Medically Needy LTC in a Medical Facility – with Spenddown (L99)

Created on: 
Sep 12 2017

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

Who is eligible to receive L99 (LTC MN or Hospice with Spenddown)?

Clients who meet the criteria described in Apple Health (Medicaid) Manual – WAC 182-513-1395 Determining eligibility for institutional or hospice services for people living in a medical institution under the SSI-related medically needy program.

How long is the L99 (LTC MN or Hospice with Spenddown) certification period?

The default certification/base period for L99 is six months, which can be shortened to three months following the instructions in Spenddown – How do I set up a spenddown Assistance Unit and base period?

Under certain conditions, the base period can be set to a period other than three or six months. See Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program for these conditions.

Online Processing

How do I screen L99 (LTC MN or Hospice with Spenddown)?

An L99 Assistance Unit (AU) is initially screened as an L02 (CN SSI Related Long Term Care) AU. For more information on screening, see How do I screen L02 medical?

  • If the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as a L22 (CN Waiver or Hospice - SSI Related).

If appropriate the L02/L22 AU trickles to an L99 when finalizing. This determination is based on the income, living arrangement and the coding on the Facility or Home and Community Based Services page. For more information on finalizing the AU, see How do I complete Finalize Application?

How do I process a pending L99 (LTC MN or Hospice with Spenddown) 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 L02 (CN SSI Related Long Term Care) or L22 (CN Waiver or Hospice - SSI Related) and is processed following the steps in How do I process a pending L02 AU?

If the AU exceeds the income standard for L02, it trickles to L99 in MA Spenddown (M) status.

For additional information on the spenddown process, see Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program.

The Hospice (H) indicator displays in the Cost of Care section on the Eligibility Details page when hospice is the priority program.

How do I enter spenddown medical expenses for an L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU) in M status?

To enter medical expenses to meet the client’s spenddown liability on an L99 AU in MA Spenddown (M) status, follow the instructions in How do I enter medical expenses?

How do I add a person to an L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU)?

When a L02 (CN SSI Related Long Term Care) or L22 (CN Waiver or Hospice - SSI Related) trickles to a L99 (LTC MN or Hospice with Spenddown), additional AU members cannot be added.

To add a person to an L99 AU, take the following steps:

  1. Manually close the current L99 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 L99 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 L02 AU including the new AU member(s) and following the instructions in Online Processing - How do I screen L02 (Categorically Needy LTC in a Medical Facility - SSI Related) medical?.
  2. Process the pending L02 AU following the instructions in Online Processing - How do I process a pending L02 (Categorically Needy LTC in a Medical Facility - SSI Related) Assistance Unit (AU)?.

When can I initiate an Eligibility Review on an L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU)?

Eligibility reviews can be initiated on L99 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 L99 AU following the instructions in the Eligibility Review chapter.

Mainframe Processing

How do I screen L99 (LTC MN or Hospice with Spenddown)?

An L99 Assistance Unit (AU) is initially screened as an L02 (CN SSI Related Long Term Care) AU. For more information on screening, see How do I screen L02 medical?

  • If the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as a L22 (CN Waiver or Hospice - SSI Related).

If appropriate the L02/L22 AU trickles to an L99 when finalizing. This determination is based on the income, living arrangement and INST screen coding. For more information on finalizing the AU, see How do I complete Finalize Application?

How do I process a pending L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU)?

While pending, the AU is still a L02 (CN SSI Related Long Term Care) or L22 (CN Waiver or Hospice - SSI Related) and is processed following the steps in How do I process a pending L02 AU?

If the AU exceeds the income standard for L02, it trickles to L99 in [M] - MA Spenddown status.

For additional information on the spenddown process, see Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program.

The HOSPICE indicator displays on the ELIG and STAT screen when hospice is the priority program for the AU.

How do I add a person to an L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU)?

When a L02 (CN SSI Related Long Term Care) or L22 (CN Waiver or Hospice - SSI Related) trickles to a L99 (LTC MN or Hospice with Spenddown), additional AU members cannot be added.

To add a person to an L99 AU, see Online Processing - How do I add a person to an L99 (LTC MN or Hospice with spenddown) Assistance Unit (AU)?.

How do I enter spenddown medical expenses for an L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU) in M status?

To enter medical expenses to meet the client’s spenddown liability on an L99 AU in [M] - MA Spenddown status, follow the instructions in How do I enter medical expenses?

When can I initiate an Eligibility Review on an L99 (LTC MN or Hospice with Spenddown) Assistance Unit (AU)?

Eligibility reviews can be initiated on L99 AUs in [A] – Active status. If the AU is in [M] – MA Spenddown 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 L99 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.