Medically Needy Non-Institutional Medical in an Alternate Living Facility Spenddown (G99)

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 G99 (Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown) medical?

SSI-related individuals paying privately in a state-contracted 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 Alternate Living Facility (ALF) has the same program rules as SSI-related Medicaid but with a higher income standard. The private daily rate drives the eligibility.

The difference between the SSI related series (S95, S99) and the non-institutional in an ALF related series (G95, G99) is the income standard.  If income exceeds the private daily rate, the client will have a spenddown liability.

The ACES medical coverage group (MCG) G95/G99 is for private pay clients. 

How long is Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown (G99) certified?

G99 defaults to 6 month base period. 

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

Online Processing

How do I screen G99 (Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown) medical?

To screen a G99 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 G99 during Finalize, if appropriate, based on the income and the AU Details page financial responsibility coding.

How do I process a pending G99 (Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown) Assistance Unit (AU)?

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

For more information on the spenddown process, see Apple Health eligibility manual - Apple Health for the Medically Needy and Spenddown overview | Washington State Health Care Authority.

How do I enter spenddown medical expenses for a G99 (Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown) Assistance Unit (AU) in M status?

To enter medical expenses to meet the client’s spenddown liability on a G99 AU in M status, take the following steps:

  1. Follow the instructions in Spenddown - How do I enter medical expenses?
  1. 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 a G99 (Medically Needy Non-Institutional Medical in an Alternate Living Facility – Spenddown) Assistance Unit (AU)?

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

  1. Complete the eligibility review on a G99 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.