WAC 388-519-0100   Eligibility for the medically needy program.  (1) A person who meets the following conditions is considered for medically needy (MN) coverage under the special rules in chapter 388-513 WAC.

     (a) A person who meets the institutional status requirements of WAC 388-513-1320; or

     (b) A person who receives waiver services under chapter 388-515 WAC.

     (2) MN coverage is considered under this chapter when a person:

     (a) Is not excluded under subsection (1) of this section; and

     (b) Is not eligible for categorically needy (CN) medical coverage because they have CN countable income which is above the CN income standard.

     (3) MN coverage is available for children, for persons who are pregnant or for persons who are SSI-related. MN coverage is available to an aged, blind, or disabled ineligible spouse of an SSI recipient even though that spouse's countable income is below the CN income standard. Adults with no children must be SSI related in order to be qualified for MN coverage.

     (4) A person not eligible for CN medical and who is applying for MN coverage has the right to income deductions in addition to those used to arrive at CN countable income. The following deductions are used to calculate their countable income for MN. Those deductions to income are applied to each month of the base period and determine MN countable income:

     (a) All health insurance premiums expected to be paid by the client during the base period are deducted from their income; and

     (b) For persons who are SSI-related and who are married, see the income provisions for the nonapplying spouse in WAC 388-450-0210; and

     (c) For persons who are not SSI-related and who are married, an income deduction is allowed for a nonapplying spouse:

     (i) If the nonapplying spouse is living in the same home as the applying person; and

     (ii) The nonapplying spouse is receiving community and home based services under chapter 388-515 WAC; then

     (iii) The income deduction is equal to the one person MNIL less the nonapplying spouse's actual income.

     (5) A person who meets the above conditions is eligible for MN medical coverage if their MN countable income is at or below the medically needy income level (MNIL) in WAC 388-478-0070. They are certified as eligible for up to twelve months of MN medical coverage. Certain SSI or SSI-related clients have a special MNIL. That MNIL exception is described in WAC 388-513-1305.

     (6) A person whose MN countable income exceeds the MNIL may become eligible for MN medical coverage when they have or expect to have medical expenses. Those medical expenses or obligations may be used to offset any portion of their income which is over the MNIL.

     (7) That portion of a person's MN countable income which is over the department's MNIL standard is called "excess income."

     (8) When a person has or will have "excess income" they are not eligible for MN coverage until they have medical expenses which are equal in amount to that excess income. This is the process of meeting "spenddown."

     (9) A person who is considered for MN coverage under this chapter may not spenddown excess resources to become eligible for the MN program. Under this chapter a person is ineligible for MN coverage if their resources exceed the program standard in WAC 388-478-0070. A person who is considered for MN coverage under chapter 388-513 WAC is allowed to spenddown excess resources.

     (10) No extensions of coverage or automatic redetermination process applies to MN coverage. A client must submit an application for each eligibility period under the MN program.



[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-519-0100, filed 7/31/98, effective 9/1/98. Formerly WAC 388-503-0320, 388-518-1840, 388-519-1930 and 388-522-2230.]