See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who meets the criteria in the following sections may be eligible for S02 medical:
For more information on how countable income and resources are determined for SSI-related medical assistance, see Apple Health eligibility manual - WACs 182-512-0200 through 182-512-0960 for information on how countable income and resources are determined for SSI-related medical assistance.
S02 Medical is certified for 12 months. For more information, see Apple Health eligibility manual - WAC 182-504-0015 Washington Apple Health - Certification periods for categorically needy (CN) programs.
S02 is AUTO opened in some instances when a Supplemental Security Income (SSI) recipient's payments are stopped by the Social Security Administration (SSA). For more information, see Apple Health eligibility manual - WAC 182-510-0010 What happens to my categorically needy (CN) medical coverage when my supplemental security income (SSI) cash payment is terminated?
When a client active on Medically Need (S95) becomes eligible for CN medical, the medical coverage group on the AU is changed to S02 or Non Citizen CN SSI Related (S07).
When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).
To screen S02 medical, take the following steps:
To process a pending S02, take the following steps:
If the AU exceeds the income standard for S02 medical, it may trickle to SSI-Related Medically Needy - No Spenddown (S95) or SSI-Related Medically Needy with Spenddown (S99) during finalize.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who meets the criteria established in the following may be eligible for S95 medical:
For information on how countable income and resources are determined for SSI-related medical assistance, see Apple Health eligibility manual - WACs 182-512-0200 through 182-512-0960.
S95 medical is certified for 12 months. For more information, see Apple Health eligibility manual - WAC 182-504-0020 Certification periods for the noninstitutional medically needy (MN) program.
When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).
When a client active on S95 becomes eligible for CN medical, the medical coverage group on the AU is changed to SSI Related Categorically Needy (S02) or Non Citizen CN SSI Related (S07).
An S95 AU is initially screened into ACES as a S02 (SSI Related Categorically Needy) Assistance Unit (AU), following the instructions in How do I screen S02 (Categorically Needy SSI Related) medical? The S02 AU trickles to S95 during Finalize, if appropriate, based on the income and the AU Details page financial responsibility coding.
While pending, the AU is still S02 (SSI Related Categorically Needy) and is processed following the same steps as in How do I process a pending S02 (SSI Related Categorically Needy) Assistance Unit (AU)?
The S02 AU trickles to S95 during Finalize, if appropriate, based on income or AU Details page financial responsibility coding.
If the AU exceeds the income standard for S95, it may trickle to SSI-Related Medically Needy with Spenddown (S99).
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who meets the criteria established in the following manual sections may be eligible for S99 medical:
For more information on how countable income and resources are determined for SSI-related medical assistance, see Apple Health eligibility manual - WACs 182-512-0200 through 182-512-0960.
The default certification/base period for S99 defaults is six months, which can be shortened to three 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 three or six months. For more information, see Apple Health eligibility manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program.
When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).
An S99 Assistance Unit (AU) is initially screened into ACES as an SSI Related Categorically Needy (S02) AU by following the instructions in How do I screen SSI Related Categorically Needy (S02) medical?
An S02 AU trickles to S99 during Finalize, if appropriate, when the AU’s countable income exceeds the medically needy income level (MNIL) standard.
While pending, the AU is SSI Related Categorically Needy (S02) and is processed following the same steps in How do I process a pending SSI Related Categorically Needy (S02) Assistance Unit (AU)?
The S02 AU trickles to S99 in M - MA Spenddown during Finalize, when the AU’s countable income exceeds the MNIL standard.
For more information on the spenddown process, see Apple Health for the Medically Needy and Spenddown.
When a SSI Related Categorically Needy (S02) AU trickles to S99, additional AU members cannot be added.
To add a person to an S99 AU, take the following steps:
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?
Eligibility reviews can be initiated on spenddown AUs in A - Active or M - MA Spenddown status.
Complete the eligibility review on an S99 AU following the instructions in the Eligibility Review chapter.
For S99 Assistance Units (AUs) at MA Spenddown (M) status, when the system determines the client is eligible for CN or Medically Needy (MN) no spenddown in any month, users receive edit message: Screen New AU.
When the client’s eligibility changes from an active S99 Assistance Unit (AU) to an SSI Categorically Needy (S01), SSI Related Categorically Needy (S02) / Non Citizen CN SSI Related (S07) / MN SSI Related No Spenddown (S95) AU in the ongoing month, the system:
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.