Categorically Needy Non-Institutional Medical in an Alternate Living Facility (G03)

Created on: 
Oct 11 2019

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

Who is eligible for Categorically Needy Non-Institutional Medical in an Alternate Living Facility (G03)?

This program is used for SSI-related individuals receiving Long-Term Service and Support (LTSS) under Medicaid Personal Care (MPC) or Community First Choice (CFC).  It is also used for Regional Support Network (RSN) placements in Alternate Living Facilities (ALF).

The individual income test is performed for all G03 clients. They are income eligible if their countable income is over the Categorically Needy Income Level (CNIL), but under the Special Income Level (SIL) and the state-contracted rate (x) number of days.  The state contracted daily rate drives the eligibility for G03.

  • The income calculation for G03 AUs follows the same path as SSI Related Categorically Needy (S02) AUs. When a G03 recipient’s own net income is less than or equal to the one person Categorically Needy Income Level (CNIL), the following edit message displays on the Eligibility and Eligibility Details pages: Client is eligible for S02. Screen in S02 and Close G03.
  • If the G03 applicant or recipient's own countable Net Income is less than or equal to the calculated Group C income standard, they are eligible for G03.
  • If the G03 applicant or recipient's own countable Net Income is greater than the calculated Group C income standard, they are not eligible for G03 and the system trickles to MN and performs tests for G95 or G99.  SSI-related individuals paying privately in a state-contracted Alternate Living Facilities (ALF) can be considered for this program under Medically Needy Non-Institutional Medical in an Alternate Living Facility – No Spenddown (G95) or Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown (G99).     

For more information, see Apple Health eligibility manual - WAC 182-513-1205 Determining eligibility for non-institutional coverage in an alternate living facility.

How long is Categorically Needy Non-Institutional Medical in an Alternate Living Facility (G03) certified?

G03 is certified for 12 months.

For more information, see Apple Health eligibility manual - WAC 182-504-0015 Washington apple health -- Certification periods for categorically needy programs.

Online Processing

How do I screen G03 (Categorically Needy Non-Institutional Medical in an Alternate Living Facility)?

  1. To screen a G03 Assistance Unit, take the following steps:

    Follow the instructions in Screening an Application - How do I screen an application for a client?

    •           On the Programs page, click the checkmark next to Medical.

    •           On the Finalize page, take the following steps in the Specify Program Section:

  • Program field – Select Medical Assistance (MA) from the drop down list,
  • Medical Coverage Group field – Select Alternate Living Facility (G03) from the drop down list.  
  • Program Type field – Select the appropriate program type from the drop down field.

How do I process a pending G03 (Categorically Needy Non-Institutional Medical in an Alternate Living Facility) Assistance Unit (AU)?

  1. Follow the steps in Interview - How do I initiate and complete an intake interview?

Data entered through the Start Interview option is copied back to all months in the application period unless a client is active in another Assistance Unit. In that situation, all information for the client must be entered in each of the application months, see Process Application Months - How do I complete Process Application Months? 

  1. Follow the steps in Finalize Application - How do I complete Finalize Application?
NOTE:  If the AU exceeds the income standard for G03, it may trickle to Medically Needy Non-Institutional Medical in an Alternate Living Facility – No Spenddown (G95)  or Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown (G99) during finalize.

Mainframe Processing

How do I screen G03 (Categorically Needy Non-Institutional Medical in an Alternate Living Facility) medical?

Screening is only available from ACES.online.   See How do I screen G03 (Categorically Needy Non-Institutional Medical in an Alternate Living Facility)?

 

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