SSI Related Medical

Created on: 
Aug 11 2017

Categorically Needy SSI Related Medical (S02)

Created on: 
Jan 18 2019

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive Categorically Needy SSI Related (S02) medical?

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.

How long is the Categorically Needy SSI Related (S02) medical certification period?

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.

When is Categorically Needy SSI Related (S02) medical AUTO opened?

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).

Can a client receive Categorically Needy SSI Related (S02) medical coverage while incarcerated?

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).

Online Processing 

How do I screen Categorically Needy SSI Related (S02) medical?

To screen S02 medical, take the following steps:

  1. Follow the instructions in How do I screen an application for a client?
  • On the Finalize page, select the program SSI Related Categorically Need (S02).

How do I process a pending Categorically Needy SSI Related (S02) Assistance Unit (AU)?

To process a pending S02, take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access the Case Actions page in ACES 3G?
  2. Complete the interview following the steps in How do I initiate and complete an intake interview?
  3. On the AU Details page, in the Financial Responsibility field select the following from the drop down menu:
  • Applicant (PN) for the applicant and spouse (if the spouse is applying too).
  • Ineligible Spouse (SP) for an ineligible or non-applying spouse.
  • Child - SSI/Of SSI-related Parent/Used for HH Size (SC) for non applying children of the applicant/s.
  • ABD Parent (AP) for the parents of the applicant if the applicant is under 18 years old.
  1. On the Client Details page for each applicant(s) enter the disability information in the Disability/Incapacitated/Psychiatric section.
  • If the S02 program eligibility is based on age, coding the Disability/Incapacitated/Psychiatric section is optional.
  1. If the applicant has ever received Supplemental Security Income (SSI):
  • On the Unearned Income page, in the Ever Received SSI field check Yes.
  • Click the Add icon, under Income select Other Agency Application/Benefit and choose the applicant from the Client dropdown menu.
  • On the Other Agency Application/Benefit page, in the:
NOTE:  Once SSI termination information has been entered in the Ever Received SSI and Application/Benefits fields, these fields are no longer editable. These fields are only editable when ACES receives updated information from SDX and/or BENDEX, AUTO can update the fields as appropriate, or when a user or AUTO enters SSI income back to a case, the information in the fields can be deleted.  Only users with SSI SPECIAL AUTH in their ACES profile are permitted update ability for these fields in ACES 3G only.
  1. On the Expense page, click the Add icon to get to the Shelter Expense page for the applicant. Enter [the applicant's shelter expense information] in the appropriate fields.
  1. On the Resources Vehicles/Vessels page, to exempt the entire value of one vehicle, select Transportation for Disabled Person(TD) in the MA/CA Use field. 
  2. Complete all other screens as needed following the instructions in the Interview chapter.
  3. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  4. 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 medical, it may trickle to SSI-Related Medically Needy - No Spenddown (S95) or SSI-Related Medically Needy with Spenddown (S99) during finalize.

Mainframe Processing

How do I process a pending Categorically Needy SSI Related (S02) Assistance Unit (AU)?

To process S02 medical take the following steps:

  1. From the AMEN, access the pending AU via Option [O] - Interview.
  2. On the STAT screen, complete the Finl Resp fields as follows,
  • [PN] - Applicant for the applicant and an applying spouse.
  • [AP] - ABD Parent for the parents of the applicant if the applicant is a child.
  • [SP] - Ineligible Spouse for an ineligible or non-applying spouse.
  • [SC] - Child of SSI Related Parents/Child used to determine household size for any non-applying children.
  1. On the DEM2 screen, enter the [applicant’s disability information] in the Disability/Incapacity fields. See <F1> Help.
  • If the S02 program eligibility is based on age, coding the Disability/Incapacity fields is optional.
  1. If the applicant has ever received SSI code the UNER screen as follows:
  • Ever received SSI? Field - Enter [Y] - Yes.
  • Application/Benefit Type field - Enter [SI] - SSI.
  • Stat field - Enter [the appropriate valid value for the reason the client’s SSI was terminated]. See <F1> help.
  • Date field - Enter the [date SSI terminated].

For more information about Special Income Disregards, see Apple Health eligibility manual/Income - Special Disregards.

NOTE:  Once SSI termination information has been entered in the Ever Received SSI and Application/Benefits fields, these fields are no longer editable. These fields are only editable when ACES receives updated information from SDX and/or BENDEX, AUTO can update the fields as appropriate, or when a user or AUTO enters SSI income back to a case, the information in the fields can be deleted. Only users with SSI SPECIAL AUTH in their ACES profile are permitted update ability for these fields in ACES 3G only.
  1. On the SHEL screen, code any shelter costs the client is responsible to pay.
  1. Complete all other screens as needed following the instructions in the Interview chapter.
  2. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  3. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S02 eligibility determination.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Medically Needy SSI Related Medical With No Spenddown (S95)

Created on: 
Jan 18 2019

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive Medically Needy SSI Related No Spenddown (S95) medical?

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.

How long is the Medically Needy SSI Related No Spenddown (S95) certification period?

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.

Can a client receive Medically Needy SSI Related No Spenddown (S95) medical coverage while incarcerated?

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).

What happens when a Medically Needy SSI Related No Spenddown (S95) recipient becomes eligible for Categorically Needy (CN) medical?

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).

Online Processing

How do I screen Medically Needy SSI Related No Spenddown (S95) medical?

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.

How do I process a pending Medically Needy SSI Related No Spenddown (S95) Assistance Unit (AU)?

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).

Mainframe Processing

How do I screen Medically Needy SSI Related No Spenddown (S95) medical?

An S95 Assistance Unit (AU) is initially screened into ACES as an S02 (SSI Related Categorically Needy) AU, following the instructions in How do I screen S02 (SSI Related Categorically Needy) medical?  The S02 AU trickles to S95 during Finalize, if appropriate, based on income or STAT screen financial responsibility coding.

How do I process a pending Medically Needy SSI Related No Spenddown (S95) Assistance Unit (AU)?

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 STAT screen 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.

Medically Needy SSI Related Medical With Spenddown (S99)

Created on: 
Jan 18 2019
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive Medically Needy SSI Related Medical with Spenddown (S99) medical?

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.

How long is the Medically Needy SSI Related Medical with Spenddown (S99) certification/base period?

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.

Can a client receive Medically Needy SSI Related Medical with Spenddown (S99) medical coverage while incarcerated?

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).

Online Processing

How do I screen Medically Needy SSI Related Medical with Spenddown (S99) medical?

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.

How do I process a pending Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

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.

How do I add a person to a Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

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:

  1. Manually close the current S99 AU following the instruction in the Online Processing - How do I manually close an Assistance Unit (AU) or client?.
NOTE: Before manually closing the current S99 AU, review the base period and shorten if necessary. For more information, see Online Processing - How do I shorten a spenddown Assistance Unit (AU) base period?.
  1. Screen in a new S02 AU including the new AU member(s) and following the instructions in Online Processing - How do I screen SSI Related Categorically Needy (S02) medical?.
  2. Process the pending S02 AU following the instructions in Online Processing - How do I process a pending SSI Related Categorically Needy (S02) Assistance Unit (AU)? 

How do I enter spenddown medical expenses for an Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (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 Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

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.

What happens when a Medically Needy Spenddown (S99) – M Status recipient becomes eligible for Categorically Needy (CN) medical or MN SSI Related No Spenddown (S95) medical?

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.

What happens when a Medically Needy Spenddown (S99) – A Status recipient becomes eligible for Categorically Needy (CN) medical or MN SSI Related No Spenddown (S95) medical?

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:

  • Closes the S99 AU with a paid through date that is the last day of the month prior to month when the new coverage begins.
  • Changes the AU to the new coverage group.
  • Sets certification period according to the new program type (no end date for S01, 12 month for S02 or non-AEM S95).
  • Sends Letter 002-01 (Approval Letter).

Mainframe Processing

How do I process a pending Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

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 medically needy income level (MNIL) standard.

For more information on the spenddown process, see Apple Health eligibility manual - Apple Health for the Medically Needy (MN) and Spenddown.

How do I add a person to a Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

When a SSI Related Categorically Needy (S02) Assistance Unit (AU) trickles to S99, additional AU members cannot be added.

To add a person to an S99 AU, see Online Processing - How do I add a person to a Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?.

How do I initiate an Eligibility Review on an Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

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.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.