Overview of Medically Needy Program
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Overview of Medically Needy Program

Revised May 2, 2014

  1. The Medically Needy (MN) program provides Medicaid benefits for aged, blind, or disabled persons, institutionalized individuals, hospice clients, pregnant women, children, and certain refugees with income above Categorically Needy (CN) standards and countable resources below the appropriate MN resource standards. Those standards are defined in the standards chapter of this manual. There is no TANF-related MN program for adults who have no children.

  2. A person who is eligible for MN without spenddown could be eligible for three months of retroactive coverage and 12 months of ongoing coverage.  See WAC 388-416-0020  for information on MN certification periods.  The certification period for individuals who are subject to spenddown is three or six months, except for the retroactive base period.  Additional information on establishing base periods is described in the Base Period chapter of this section.

  3. There may be a difference between CN countable income and MN countable income. This results from the extra income deductions which apply to MN WAC 182-519-0100 (5).Decisions regarding CN eligibility and MN eligibility should be based on the appropriate calculation of countable income.  When determining countable income for individuals who are aged, blind or disabled, use SSI related income rules and deeming methodologies.  When determining countable income for children and pregnant women, use TANF related income rules and deeming methodologies.

  4. There is no asset test for pregnant women who are eligible for CN medical coverage.  However, prior to approving medically needy coverage, the department is required consider resources for pregnant women.  The resource standard is the MN standard based on the number of family members in the household.  See standards at: Medical Assistance Income and Resource standards chart.When a client's income goes down, CN coverage is authorized for any month in the base period in which CN countable income and resources are equal to or less than the CN standards. This is necessary to provide the household with the broader scope of care available with the CN benefit.  See the Change of Circumstances section for information regarding recalculating the spenddown liability for months prior to approval for CN medical.

  5. Medically Needy coverage for persons in institutions is determined according to  WAC 388-513-1395. This is covered in Long Term Care  section of the manual.

Modification Date: May 2, 2014