WAC 182-512-0150 SSI related medical -- Medically needy (MN) medical eligibility

1. Medically needy (MN) medical coverage is available for any of the following: 
   1. An individual who is SSI related and not eligible for CN medical coverage because the individual has countable income that is above the CN income standard (or for long-term care (LTC) clients, above the special income limit (SIL));
      1. The indivdual's countable income is at or below MN standards, leaving no spenddown requirement; or
      2. The individual's countable income is above MN standards requiring the individual to spenddown their excess income (see subsection (4) of this section). See WAC 182-512-0500 through WAC 182-512-0800 for rules on determining countable income, and WAC 182-519-0050 for program standards or chapter 388-513 WAC for institutional standards.
   2. An SSI related ineligible spouse of an SSI recipient;
   3. An individual who meets SSI program criteria but is not eligible for the SSI cash grant due to immigration status or sponsor deeming. See WAC 388-424-0010 for limits on eligibility for aliens;
   4. An individual who meets the MN LTC services requirements of chapter 388-513 WAC;
   5. An individual who lives in an alternate living facility and meets the requirements of WAC 388-513-1305; or
   6. An individual who meets resource requirements as described in chapter 182-512 WAC, elects and is certified for hospice services per chapter 182-551 WAC.
2. Individuals whose countable resources are above the SSI resource standards are not eligible for MN non-institutional medical benefits. See WAC 182-512-0200 through WAC 182-512-0550 to determine countable resources.
3. Individuals who qualify for services under long term care have different criteria and may spend down excess resources to become eligible for LTC institutional or waiver medical benefits. Refer to WAC 388-513-1315 and WAC 388-513-1395.
4. An individual with income over the effective medically needy income limit (MNIL) described in WAC 182-519-0050 may become eligible for MN coverage when the individual has incurred medical expenses that are equal to the excess income. This is the process of meeting spenddown. Refer to chapter 182-519 WAC for spenddown information.
5. An individual may be eligible for medical coverage for up to three months immediately prior to the month of application, if the individual:
   1. Met all eligibility requirements for the months being considered; and
   2. Received medical services covered by Medicaid during that time.
6. An individual eligible for MN without a spenddown is certified for up to twelve months. For an individual who must meet a spenddown, refer to WAC 182-519-0110. For a long term care MN individual, refer to WAC 388-513-1305 and WAC 388-513-1315.
7. A individual must reapply for each certification period. There is no continuous eligibility for MN. Although each additional certification period requires a new application, if the medical benefits have been closed less than thirty days, an eligibility review form may be used to reapply.