.        Receives a LIHEAA (Low Income Home Energy Assistance Act) payment of more than $20 annually for the AU's current residence from a state or local agency or from an Indian Tribal Organization; or

                                iii.        Lives in public housing, uses a shared utility meter, and is billed only for  excess utility expenses.


To determine that a household is eligible for the SUA based on getting a LIHEAA benefit of more than $20, we must be able to reasonably expect that the household will receive the benefit.

  • If the household has received this benefit previously, and they have not moved or had another significant change in circumstances, we can expect that their LIHEAA eligibility has not changed.
  • If someone received SUA as a part of their WASHCAP benefits and they lose eligibility for WASHCAP, we must redetermine their eligibility for SUA, LUA, TUA, or ZUA based on their current circumstances.

NOTE:

The utility standards come from an average annual expense.  Clients that heat with oil and fill the tank once a year are eligible for SUA for the entire year, even though they actually pay the bill in one month.


WASHCAP households receive SUA as a part of the WASHCAP demonstration project waiver.  If a person loses eligibility for WASHCAP, we must review the household's eligibility for SUA, LUA, TUA, or ZUA (zero utility allowance) based on their current circumstances.  


A vendor payment to partially or occasionally cover heating or cooling costs the client is responsible to pay does not affect the client’s eligibility for SUA.  Examples include when the expense is paid through a friend, relative, AREN, or another agency.


    b.     What counts as a heating cost?

Clients have a heating cost when they are responsible for out-of-pocket fuel costs to operate a device used as the primary heat source for the living quarters.

  • If wood is the primary heat source for the residence, the client must have out-of-pocket costs for the wood fuel.  Costs to operate a cooking stove, oven, or indirect costs for gathering wood do not qualify the AU for SUA. 
  • If a client is responsible to pay the cost of using a device that delivers heat, but no costs to create the heat, the client does not qualify the AU for SUA.
  • Costs to operate any device that is used as the client's primary heat source qualifies the AU for SUA when:
    • The landlord does not include heating costs in the rent; or
    • The landlord includes heating costs in the rent, but the heating is unavailable.  We consider it to be unavailable if:
      • The source of heat is not working; or
      • The client can't use the source of heat for health reasons.

EXAMPLE

A client who buys a cord of firewood or buys pellets for the client's pellet stove would qualify for SUA.  A client who buys a chainsaw, gasoline, and a permit to cut firewood does not qualify for SUA if the client has no costs for wood fuel.


EXAMPLE

Client has an apartment with steam heat. Heat is brought into the apartment by an electric fan that the client pays for by separate metering. The heat is included in the cost of renting the apartment. This client is not eligible for SUA.


EXAMPLE

Client has a wood stove and wood provided by the landlord, but the client’s doctor has advised him that the wood stove is aggravating his asthma. The client uses an electric space heater instead, and pays for the electricity for the residence.  In this case, we would allow the SUA.


NOTE:

When we allow the SUA for a client that uses a source different than what is standard for the home, we must document that the source is the client's primary heating source.  If a heating cost is included in the rent, we must document why this source of heat is not available.


      c.   What counts as a cooling cost? 

Clients have a cooling cost when they are responsible to pay costs to operate an air conditioning system, room air conditioner, or swamp cooler. (Electric fans do not count as air conditioners.)

d.     How do you tell if the cost is separate from rent? 

We consider heating or cooling costs as separate from rent when the AU must pay for utilities which are billed separately from the rent or itemized individually.

e.     How do you tell if a client should be given a utility allowance or if utilities are included in the rent?

  • If all utilities are clearly included in the rent, clients receive the shelter deduction for the rent amount and no utility allowance.
  • If it is not clear whether all utilities are included with rent, we must determine if the client:
    • Pays separately for any utilities;
    • Has a specific portion of the rent consistently designated to cover utilities;
    • Pays for excess utility usage; or
    • Pays rent only.

f.    What happens when households in separate residences share a common utility meter? 

      When households in two residences share a utility meter for heating or cooling, each AU can receive a SUA.  If the shared utility meters are not for heating or cooling services, each AU can receive a LUA if they pay for another countable utility.


EXAMPLE

In a shared residence, one AU pays for all utilities, except phone service. This includes heating. They do not pay for phone service. The other AU receives the phone bill and pays for phone service. Each AU is eligible for a SUA.


EXAMPLE

Landlord provides heat, but the client uses an additional heat source because the landlord's system doesn't heat well enough. In this case, we don't allow the SUA.


EXAMPLE

Client lives in a trailer and gets electricity (heat source) from an extension cord to a friend's house. The friend gets the bill and charges the client for her share of the bill each month. The client and the friend each qualify for a SUA.


2.    The Limited Utility Allowance (LUA):

a.    What is required for an AU to be eligible for LUA? 

To qualify for the LUA, an AU must be responsible to pay any two allowable out-of-pocket utility costs:

                              i.        Separate from rent or mortgage costs;

                            ii.        That do not qualify the AU for the SUA; and

                           iii.        May include telephone as one of the costs.

b.    What costs qualify a client for the LUA? 

Any two of the following expenses will qualify an AU for the LUA:

                              i.      Electricity or gas not used to heat or cool the residence;

                            ii.      Cooking fuel;

                           iii.      Water;

                           iv.      Telephone service:

                             v.      Garbage/trash collection; or

                           vi.      Sewer, well or septic tank costs.


NOTE:

The utility standards come from an average annual expense.  Clients that have their septic tank or well system serviced once a year can have this expense count as one of their two qualifying expenses for the LUA.


5.    The Telephone Utility Allowance (TUA):

                       a.    How do clients qualify for the TUA?

Clients qualify for the TUA when they:

  • Do not qualify for the SUA or LUA; and
  • Incur or expect to incur costs for telephone service.

                       b.      Does voicemail, or a pager qualify a household for the TUA?

Costs for alternative phone services such as beepers, voice mail, pagers and cellular phones qualify a household for the TUA if they don’t receive a higher allowance for the SUA or LUA. 

 

c.      Does an AU qualify for the TUA if the AU must pay the phone bill, but they are not listed on the bill?

      Clients qualify for the TUA if they can verify that they are responsible for the telephone service. This is true even if they are not named on the bill.

d.    Can two AUs in one residence each have a phone service and each qualify for a TUA?

Yes.

 


EXAMPLE

Client has a cell phone. The bill for several cell phones are in the client’s mother’s name. The client’s mother verifies that the client is responsible for paying the portion of the bill associated with their phone. The client qualifies for the TUA.


6.    How ineligible AU members affect the SUA:  

Our utility allowances (SUA, LUA, or TUA) apply for all Basic Food households, even if there is more than one assistance unit in a single residence.  

Even though the expenses of an ineligible member may be prorated as a part of the AU’s expenses as described under WAC 388-450-0140, we do not prorate the SUA, LUA, or TUA.


WORKER RESPONSIBILITIES

1.    Determine the appropriate utility allowance:

a.    Decide if the AU is eligible for:

                                      i.        The standard utility allowance (SUA);

                                    ii.        The limited utility allowance (LUA)

                                   iii.        The telephone utility allowance (TUA).

b.    Deny utility allowance to AUs:

                                      i.        When all utility costs are included as part of their rent;

                                    ii.        Who have only one utility expense that is not for heating, cooling, or phone.

2.    Redetermine if an AU qualifies for the SUA, LUA or TUA:

a.    At recertification, including when a household who received WASHCAP benefits is now applying for Basic Food;

b.    When an AU changes residences; and

c.  When the client reports the beginning or end of heating and/ or cooling costs.  For example:  The client has been using free wood for heating and now reports that they are now using heating oil.


NOTE:

To determine that a household is eligible for the SUA based on getting a LIHEAA benefit of more than $20, we must be able to reasonably expect that the household will receive the benefit.

  • If the household has received this benefit previously, and they have not moved or had another significant change in circumstances, we can expect that their LIHEAA eligibility has not changed.
  • If someone received SUA as a part of their WASHCAP benefits and they lose eligibility for WASHCAP, we must redetermine their eligibility for SUA, LUA, TUA, or ZUA based on their current circumstances.

Go to Utility Chart


WAC 388-450-0200
WAC 388-450-0200

Effective October 1, 2013

WAC 388-450-0200 Will the medical expenses of elderly persons or individuals with disabilities in my assistance unit be used as an income deduction for Basic Food?

  1. If your Basic Food Assistance Unit (AU) includes an elderly person or individual with a disability as defined in WAC 388-400-0040, your AU may be eligible for an income deduction for that person's out-of-pocket medical expenses. We allow the deduction for medical expenses over $35 each month.

  2. You can use an out-of-pocket medical expense toward this deduction if the expense covers services, supplies, medication, or other medically needed items prescribed by a state-licensed practitioner or other state-certified, qualified, health professional. Examples of expenses you can use for this deduction include those for: 

    1. Medical, psychiatric, naturopathic physician, dental, or chiropractic care;

    2. Prescribed alternative therapy such as massage or acupuncture;

    3. Prescription drugs;

    4. Over the counter drugs;

    5. Eye glasses;

    6. Medical supplies other than special diets;

    7. Medical equipment or medically needed changes to your home;

    8. Shipping and handling charges for an allowable medical item. This includes shipping and handling charges for items purchased through mail order or the Internet;

    9. Long distance calls to a medical provider;

    10. Hospital and outpatient treatment including:

      1. Nursing care; or

      2. Nursing home care including payments made for a person who was an assistance unit member at the time of placement.

    11. Health insurance premiums paid by the person including:

      1. Medicare premiums; and

      2. Insurance deductibles and co-payments.

    12. Out-of-pocket expenses used to meet a Spenddown as defined in WAC 182--519-0010. We do not allow your entire Spenddown obligation as a deduction. We allow the expense as a deduction as it is estimated to occur or as the expense becomes due.

    13. Dentures, hearing aids, and prosthetics.

    14. Cost to obtain and care for a seeing eye, hearing, or other specially trained service animal. This includes the cost of food and veterinarian bills. We do not allow the expense of food for a service animal as a deduction if you receive Ongoing Additional Requirements under WAC 388-473-0040 to pay for this need.

    15. Reasonable costs of transportation and lodging to obtain medical treatment or services.

    16. Attendant care necessary due to age, infirmity, or illness.  If your AU provides most of the attendant's meals, we allow an additional deduction equal to a one-person allotment.

  3. There are two types of deductions for out-of-pocket expenses:

    1. One-time expenses are expenses that cannot be estimated to occur on a regular basis.  You can choose to have us:

      1. Allow the one-time expense as a deduction when it is billed or due;

      2. Average the expense through the remainder of your certification period; or

      3. If your AU has a 24-month certification period, you can choose to use the expense as a one-time deduction, average the expense for the first twelve months of your certification period, or average it for the remainder of your certification period.

    2. Recurring expenses are expenses that happen on a regular basis.  We estimate your monthly expenses for the certification period.

  4. We do not allow a medical expense as an income deduction if:

    1. The expense was paid before you applied for benefits or in a previous certification period;

    2. The expense was paid or will be paid by someone else;

    3. The expense was paid or will be paid by the department or another agency;

    4. The expense is covered by health care insurance;

    5. We previously allowed the expense, and you did not pay it.  We do not allow the expense again even if it is part of a repayment agreement.

    6. You included the expense in a repayment agreement after failing to meet a previous agreement for the same expense; or

    7. You claim the expense after you have been denied for presumptive SSI; and you are not considered disabled by any other criteria.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. To be eligible for the medical deduction, people must report all incurred and anticipated medical expenses at application and recertification.

  2. We do not have to re-verify ongoing medical expenses during the certification period if they are not likely to change.

  3. People do not have to report any changes in medical expenses during the certification period.

  4. Anticipated expenses: 

    Persons eligible for a medical deduction may estimate medical expenses they expect to incur during the certification period.

  1. The estimate must be based upon current, verified medical expenses that the AU member incurred, as well as other available information about the member's medical condition and insurance coverage.
  2. If an AU reports an anticipated medical expense at the time of application or recertification but can't provide the verification at that time, we allow the expense when the verification is provided during the certification period.
  3. If an AU voluntarily reports a change in a recurring medical expense, we treat the change as aCHANGE OF CIRCUMSTANCES.
  1. Incurred expenses

    We allow out-of-pocket medical expenses that the eligible AU member incurs when the person:

  1. Has an unpaid bill that has not been allowed previously,

  2. Has a paid bill incurred during the certification period not reported previously; or

  3. Arranges a payment plan for an expense and verifies when the installments are due.

  1. One-time medical expense deduction:

    Customers who report a one-time, non-recurring medical expense can elect to have the entire expense budgeted in a single month for a one-time deduction. This would be a likely choice for bills that when averaged using one of the options in WAC 388-450-0200(3)(a) would not result in an increase in benefits.


EXAMPLE

Joan reports on May 20th that she paid for a doctor visit on May 15th in the amount of $200. She has 10 months remaining in her certification period. Averaging the expense would only allow a $20 monthly expense and would not impact her ongoing Basic Food benefits since she has no other expenses. The customer could choose to budget the $200 in one month and either have her May benefits supplemented or have her June benefits increased.


  1. Medical expenses of other AU members:

    This deduction is only for out-of pocket costs for the elderly person or an individual with a disability's medical needs. We can’t allow a deduction for medical expenses of an AU member who is not an elderly person or does not have a disability under WAC 388-400-0040 even if the individual in the AU who does meet these criteria pays the medical expense.

  2. Medical equipment: 

    We can allow the cost of equipment as a medical deduction if it is needed due to the person's medical condition.  Examples of allowable medical equipment are:

  1. Specialized telephone devices or TTY for hearing impaired people; and

  2. Items needed for people with limited mobility such as:

    1. Wheelchairs;

    2. Walkers; and

    3. Modifications to the person's home such as:

      1. Grab bars;

      2. Wheelchair ramps; and

      3. Lowered countertops


NOTE:

If a person has improvements related to their medical condition completed along with improvements not related to their condition, we can't allow the expense as a medical deduction because they aren't separately identified and billed.


If the improvements were paid for by a second mortgage, we allow the entire amount as a shelter expense instead of a medical expense.


  1. Health insurance premiums:
    1. We do not allow the cost of third party health and accident insurance when the insurance benefit:
      1. Is payable in a lump sum payment upon death or dismemberment;

      2. Covers mortgage or loan payments upon death or disability; or

      3. Will be reimbursed.

    1. We allow the cost of Medicare premiums as a deduction:

      1. When the person is responsible to pay the premium; and

      2. For the period of time between approval of Medicare Savings benefits and the start of the buy-in.  For information on buy-in, see Medicare Savings Program.


NOTE:

It takes 1 - 2 months from when Medicare Savings benefits are approved for the state to start paying the premium.  We can't make recipient persons tell when the buy-in starts, but we must end the deduction when we start to pay the premium.


10. Reasonable medical transportation costs: 

We must determine transportation costs on a case-by-case basis.  It is essential that the case documentation clearly show why an expense was allowed or denied.  If the cost is reasonable according to the situation, we can allow the costs.  Examples of allowable expenses are:

a.    Bus fare to get to medical appointments;

b.    The standard mileage rate for a privately owned vehicle as determined by the Internal Revenue Service.  Information on the current rate may be found in section 10.90.20 of The Office of Financial Management’s State Administrative and Accounting Manual: http://www.ofm.wa.gov/policy/10.90a.pdf.

c.    A rental car or taxi in an area or circumstance where bus service or a private vehicle is not available; and

d.    Long-distance phone calls to the person's medical practitioner instead of travel.

11. Postage or shipping cost for mail-order prescriptions:

Some people who use mail-order pharmacies must pay a shipping or postage fee in addition to the cost of their medicines. We allow the out-of-pocket costs of medications for certain AU members as an expense for the excess medical expense deduction. This includes postage or shipping fees if they are not included in the cost of the medications.

12. Spenddown: 

We do not allow the total spenddown obligation as a medical expense.  We allow the out-of-pocket expenses as they are incurred or anticipated.

13. Attendant care: 

We allow attendant care that is necessary due to age, infirmity, or illness.  Allowable attendant care includes, but is not limited to:

a.    Homemaker;

b.    Home health aide; or

c.    Housekeeper.


NOTE:

If the AU provides the majority of the attendant's meals, we allow an additional deduction equal to a one-person allotment.  If allotments are increased during the certification period, we update the deduction at the next recertification.


If attendant care can be claimed as either a dependent care or medical expense, we allow the deduction as a medical expense.


  1. Expenses from non-standard providers: 

    We allow medical expenses prescribed by a state-licensed practitioner or other state-certified health professional.  If the person's health professional prescribes the treatment, we allow the medical deduction.  Expenses we allow when prescribed by a licensed or certified health professional include treatment by:

    1. Acupuncturists;
    2. Sanipractors;
    3. Homoeopathists;
    4. Herbalists;
    5. Massage Therapists; and
    6. Christian Science practitioners or theological healers.
  2. Installment agreements: 

    We can allow expenses when they are anticipated to become due in an installment agreement. If the person misses some payments, we do not allow the expense again when it is actually paid, as it has already been allowed based on when it was originally due.

  3. Expenses from medical marijuana: 

    The costs of medical marijuana and transportation expenses as described in # 10 above to and from the medical marijuana dispensary are not allowable as a medical expense income deduction for Basic Food.


NOTE:

There is no need to ask applicants or recipients why the individual went to see a doctor or other medical practitioner to find out if the doctor prescribed marijuana.  Allow reasonable transportation costs for visits to licensed medical practitioners without regard to the reason for the visit.


WORKER RESPONSIBILITIES

Determining Allowable Medical Expenses

  1. Review the application for a statement that the client has a medical expense.
  2. Ask all AUs with an elderly person or an individual with a disability if those members have:
    • Any medical/dental bills or expect to have these expenses; and/or
    • Verify the portion of the expense that will not be reimbursed or paid by another source by obtaining:
      • Proof of the amount of covered and uncovered expenses from all insurance carriers including Medicare; or
      • A billing from the provider showing the amount due after insurance coverage.
    • Certify the AU's benefits without the claimed deduction if the expense is not verified. 
    • When Medicare Savings benefits have been approved but the buy-in has not started, allow the deduction.  Set an alert to remove this deduction when the state starts to pay the premium.

 


CLARIFYING INFORMATION

COLA increases are not counted as income until April 1 of each year for the QMB, SLMB, ESLMB, QDWI, and QI programs.

The medical programs described in subsection (3) of the above WAC use the TANF / SFA income rules to determine countable income.  After determining countable income, treatment of income for medical programs may be different.  For example, see the Assistance Units for more information on family financial responsibility and when separate medical assistance units must be established.

For children's and pregnant women's programs with monthly income standards based on the FPL, the earned income deduction is limited to $90 for each working adult.  When the family income exceeds the CNIL, the case trickles to F99 / P99.  The medically needy monthly income standards are not based on the FPL.  The earned income deduction changes to the 50% deduction.

The income exclusion described in subsection (4)(i) is designed to assist families to meet the "three out of last six months" federal requirement.  See the Medical Extensions for further information.


Aces Procedures

See Basic Food Program - Medical Expenses as a Deduction

See Interviews - (DPEX) Dependent Care Expenses

See Interview - (SHEL) Shelter Expenses

Modification Date: October 22, 2014