SSI-related medical -- Medically needy (MN) medical eligibility
Effective October 1, 2013.
Washington apple health (WAH) medically needy (MN) health care coverage is available for any of the following:
A person who is SSI-related and not eligible for WAH categorically needy (CN) medical coverage because the person has countable income that is above the WAH CN income level (CNIL) (or for long-term care (LTC) recipients, above the special income limit (SIL)):
The person's countable income is at or below WAH MN standards, leaving no spenddown requirement; or
The person's countable income is above WAH MN standards requiring the person to spenddown their excess income (see subsection (4) of this section). See WAC 182-512-0500
for rules on determining countable income, and WAC 182-519-0050
for program standards or chapter 182-513
WAC for institutional standards.
An SSI-related ineligible spouse of an SSI recipient;
A person who meets SSI program criteria but is not eligible for the SSI cash grant due to immigration status or sponsor deeming. See WAC 182-503-0535
for limits on eligibility for aliens;
A person who meets the WAH MN LTC services requirements of chapter 182-513
A person who lives in an alternate living facility and meets the requirements of WAC 182-513-1305
A person who meets resource requirements as described in chapter 182-512
WAC, elects and is certified for hospice services per chapter 182-551
A person whose countable resources are above the SSI resource standards is not eligible for WAH MN noninstitutional health care coverage. See WAC 182-512-0200
to determine countable resources.
A person who qualifies for services under WAH long-term care programs has different criteria and may spend down excess resources to become eligible for WAH LTC institutional or waiver health care coverage. Refer to WAC 182-513-1315
A person with income over the effective WAH MN income limit (MNIL) described in WAC 182-519-0050
may become eligible for WAH MN coverage when the person has incurred medical expenses that are equal to the excess income. This is the process of meeting spenddown. Refer to chapter 182-519
WAC for spenddown information.
A person may be eligible for health care coverage for any or all of the three months immediately prior to the month of application, if the person has:
Met all eligibility requirements for the months being considered; and
Received medical services covered by medicaid during that time.
A person who is eligible for WAH MN without a spenddown is certified for up to twelve months. For a person who must meet a spenddown, refer to WAC 182-519-0110
. For a person who is eligible for a WAH long-term care MN program, refer to WAC 182-513-1305
A person must reapply for each certification period. There is no continuous eligibility for WAH MN.