Categorically Needy LTC – Family (K01)

Created on: 
Mar 17 2017

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

Who is eligible for Categorically Needy LTC - Family (K01) Medical?

A child or adult who has met institutional status described in the Apple Health eligibility manual - WAC 182-513-1320 Determining institutional status for long-term care (LTC) services may be eligible for K01 medical if they also meet the following requirements:

  • Residing in a medical institution for a period of 30 days or longer; or
  • Is between 18-21 years old and resides in a psychiatric institution for 30 days or longer; or
  • Is a child age 17 or younger and resides in a psychiatric institution for 90 days or longer.

K01 medical coverage is for children and adults who do not meet aged, blind or disabled criteria and who are one of the following:

  • The parent of, or relative caring for, an eligible dependent child;
  • A dependent child age 18 or younger;
  • A pregnant woman;
  • An individual who is not a dependent or a parent, but who is under the age of 21 (or 22 if already residing in the institution and the application is received prior to their 21st birthday).

For more information, see the following Apple Health eligibility manual references:

NOTE: Federally qualified Supplemental Security Income (SSI) related clients aged 18 and older, who meet the following should be opened on an L-track medical program:
  • Reside in an Institution for Medically Diseased (IMD) or Psychiatric Residential Treatment Facility (PRFT)
  • Applied for LTC prior to their 21st birthday
  • Meet all financial and non-financial eligibility rules

How long is the Categorically Needy LTC - Family (K01) Medical certification period?

The K01 certification period is for 12 months.

If a client loses their institutional status during their certification period, a re-determination for other medical coverage needs to be completed.

Children under the age of 19 who lose institutional status remain continuously eligible for Categorically Needy (CN) coverage until the end of the K01 certification period.

Online Processing

How do I screen a Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

To screen in a K01 AU, take the following steps:

  1. Follow the instructions in Screening an Application.
Note: If the applicant is a child, screen in the child as the head of household.
  • On the Programs page, select the checkbox next to Long Term Care.
  • On the Finalize page, use the Specify Program option to select the Medical Assistance (MA) for the K01 program.

How do I process a pending Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

To process a pending K01 AU, take the following steps:

  1. On the AU Details page, complete the Financial Responsibility field as follows:
    • Applicant (PN) for the applicant.
    • Non-Member (NM) for any other household member(s).
  2. On the Client Details page, complete the following fields:
    • Marital Status field - Select the appropriate marital status from the drop down menu.
    • Living Arrangement field - Select the appropriate living arrangement from the drop down menu.
  3. On the Facility page, complete the following fields:
    • Type field - Select the type of facility from the drop down menu.
Note: The facility type must be from the same subset as the living arrangement coded on the Client Details page.
  • ID field - Enter the [provider number] if the provider is a Nursing Facility - Medicaid (MD), Nursing Facility - Medicare (ME) or  Hospice Care Center (HC).
  • Entry Date field - Enter the [first of the month the client was admitted].
  • Level of Care field - Select the client's level of care from the drop down menu.
  • Payment Auth Date field - Enter the [date payment to the facility should begin].
  • Private Rate field - Enter the [facility's private daily rate].
  • State Rate field - Enter the [state daily rate].  
  1. On the Long Term Care Expense/Deduction page, complete the following fields:
  • Type field - Select the type of expense from the drop down menu.
  • Amount field - Enter the [amount of the expense/deduction].
  1. If the client has dependent family members, complete the following fields on the Family Member Allowance page:
  • Type field - Select Child (C) for a dependent living with a community spouse or Other Dependent (O) for a dependent not living with a community spouse.
  • Amount field - Enter the [dependent's gross monthly income].
  1. On the Unearned Income page, complete the following fields if the applicant child receives monies from a parent:
  • Source field - Select Other Countable (OC) from the drop down menu.
  • Method field - Select the appropriate method from the drop down menu.
  • Amount field - Enter the [income contributed to a child from their parents].
  1. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  2. Once the pending months have been processed, follow the instructions in the Finalize Application chapter.

Mainframe Processing

How do I process a pending Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

This function has been removed from ACES Mainframe, see Online Processing - How do I process a pending Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

 

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