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.