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

Created on: 
Sep 08 2017

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) (S02) or Community First Choice (CFC) (L52) when their countable income is over the Categorically Needy Income Level (CNIL), but under the Special Income Level (SIL) and state-contracted rate.  

It is also used for Regional Support Network (RSN) placements in alternate living facilities (ALF) (G03).

SSI-related individuals paying privately in a state-contracted Alternate Living Facility (ALF) can be considered for this program under medically needy (MN) G95, G99.    For more information, see Apple Health eligibility manual - WAC 182-513-1205 Determining eligibility for non-institutional coverage in an alternate living facility.

Non- institutional Medicaid in an ALF has the same program rules as SSI related Medicaid but with a higher income standard. The state contracted daily rate drives the eligibility for G03.

The difference between the SSI related series (S02, S95, S99) and the non-institutional in an ALF related series (G03, G95, G99) is the income standard.  Income must be at or below both the:

         SIL; and

The daily rate x 31 days plus the ABD cash standard of $38.84.

The ACES medical coverage group (MCG) G03 is for Medicaid Personal Care (MPC) and G95/G99 is for private pay clients. 

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.