Medically Needy LTC - Family with Spenddown (K99)

Created on: 
Oct 26 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) medical. See the Apple Health (Medicaid) Manual - Modified Adjusted Gross Income (MAGI) - Based Institutional Care for more information.

The Categorically Need LTC - Family (K01) Assistance Unit (AU) trickles to a K99 AU if the child is 18 years and younger and their 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 Spenddown - Processing – How do I set up a spenddown Assistance Unit (AU) and base period?

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 as a Categorically Needy LTC - Family (K01) AU. For more information on screening a K01 AU, see Categorically Needy LTC - Family (K01) 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.

How do I enter spenddown medical expenses for a Medically Needy Family LTC with Spenddown (K99) Assistance Unit (AU) in M status?

To enter medical expenses to meet the client's spenddown liability on a K99 AU in MA Spenddown (M) status, follow the instructions in Spenddown - Processing - How do I enter medical expenses?

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

When a Categorically Needy LTC - Family (K01) AU trickles to K99, additional AU members cannot be added.

To add a person to a K99 AU, take the following steps:

  1. Manually close the current K99 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 K99 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 K01 AU including the new AU member(s), following the instructions in Categorically Needy LTC - Family (K01) How do I screen a Categorically Needy LTC - Family (K01) Assistance Unit (AU)?
  2. Process the pending K01 AU following the instructions in Categorically Needy LTC - Family (K01) - How do I process a pending Categorically Needy LTC - Family (K01) Assistance Unit (AU)?

When can I initiate an Eligibility Review on a Medically Needy Family LTC with Spenddown (K99) Assistance Unit (AU)?

Eligibility reviews can be initiated on K99 AUs in Active (A) status. If the AU is in MA Spenddown (M) status, an eligibility review can be initiated when the ongoing month is the month after the current base period end month.

Complete the eligibility review on an active K99 AU following the instructions in the Eligibility Review chapter.

Mainframe Processing

Mainframe processing for this program is unavailable, see Online Processing.

 

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