Medically Needy LTC or Hospice - No Spenddown (L95)

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 for Medically Needy LTC or Hospice - No Spenddown (L95) medical?

Supplemental Security Income (SSI) related clients who reside in a medical institution, including clients who receive hospice services, and have non-excluded income over the Special Income Level (SIL) and less than the facility’s department contracted rate. 

Children who are blind or disabled, reside in a medical institution, and have non-excluded income over the categorically needy (CN) standard for the children’s medical program and less than the facility’s department contracted rate.

For more information, see Apple Health eligibility 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 Medically Needy LTC or Hospice - No Spenddown (L95) certification period?

The certification period for L95 medical is 12 months.

What happens when a Medically Needy LTC or Hospice – No Spenddown (L95) recipient becomes eligible for Categorically Needy (CN) medical?

When a client active on L95 medical becomes eligible for CN medical, the medical coverage group is changed to CN SSI Related Long Term Care (L02), Non-Citizen CN SSI Related Long Term Care (L04), PACE or Hospice (L32), Roads to Community Living (L42), or Community First Choice (L52).

Online Processing

How do I screen Medically Needy LTC or Hospice - No Spenddown (L95) medical?

  1. An L95 Assistance Unit (AU) is initially screened as a Categorically Needy LTC in a Medical Facility - SSI Related (L02) AU following the instructions in How do I screen an application for a client?
NOTE: If the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as Categorically Needy Waiver or Hospice Services - SSI Related (L22).

How do I process a pending Medically Needy LTC or Hospice - No Spenddown (L95) Assistance Unit (AU)

  1. While pending the AU remains Categorically Needy LTC in a Medical Facility - SSI Related (L02) or Categorically Needy Waiver or Hospice Services - SSI Related (L22) and is processed following the steps in How do I process a pending L02 AU?
NOTE:HOSPICE indicator displays on the Eligibility Details and Assistance Unit Details pages when hospice is the priority program for the AU.

Mainframe Processing

How do I process a pending Medically Needy LTC or Hospice - No Spenddown (L95) Assistance Unit (AU)?

  1. While pending, the AU remains Categorically Needy LTC in a Medical Facility - SSI Related (L02) or Categorically Needy Waiver or Hospice Services - SSI Related (L22) and is processed following the steps in How do I process a pending L02 AU?
NOTE: A HOSPICE indicator displays on the ELIG and STAT screens when hospice is the priority program for the AU.

 

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