Medically Needy Non-Institutional Medical in an Alternate Living Facility - No Spenddown (G95)

Created on: 
Sep 08 2017

 

Medically Needy (MN) Non-Institutional Medical In an Alternate Living Facility No Spenddown (G95)

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

Who is eligible to receive G95 (Medically Needy (MN) Non-Institutional medical in an Alternate Living Facility No spenddown)?

SSI-related people 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 private daily rate drives the eligibility for G95.

The difference between the SSI related MN series (S95, S99) and the non-institutional in an ALF related MN series (G95, G99) is the income standard. Income must be either over the SIL or over the daily rate x 31 days plus the ABD cash standard of $38.84; or both:

  • If income is over the SIL, but less than the private daily rate: G95; and

  • If income is over the private daily rate; G99

The ACES medical coverage group (MCG) 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 Medically Needy Non-Institutional Medical in an Alternate Living Facility (G95) certified?

G95 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.

Online Processing

How do I screen a G95 (Medically Needy (MN) Non-Institutional Medical in an Alternate Living Facility - No Spenddown) Assistance Unit (AU)?

To screen a G95 AU, take the following steps:

  1. Follow the instructions in Categorically Needy Non-Institutional Medical in an Alternate Living Facility (G03) - How do I screen G03 (Categorically Needy Non-Institutional Medical in an Alternate Living Facility)?

  • The G03 AU trickles to G95 during Finalize, if appropriate, based on the income and the Details page financial responsibility coding.

How do I process a pending G95 (Medically Needy (MN) Non-Institutional Medical in an Alternate Living Facility - No Spenddown) Assistance Unit (AU)?

  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.

 

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