See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who receives federal cash benefits under the Supplemental Security Income (SSI) program who also meets the eligibility and institutional criteria in the following may be eligible for L01 medical:
L01 medical has no review end date and is certified for as long as the client is eligible for both Supplemental Security Income (SSI) and institutional Long-Term Care (LTC) services.
To screen an L01 Assistance Unit (AU), take the follow the steps:
To process a pending L01 AU, follow the steps in How do I process a pending L02 AU?
When Social Security Administration (SSA) determines a Supplemental Security Income (SSI) only recipient’s stay in a medical facility is to exceed three months, the SSI cash payment is reduced to $30 a month. When this occurs, ACES issues a cash supplement to bring the client’s income up to the Personal Needs Allowance (PNA) standards. For more information, see Apple Health eligibility manual - Long-Term Care - Personal Needs Allowance (PNA) Chart.
When a cash benefit is issued from an L01 AU, the program type is set to SSI MIL Client/Aged with Cash Payment (M), Blind with Cash Payment (N) or Disabled with Cash Payment (O) and the benefit amount displays in the PNA/CPI field in the Income/Expenses section on the Eligibility Details page.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Clients who meet the eligibility criteria described in the following manual sections may be eligible for L02 medical:
The L02 medical program is certified for 12 months.
To screen an L02 Assistance Unit, take the following steps:
To process a pending L02 AU, take the following steps;
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Non-citizen clients in a nursing facility who are pre-approved by HCS and meet the eligibility requirements described in the following:
Non-citizen clients in a hospital approved by the Health Care Authority (HCA):
L04 medical is certified for 12 months.
An L04 Assistance Unit (AU) is initially screened as a L02 (CN SSI Related Long Term Care) AU following the steps in How do I screen L02 Medical?
The L02 AU trickles to a L04 during finalize, if appropriate, based on the eligibility, living arrangement, and coding on the Clients Detail and Facilities pages.
To process a pending L04 AU, take the following steps:
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person with SSI income who meets the criteria in the following manual sections may be eligible for L21 medical:
L21 medical has no review end date and is certified for as long as the client is eligible for both SSI and waiver service coverage.
To screen an L21 AU, take the following steps:
To process a pending L21 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who is Supplemental Security Income (SSI) related and who meets the criteria in the following manual sections may be eligible for L22 medical:
The certification period for L22 medical is 12 months.
To screen an L22 Assistance Unit, take the following steps:
To process a pending L22 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Non-citizen clients at home or in an Alternate Living Facility (ALF) who are pre-approved by the Aging and Long-Term Support Administration (ALTSA) and meet the eligibility requirements described in:
L24 medical is certified for 12 months.
An L24 AU is initially screened as L22 (Categorically Needy Waiver or Hospice Services - SSI Related). Follow the steps in How do I screen an application for a client?
To process a pending L24 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person with SSI income who meets the criteria in the following Apple Health Manual sections may be eligible for L31 medical:
L31 should not be used for recipients who are not in a medical facility; instead, S01 (SSI Categorically Needy) medical should be approved for these clients.
L31 recipients in a medical facility may be issued a cash payment to bring their income up to the Personal Needs Allowance (PNA).
L31 medical has no review end date and is certified for as long as the client is eligible for SSI.
To screen an L31 AU, take the following steps:
To process a pending L31 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who is SSI related who meets the criteria in the following manual sections may be eligible for L32 medical:
L32 is certified for 12 months.
To screen an L32 Assistance Unit (AU), take the following steps:
To process a pending L32 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person with SSI income who meets the following criteria may be eligible for L41 medical:
L41 recipients may also be eligible for and receive State Supplement Payments (SSP) or Ongoing Additional Requirements.
L41 medical has no review end date. Roads to Community Living (RCL) has continuous eligibility for 365 days from the date client is authorized. Income or Resource changes don’t impact the client’s eligibility.
To screen an L41 Assistance Unit (AU), take the following steps:
1. Follow the instructions in Screening an Application.
To process a pending L41 AU, follow the steps in How do I process a pending L02 AU?
An active L41 (AU) can only be closed for one of the following reason codes:
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
An SSI-related person who meets the criteria in the Apple Health eligibility manual - WAC 182-513-1235 Roads to Community Living (RCL) may be eligible for L42 medical.
The certification period for L42 medical is set to the last day of the month of the Roads to Community Living (RCL) end date. If this doesn't allow enough time to put the Assistance Unit into a review cycle, the system auto adjusts the Certification Period by one or two months.
To screen an L42 AU, take the follow the steps:
To process a pending L42 AU, follow the steps in How do I process a pending L02 AU?
An active L42 AU can only be closed for one of the following reason codes:
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person with SSI income who meets the criteria in the following manual sections may be eligible for L51 medical:
Recipients of L51 may also be eligible for and receive Ongoing Additional Requirements (OAR). For more information, see EA-Z Manual Ongoing Additional Requirements (OAR).
L51 medical has no review end date and is certified for as long as the client is eligible for both Supplemental Security Income (SSI) and Community First Choice.
To screen an L51 AU, take the following steps:
To process a pending L51 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
A person who is Supplemental Security Income (SSI) related and meets the criteria in the following sections may be eligible for L52 medical:
L52 is certified for 12 months.
To screen an L52 Assistance Unit (AU), take the following steps:
1. Follow the instructions in How do I screen an application for a client?
To process a pending L52 AU, follow the steps in How do I process a pending L02 AU?
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Supplemental Security Income (SSI) related clients who reside in a medical institution, including clients who receive hospice services, and have non-excluded income over the Special Income Level (SIL) and less than the facility’s department contracted rate.
Children who are blind or disabled, reside in a medical institution, and have non-excluded income over the categorically needy (CN) standard for the children’s medical program and less than the facility’s department contracted rate.
For more information, see Apple Health eligibility manual - WAC 182-513-1395 Determining eligibility for institutional or hospice services for people living in a medical institution under the SSI-related medically needy program.
The certification period for L95 medical is 12 months.
When a client active on L95 medical becomes eligible for CN medical, the medical coverage group is changed to CN SSI Related Long Term Care (L02), Non-Citizen CN SSI Related Long Term Care (L04), PACE or Hospice (L32), Roads to Community Living (L42), or Community First Choice (L52).
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
Clients who meet the criteria described in Apple Health (Medicaid) Manual – WAC 182-513-1395 Determining eligibility for institutional or hospice services for people living in a medical institution under the SSI-related medically needy program.
The default certification/base period for L99 is six months, which can be shortened to three months following the instructions in Spenddown – How do I set up a spenddown Assistance Unit and base period?
Under certain conditions, the base period can be set to a period other than three or six months. See Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program for these conditions.
When a client active on L99 medical becomes eligible for CN or MN No Spenddown medical, the worker receives message: Client appears eligible for CN or MN no Spenddown. Screen new AU.
An L99 Assistance Unit (AU) is initially screened as a CN SSI Related Long Term Care (L02) AU. For more information on screening, see How do I screen L02 medical?
If appropriate the L02/L22 AU trickles to an L99 when finalizing. This determination is based on the income, living arrangement and the coding on the Facility or Home and Community Based Services page. For more information on finalizing the AU, see How do I complete Finalize Application?
While pending, the AU is still CN SSI Related Long Term Care (L02) or CN Waiver or Hospice - SSI Related (L22) and is processed following the steps in How do I process a pending L02 AU?
If the AU exceeds the income standard for L02, it trickles to L99 in MA Spenddown (M) status.
For additional information on the spenddown process, see Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program.
The Hospice (H) indicator displays in the Cost of Care section on the Eligibility Details page when hospice is the priority program.
To enter medical expenses to meet the client’s spenddown liability on an L99 AU in MA Spenddown (M) status, follow the instructions in How do I enter medical expenses?
When a CN SSI Related Long Term Care (L22) or CN Waiver or Hospice - SSI Related (L22) trickles to L99, additional AU members cannot be added.
To add a person to an L99 AU, take the following steps:
Eligibility reviews can be initiated on L99 AUs in Active (A) status. If the AU is in MA Spenddown (M) status, an eligibility review can be initiated when the ongoing month is the month after the current base period end month.
Complete the eligibility review on an active L99 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.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
TSOA provides limited support services to family caregivers when the care is for a client who is not a current recipient of Categorically Needy or Alternative Benefit plan (CN/ABP) Medicaid and the client:
For more information on the TSOA medical program, see Apple Health eligibility manual - Tailored supports for older adults (TSOA).
A client who resides in an at home sub-setting and is found to be functionally, financially, and resource eligible may be eligible for TSOA.
For more information on the TSOA medical program, see the Apple Health eligibility manual - WAC 182-513-1615 Tailored Supports for Older Adults (TSOA) - General Eligibility and Apple Health eligibility manual - WAC 182-513-1655 Tailored supports for older adults (TSOA) - Renewals.
To screen in a T02 AU, take the following steps:
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
If the client does not meet institutional status to establish eligibility in the hospital, then users need to consider S02 (Categorically Needy SSI Related Medical) eligibility. However, there are certain situations when L-track medical would be to the client’s advantage. These cases need to be reviewed by policy if the worker is uncertain what program would be best for the client.
To process a change when a client changes from one setting or service to another, take the following steps:
To process the change for the months after the change took place, take the following steps:
For a Long-Term Care client with a Community Spouse, shelter expenses must be entered on the Community Spouse’s Shelter Expenses page to be used in the community spousal allowance/excess shelter calculation.
The excess shelter allocation is the amount in excess of the appropriate standard. For additional information, see Apple Health eligibility manual - WAC 182-513-1380 Determining a person's financial participation in the cost of care for long-term care (LTC) services.
ACES uses the four-person Standard Utility Allowance (SUA) in this computation. If utilities are included in the rent, mortgage, maintenance fees or condo fees, deduct that amount of the four-person SUA from these expenses so it is not allowed twice.
If the State Data Exchange (SDX) interface indicates a client is no longer SSI eligible the following occurs:
When a client’s SSI benefits are terminated, re-determine the client’s medical eligibility for other programs (such as L02 if the client is still residing in a medical institution) following the processes outlined in the Apple Health eligibility manual - WAC 182-504-0120 Washington apple health - Effective dates of changes.
The Facility page should be used when:
To close a LTC medical program for a client who is deceased, complete the following steps:
To correctly calculate eligibility for a Long Term Care (LTC) Assistance Unit (AU) and the spousal/dependent allocation amount, the following data is required:
Information regarding the spouse’s resources and income must be entered using the standard client based screens such as the Client Details, Unearned Income, Earned Income, Shelter Expenses and Resources pages.
To code a legal dependent on an LTC AU, complete the following fields on the Dependent/Child Income and Allowance page:
When participation is split between multiple providers, the participation amounts for each provider can be viewed on the Eligibility Details page in the Post Eligibility section.
The Post Eligibility section displays:
In ACES.online, the split participation can be viewed on the Medical Eligibility page in the Split Cost of Care section.
The participation amounts can be viewed on the LTCP screen when it is split between multiple providers.
The MAFI screen displays the LTCP indicator next to the Total Payment field and it can be accessed by pressing <F16> on the MAFI screen.
The LTCP screen is an inquiry only screen and can be accessed from any other data collection screen. For more information, see How do I fast-path to a specific screen?
The LTCP screen displays:
The STAY screen displays when a medical client is institutionalized or elects Hospice for a short period of time. Use the STAY screen to access the SSCC screen that displays the amount the client owes the provider for a specified Short Stay. The SSCC screen is accessible only from the STAY screen.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
This is the standard amount of income that an institutional client is allowed to keep to use for housing, clothing, personal items and other incidentals. This allowance is sometimes referred to as Clothing and Personal Incidentals (CPI). For more information see Apple Health eligibility manual – WAC 182-513-1380 Determining a client’s financial participation in the cost of care for long-term care (LTC) services. The PNA is deducted from the client’s countable income when determining their cost-of-care responsibility.
A client’s PNA is calculated based on the clients living arrangement, authorized services and marital status. For more information see Apple Health eligibility manual – Long-Term Care Personal Needs Allowance (PNA) charts. When a client is in multiple settings during the month, the PNA used in the cost-of-care calculation will be the highest PNA the client was eligible for at any point during the month.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.