Categorically Needy SSI Related Medical (S02)

Created on: 
Jul 12 2017

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

Who is eligible to receive Categorically Needy SSI Related (S02) medical?

A person who meets the criteria in the following sections may be eligible for S02 medical:

For more information on how countable income and resources are determined for SSI-related medical assistance, see Apple Health eligibility manual - WACs 182-512-0200 through 182-512-0960 for information on how countable income and resources are determined for SSI-related medical assistance.

How long is the S02 (Categorically Needy SSI Related) medical certification period?

S02 Medical 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 (CN) programs.

When is S02 (Categorically Needy SSI Related) medical AUTO opened?

S02 is AUTO opened in some instances when a Supplemental Security Income (SSI) recipient's payments are stopped by the Social Security Administration (SSA). For more information, see Apple Health eligibility manual - WAC 182-510-0010 What happens to my categorically needy (CN) medical coverage when my supplemental security income (SSI) cash payment is terminated? 

Can a client receive S02 (Categorically Needy SSI Related) medical coverage while incarcerated?

When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).

Online Processing 

How do I screen S02 (Categorically Needy SSI Related) medical?

To screen S02 medical, take the following steps:

  1. Follow the instructions in How do I screen an application for a client?
  • On the Finalize page, select the program with Coverage Group SSI Related Categorically Need (S02).

How do I process a pending S02 (Categorically Needy SSI Related) Assistance Unit (AU)?

To process a pending S02, take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access the Case Actions page in ACES 3G?
  2. Complete the interview following the steps in How do I initiate and complete an intake interview?
  3. On the AU Details page, in the Financial Responsibility field select the following from the drop down menu:
  • Applicant (PN) for the applicant and spouse (if the spouse is applying too).
  • Ineligible Spouse (SP) for an ineligible or non-applying spouse.
  • Child - SSI/Of SSI-related Parent/Used for HH Size (SC) for non applying children of the applicant/s.
  • ABD Parent (AP) for the parents of the applicant if the applicant is under 18 years old.
  1. On the Client Details page for each applicant(s) enter the disability information in the Disability/Incapacitated/Psychiatric section.
  • If the S02 program eligibility is based on age, coding the Disability/Incapacitated/Psychiatric section is optional.
  1. If the applicant has ever received Supplemental Security Income (SSI):
  • On the Unearned Income page, in the Ever Received SSI field check Yes.
  • Click the Add icon, under Income select Other Agency Application/Benefit and choose the applicant from the Client dropdown menu.
  • On the Other Agency Application/Benefit page, in the:
NOTE:  Once SSI termination information has been entered in the Ever Received SSI and Application/Benefits fields, these fields are no longer editable. These fields are only editable when ACES receives updated information from SDX and/or BENDEX, AUTO can update the fields as appropriate, or when a user or AUTO enters SSI income back to a case, the information in the fields can be deleted.  Only users with SSI SPECIAL AUTH in their ACES profile are permitted update ability for these fields in ACES 3G only.
  1. On the Expense page, click the Add icon to get to the Shelter Expense page for the applicant. Enter [the applicant's shelter expense information] in the appropriate fields.
  1. On the Resources Vehicles/Vessels page, to exempt the entire value of one vehicle, select Transportation for Disabled Person(TD) in the MA/CA Use field. 
  2. Complete all other screens as needed following the instructions in the Interview chapter.
  3. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  4. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S02 eligibility determination.

If the AU exceeds the income standard for S02 medical, it may trickle to SSI-Related Medically Needy - No Spenddown (S95) or SSI-Related Medically Needy with Spenddown (S99) during finalize.

Mainframe Processing

How do I screen S02 (Categorically Needy SSI Related) medical?

To screen S02 medical, see Online Processing - How do I screen S02 medical?

How do I process a pending S02 (Categorically Needy SSI Related) Assistance Unit (AU)?

To process S02 medical take the following steps:

  1. From the AMEN, access the pending AU via Option [O] - Interview.
  2. On the STAT screen, complete the Finl Resp fields as follows,
  • [PN] - Applicant for the applicant and an applying spouse.
  • [AP] - ABD Parent for the parents of the applicant if the applicant is a child.
  • [SP] - Ineligible Spouse for an ineligible or non-applying spouse.
  • [SC] - Child of SSI Related Parents/Child used to determine household size for any non-applying children.
  1. On the DEM2 screen, enter the [applicant’s disability information] in the Disability/Incapacity fields. See <F1> Help.
  • If the S02 program eligibility is based on age, coding the Disability/Incapacity fields is optional.
  1. If the applicant has ever received SSI code the UNER screen as follows:
  • Ever received SSI? Field - Enter [Y] - Yes.
  • Application/Benefit Type field - Enter [SI] - SSI.
  • Stat field - Enter [the appropriate valid value for the reason the client’s SSI was terminated]. See <F1> help.
  • Date field - Enter the [date SSI terminated].

For more information about Special Income Disregards, see Apple Health eligibility manual/Income - Special Disregards.

NOTE:  Once SSI termination information has been entered in the Ever Received SSI and Application/Benefits fields, these fields are no longer editable. These fields are only editable when ACES receives updated information from SDX and/or BENDEX, AUTO can update the fields as appropriate, or when a user or AUTO enters SSI income back to a case, the information in the fields can be deleted. Only users with SSI SPECIAL AUTH in their ACES profile are permitted update ability for these fields in ACES 3G only.
  1. On the SHEL screen, code any shelter costs the client is responsible to pay.
  1. Complete all other screens as needed following the instructions in the Interview chapter.
  2. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.
  3. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S02 eligibility determination.

 

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