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SSI Related Medical

Revised October 19, 2009

Categorically Needy SSI Related Medical (S02) Medically Needy SSI Related Medical With No Spenddown (S95) Medically Needy SSI Related Medical with Spenddown (S99)

Categorically Needy SSI Related Medical (S02) Who is eligible to receive S02 Medical? How long is the S02 certification period? How do I screen S02 medical? How do I process a pending S02 AU? When is S02 AUTO opened? Who is eligible to receive S02 medical? A person who meets the criteria in the following WAC/EAZ Manual sections may be eligible for S02 Medical: WAC 388-503-0505 General eligibility requirements for medical programs. WAC 388-475-0050 SSI related medical -- General information. WAC 388-475-0100 SSI related medical -- Categorically needy (CN) medical eligibility. WAC 388-478-0080 Supplemental Security Income (SSI) standards; SSI-related categorically needy income level (CNIL); and countable resource standards. See EAZ Manual SSI-Related Medical/HWD - WACs 388-475-0200 through 388-475-0900 for information on how countable income and resources are determined for SSI-related medical assistance. How long is the S02 certification period? S02 Medical is certified for 12 months. See EAZ Manual WAC 388-416-0015 Certification periods for categorically needy (CN) medical and children's health insurance program (CHIP). How do I screen S02 medical? From the Welcome back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window. On the Applicant page: Enter the applicant’s (head of household) name in the Applicant Name field. Enter the applicant’s home address under the Residential Address. If the applicant has a mailing address, uncheck the box next to Mailing Address same as above and enter the applicant’s mailing address. Click the Next button. The Address Validation page displays. Click the Next button and the Programs page displays. Enter a checkmark in the checkbox next to Medical. If the client is disabled and/or blind, enter a checkmark in the checkbox next to the appropriate field. Click the Next button. Click the Next button. The Add Member – Search Criteria page displays. Add all household members and complete the screening process. For more information, see Screening – aces.online.   How do I process a pending S02 AU?   1.    From the AMEN, access the pending AU via Option O – Interview.   2.    On the STAT screen, complete the Finl Resp fields as follows,   o    [PN] - Applicant for the applicant and an applying spouse   o    [AP] – ABD Parent for the parents of the applicant if the applicant is a child.   o    [SP] - Ineligible Spouse for an ineligible or non-applying spouse   o    [SC] - Child of SSI Related Parents/Child used to determine household size for any non-applying children   3.    On the DEM2 screen, enter the applicant’s disability information in the Disability/Incapacity fields. See <F1> Help.   o    If the S02 program eligibility is based on age, coding the Disability/Incapacity fields is optional.   4.    If the applicant has ever received SSI code the UNER screen as follows:   o    In the Ever received SSI? Field enter [Y]   o    In the Application/Benefit Type field, enter [SI]   o    In the Stat field, enter the appropriate valid value for the reason the client’s SSI was terminated. See <F1> help.   o    In the Date field, enter [date SSI terminated]   o    See EAZ Manual - WAC 388-475-0880 Special Income disregards for SSI-related medical programs.   5.    On the SHEL screen, code any shelter costs the client is responsible to pay.   o    If no shelter cost is entered, the client’s income will be compared to the supplied shelter standard. See EAZ Manual WAC 388-478-0080 Supplemental Security Income (SSI) standards.

Complete all other screens as needed following the instructions in the Interview chapter. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S02 eligibility determination. If the AU exceeds the income standard for S02, it may trickle to SSI-Related Medically Needy – No Spenddown (S95) or SSI-Related Medically Needy with Spenddown (S99) during finalize. When is S02 AUTO opened? A pending S02 medical sprouts when a General Assistance (GA - X) AU is denied for the following Reason Codes. Users receive Alert 417 – DETERMINE MEDICAL ELIGIBILITY FOR AU. 550 – Voluntary Withdrawal of Application 566 – Non Cooperation with Eligibility Process An active S02 AU sprouts when an active GA (X) is closed for the following Reason Codes: 230 – Verification 235 – Review Not Complete 525 – No Eligibility Review Form 552 – Failed to Provide Verification 551 – Whereabouts Unknown 557 – AU Requests Closure, See EAZ Manual - WAC 388-418-0025 Effects of Changes on Medical.

Medically Needy SSI Related Medical With No Spenddown (S95) Who is eligible to receive S95 Medical? How long is the S95 certification period? How do I screen S95 medical? How do I process a pending S95 AU? Who is eligible to receive S95 medical? A person who meets the criteria established in the following WAC/EAZ Manual sections may be eligible for S95 medical: WAC 388-503-0505 General eligibility requirements for medical programs. WAC 388-475-0050 SSI related medical -- General information. WAC 388-475-0100 SSI related medical -- Medically needy (MN) medical eligibility. WAC 388-478-0070 Monthly income and countable resource standards for medically needy (MN). See EAZ Manual SSI-Related Medical/HWD - WACs 388-475-0200 through 388-475-0900 for information on how countable income and resources are determined for SSI-related medical assistance. How long is the S95 certification period? S95 medical is certified for 12 months. See EAZ Manual WAC 388-416-0020 Certification periods for non institutionalized medically needy (MN) program. How do I screen S95 medical? An S95 AU is initially screened into ACES as an S02 AU, following the instructions in How do I screen an S02 AU?The S02 AU will trickle to S95 during Finalize, if appropriate, based on income or STAT screen coding. How do I process a pending S95 AU? While pending, the AU is still S02 and is processed following the same steps as inHow do I process a pending S02 AU? The S02 AU will trickle to S95 during Finalize, if appropriate, based on income or STAT screen coding. If the AU exceeds the income standard for S95, it may trickle to SSI-Related Medically Needy with Spenddown (S99).

Medically Needy SSI Related Medical with Spenddown (S99) Who is eligible to receive S99 medical? How do I screen S99 medical? How do I process a pending S99 AU? How long is the S99 certification/base period? How do I enter spenddown medical expenses for an S99 AU in M status? How do I initiate an Eligibility Review on an S99 AU? Who is eligible to receive S99 medical? ·         A person who meets the criteria established in the following WAC/EAZ Manual sections may be eligible for S99 medical: o   WAC 388-503-0505 General eligibility requirements for medical programs   o   WAC 388-475-0050 SSI related medical -- General information   o   WAC 388-478-0070 Monthly income and countable resource standards for medically needy (MN)   o   WAC 388-519-0100 Eligibility for the medically needy program ·         See EAZ Manual Medical SSI-Related Medical – Resources and SSI-Related Medical – Income (WACs 388-475-0200 through 388-475-0900) for information on how countable income and resources are determined for SSI-related medical assistance. How do I screen S99 medical? ·         An S99 AU is initially screened into ACES as an S02 AU by following the instructions in How do I screen an S02 AU?   ·         An S02 AU will trickle to S99 during Finalize, if appropriate, when the AU’s countable income exceeds the medically needy income level (MNIL) standard. How do I process a pending S99 AU? ·         While pending, the AU is S02 and is processed following the same steps in How do I process a pending S02 AU?   ·         The S02 AU will trickle to S99 in M – MA Spenddown during Finalize, when the AU’s countable income exceeds the MNIL standard.   ·         See EAZ Manual Spenddown for additional information on the spenddown process. How long is the S99 certification/base period? ·         The default certification/base period for S99 defaults is 6 months, which can be shortened to 3 months following the instructions in Spenddown - How do I set up a spenddown AU and base period?   ·         Under certain conditions, the base period can be set to a period other than 3 or 6 months. See EAZ Manual WAC 388-519-0110 Spenddown of excess income for the medically needy program (4) for these conditions How do I enter spenddown medical expenses for an S99 AU in M status? ·         To enter medical expenses to meet the client’s spenddown liability on an S99 AU in M status, follow the instructions in Spenddown – How do I enter medical expenses?   ·         After expenses have been added, follow the steps in Spenddown - How do I assign medical expenses and authorize spenddown? How do I initiate an Eligibility Review on an S99 AU? ·         Eligibility reviews can be initiated on spenddown AUs in A - Active or M - MA Spenddown status.   o   Complete the eligibility review on an active S99 AU following the instructions in the Eligibility Review/Recertification Process chapter.

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Modification Date: October 19, 2009

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