See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
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
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.
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
To screen a G99 AU, take the following steps:
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)?
To finalizes a G99 AU, take the following steps:
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.
To enter medical expenses to meet the client’s Spenddown liability on a G99 AU in M status, take the following steps:
To initiate an Eligibility Review on a G99 AU, take the following steps:
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.