Updated September 5, 2026. Quick answer: Washington uses the standard 300%-of-SSI Special Income Level as its institutional Medicaid gate, currently about $2,982 a month, but its own administrative code then offers a direct medically-needy spend-down eligibility route for income above that level, without requiring a Qualified Income Trust the way many other income-cap states do.
The gate: a plain 300% formula
Washington’s own code defines the term directly: “’Special income level (SIL)’ means the monthly income standard that is 300 percent of the supplemental security income (SSI) federal benefit rate.” That is the same formula most income-cap states use, currently producing a figure of about $2,982 a month.
What happens above the SIL, without a trust
Washington’s code then states: “To be eligible for institutional services when living in a medical institution under the SSI-related medically needy (MN) program, a person must … have gross nonexcluded income in excess of the special income level (SIL) defined under WAC 182-513-1100.” In other words, Washington’s own rule explicitly builds a medically-needy spend-down route for people over the SIL, rather than treating a Qualified Income Trust as the only way past the cap, the pattern several other cap states in this family follow.
| Citation | Washington Administrative Code, WAC 182-513-1100 (special income level definition) and WAC 182-513-1395 (medically needy institutional eligibility) |
| What it says | “’Special income level (SIL)’ means the monthly income standard that is 300 percent of the supplemental security income (SSI) federal benefit rate. … To be eligible for institutional services when living in a medical institution under the SSI-related medically needy (MN) program, a person must … have gross nonexcluded income in excess of the special income level (SIL) defined under WAC 182-513-1100.” |
This page covers the income eligibility figure itself. How a state handles income above that figure (a Qualified Income Trust, a medically needy spend-down, or something else) is covered on Washington’s excess income mechanism page.
Every citation on this page was read directly from the state’s own Medicaid agency, administrative code, or official eligibility manual this session. General information, not legal or financial advice; a figure this specific can change with a budget cycle or a rule amendment, and a county or state caseworker has the final say on any individual application.