Medically Needy SSI Related Medical With Spenddown (S99)

Created on: 
Sep 12 2017
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

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

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

How long is the S99 (Medically Needy SSI Related Medical with Spenddown) 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 S99 (Medically Needy SSI Related Medical with Spenddown) 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 S99 (Medically Needy SSI Related Medical with Spenddown) medical?

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

Processing Alternative: No Spenddown segment created when some months are approved / denied in ACES, also rejects in ProviderOne (PR 322946)

While pending, the AU is S02 (SSI Related Categorically Needy) and is processed following the same steps in How do I process a pending S02 (SSI Related Categorically Needy) 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 S99 (Medically Needy SSI Related Medical with Spenddown) Assistance Unit (AU)?

When a S02 (SSI Related Categorically Needy) Assistance Unit (AU) trickles to a S99 (Medically Needy SSI Related Medical with Spenddown), 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?.
NOTE: Before manually closing the current S99 AU, review the base period and shorten if necessary. For more information, see Online Processing - How do I shorten a spenddown Assistance Unit (AU) base period?.
  1. Screen in a new S02 AU including the new AU member(s) and following the instructions in Online Processing - How do I screen S02 (SSI Related Categorically Needy) medical?.
  2. Process the pending S02 AU following the instructions in Online Processing - How do I process a pending S02 (SSI Related Categorically Needy) Assistance Unit (AU)? 

How do I enter spenddown medical expenses for an S99 (Medically Needy SSI Related Medical with Spenddown) 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 S99 (Medically Needy SSI Related Medical with Spenddown) 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.

Mainframe Processing

How do I screen S99 (Medically Needy SSI Related Medical with Spenddown) medical?

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

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

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

For more information on the spenddown process, see Apple Health eligibility manual - Apple Health for the Medically Needy (MN) and Spenddown.

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

When a S02 (SSI Related Categorically Needy) Assistance Unit (AU) trickles to a S99 (Medically Needy SSI Related Medical with Spenddown), additional AU members cannot be added.

To add a person to an S99 AU, see Online Processing - How do I add a person to a S99 (Medically Needy SSI Related Medical with Spenddown) Assistance Unit (AU)?.

How do I enter spenddown medical expenses for an S99 (Medically Needy SSI Related Medical with Spenddown) 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 S99 (Medically Needy SSI Related Medical with Spenddown) 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.

 

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