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

Created on: 
Aug 14 2018

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 Assistance Unit (AU)?

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)?

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

To finalizes a G99 AU, take the following steps:

  1. Follow the steps in How do I Complete Finalize Application? 
NOTE: Based on the income and the AU's financial responsibility coding, the G03 AU trickles to G95 (Medically Needy Non-Institutional Medical in an Alternate Living Facility - No Spenddown) or 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?
  2. 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)?

To initiate an Eligibility Review on a G99 AU, take the following steps:

  1. Complete the eligibility review on a G99 AU following the instructions in the Eligibility Review chapter.
NOTE: Eligibility reviews can be initiated on Spenddown AUs in Active (A) or MA Spenddown (M) status.

 

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