Medically Needy SSI Related Medical With No Spenddown (S95)

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 to receive Medically Needy SSI Related No Spenddown (S95) medical?

A person who meets the criteria established in the following may be eligible for S95 medical:

For 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.

How long is the Medically Needy SSI Related No Spenddown (S95) certification period?

S95 medical is certified for 12 months. For more information, see Apple Health eligibility manual - WAC 182-504-0020 Certification periods for the noninstitutional medically needy (MN) program.

Can a client receive Medically Needy SSI Related No Spenddown (S95) 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).

What happens when a Medically Needy SSI Related No Spenddown (S95) recipient becomes eligible for Categorically Needy (CN) medical?

When a client active on S95 becomes eligible for CN medical, the medical coverage group on the AU is changed to SSI Related Categorically Needy (S02) or Non Citizen CN SSI Related (S07).

Online Processing

How do I screen Medically Needy SSI Related No Spenddown (S95) medical?

An S95 AU is initially screened into ACES as a S02 (SSI Related Categorically Needy) Assistance Unit (AU), following the instructions in How do I screen S02 (Categorically Needy SSI Related) medical?  The S02 AU trickles to S95 during Finalize, if appropriate, based on the income and the AU Details page financial responsibility coding.

How do I process a pending Medically Needy SSI Related No Spenddown (S95) Assistance Unit (AU)?

While pending, the AU is still S02 (SSI Related Categorically Needy) and is processed following the same steps as in How do I process a pending S02 (SSI Related Categorically Needy) Assistance Unit (AU)?

The S02 AU trickles to S95 during Finalize, if appropriate, based on income or AU Details page financial responsibility coding.

If the AU exceeds the income standard for S95, it may trickle to SSI-Related Medically Needy with Spenddown (S99).

Mainframe Processing

How do I screen Medically Needy SSI Related No Spenddown (S95) medical?

An S95 Assistance Unit (AU) is initially screened into ACES as an S02 (SSI Related Categorically Needy) AU, following the instructions in How do I screen S02 (SSI Related Categorically Needy) medical?  The S02 AU trickles to S95 during Finalize, if appropriate, based on income or STAT screen financial responsibility coding.

How do I process a pending Medically Needy SSI Related No Spenddown (S95) Assistance Unit (AU)?

While pending, the AU is still S02 (SSI Related Categorically Needy) and is processed following the same steps as in How do I process a pending S02 (SSI Related Categorically Needy) Assistance Unit (AU)?

The S02 AU trickles to S95 during Finalize, if appropriate, based on income or STAT screen financial responsibility coding.

If the AU exceeds the income standard for S95, it may trickle to SSI-Related Medically Needy with Spenddown (S99).

 

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