Medically Needy SSI Related Medical With Spenddown (S99)

Who is eligible to receive Medically Needy SSI Related Medical with Spenddown (S99) medical?

A person who meets the criteria established in the following manual sections may be eligible for S99 medical:

• Apple Health eligibility manual - WAC 182-503-0505 Washington Apple Health - General eligibility requirements for medical programs.
• Apple Health eligibility manual - WAC 182-512-0050 SSI related medical -- General information.
• Apple Health eligibility manual - Apple Health for the Medically Needy (MN) and Spenddown.
• Apple Health eligibility manual - WAC 182-512-0050 Monthly income and countable resource standards for medical needy (MN).

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.

How long is the Medically Needy SSI Related Medical with Spenddown (S99) certification/base period?

The default certification/base period for S99 defaults is six months, which can be shortened to three months following the instructions in Spenddown - How do I set up a spenddown AU and base period?

Under certain conditions, the base period can be set to a period other than three or six months. For more information, see Apple Health eligibility manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program.

Can a client receive Medically Needy SSI Related Medical with Spenddown (S99) 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 Medically Needy SSI Related Medical with Spenddown (S99) medical?

An S99 Assistance Unit (AU) is initially screened into ACES as an SSI Related Categorically Needy (S02) AU by following the instructions in How do I screen SSI Related Categorically Needy (S02) medical?

An S02 AU trickles to S99 during Finalize, if appropriate, when the AU’s countable income exceeds the medically needy income level (MNIL) standard.

How do I process a pending Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

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

The S02 AU trickles to S99 in M - MA Spenddown during Finalize, when the AU’s countable income exceeds the MNIL standard.

For more information on the spenddown process, see Apple Health for the Medically Needy and Spenddown.

How do I add a person to a Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

When a SSI Related Categorically Needy (S02) AU trickles to  S99, additional AU members cannot be added.

To add a person to an S99 AU, take the following steps:

1. Manually close the current S99 AU following the instruction in the Online Processing - How do I manually close an Assistance Unit (AU) or client?.

2. Screen in a new S02 AU including the new AU member(s) and following the instructions in Online Processing - How do I screen SSI Related Categorically Needy (S02) medical?.
3. Process the pending S02 AU following the instructions in Online Processing - How do I process a pending SSI Related Categorically Needy (S02) Assistance Unit (AU)? 

How do I enter spenddown medical expenses for an Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU) in M status?

To enter medical expenses to meet the client’s spenddown liability on an S99 AU in M status, follow the instructions in Spenddown - How do I enter medical expenses?

After expenses have been added, follow the steps in Spenddown - How do I assign medical expenses and authorize spenddown?

How do I initiate an Eligibility Review on an Medically Needy SSI Related Medical with Spenddown (S99) Assistance Unit (AU)?

Eligibility reviews can be initiated on spenddown AUs in A - Active or M - MA Spenddown status.

Complete the eligibility review on an S99 AU following the instructions in the Eligibility Review chapter.

What happens when a Medically Needy Spenddown (S99) – M Status recipient becomes eligible for Categorically Needy (CN) medical or MN SSI Related No Spenddown (S95) medical?

For S99 Assistance Units (AUs) at MA Spenddown (M) status, when the system determines the client is eligible for CN or Medically Needy (MN) no spenddown in any month, users receive edit message: Screen New AU.

What happens when a Medically Needy Spenddown (S99) – A Status recipient becomes eligible for Categorically Needy (CN) medical or MN SSI Related No Spenddown (S95) medical?

When the client’s eligibility changes from an active S99 Assistance Unit (AU) to an SSI Categorically Needy (S01), SSI Related Categorically Needy (S02) / Non Citizen CN SSI Related (S07) / MN SSI Related No Spenddown (S95) AU in the ongoing month, the system:

• Closes the S99 AU with a paid through date that is the last day of the month prior to month when the new coverage begins.
• Changes the AU to the new coverage group.
• Sets certification period according to the new program type (no end date for S01, 12 month for S02 or non-AEM S95).
• Sends Letter 002-01 (Approval Letter).

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