Medically Needy LTC – Family with Spenddown (K99)

Created on: 
Jan 27 2017

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

 Who is eligible to receive Medically Needy Family LTC with Spenddown (K99) medical?

K99 medical is available only to children age (20 years and younger) and has the same non-financial eligibility requirements as Categorically Needy LTC - Family (K01). See Apple Health eligibility manual – WAC 182-514-0230 Washington Apple Health - MAGI-based long-term care program and Apple Health eligibility manual – WAC 182-519-0100 Eligibility for the medically needy program.

The Categorically Need LTC - Family (K01) Assistance Unit (AU) trickles to a K99 AU if the child is (18 years and younger) and income exceeds the state rate, but remains under the private rate.

 How long is the Medically Needy Family LTC with Spenddown (K99) certification period?

ACES defaults a K99 Assistance Unit (AU) to a six-month base period, which can be shortened to three-months by following the instructions in the Spenddown – How do I set up a spenddown AU and base period? chapter.

Retroactive medical is three-months immediately prior to the month of the application date, if the client was in the institution in the retroactive period.

Online Processing

How do I screen a Medically Needy Family LTC with Spenddown (K99) Assistance Unit (AU)?

K99 medical is initially screened into ACES as a Categorically Needy LTC - Family (K01) Assistance Unit (AU) by following the instructions in How do I screen a Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

How do I process a pending Medically Needy Family LTC with Spenddown (K99) Assistance Unit (AU)?

Processing Alternative: No Spenddown segment created when some months are approved / denied in ACES, also rejects in ProviderOne (PR 322946)

While pending, the AU is still a Categorically Needy LTC - Family (K01) AU and is processed by following the steps in the How do I process a pending Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

The K01 AU trickles to a K99 AU during finalize, if appropriate, based on eligibility, living arrangement and coding on the Institutional Care page in the Facilities section.

See the  How do I enter medical expenses? chapter for instructions on entering medical expenses for a K99 AU.

Mainframe Processing

How do I process a pending Medically Needy Family LTC with Spenddown (K99) Assistance Unit (AU)?

While pending, the AU is still a Categorically Needy LTC - Family (K01) AU and is processed by following the steps in the How do I process a pending Categorically Needy LTC - Family (K01) Assistance Unit (AU)? chapter.

The K01 AU trickles to a K99 AU during finalize, if appropriate, based on eligibility, living arrangement and coding on the INST screen.

See the  How do I enter medical expenses? chapter for instructions on entering medical expenses for a K99 AU.

 

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