Overview
The medically needy (MN) program provides Apple Health (Medicaid) health care coverage for aged, blind, or disabled persons, institutionalized individuals, hospice individuals, pregnant women, children, and refugees with income above Categorically Needy (CN) standards and countable resources below the applicable MN resource standard. Those standards are defined in the standards chapter of this manual. There is no MN program related to the Apple Health for Adults (N05) program.
MN program codes
The MN program has the following program codes: F99, G95, G99, K95, K99, L95, L99, P99, S95, and S99 .
An individual may qualify for the MN program with or without spenddown. When determining eligibility for the MN program, there may be a difference between CN countable income and MN countable income. This results from the extra income deductions which apply to MN (for more information, see WAC 182-519-0100 (5)). Decisions regarding CN eligibility and MN eligibility should be based on the appropriate calculation of countable income.
When determining countable income for individuals who are aged, blind or disabled, use SSI-related income rules and deeming methodologies.
When determining countable income for children and pregnant women, use family-related income rules and deeming methodologies.
If an individual's income goes down after the spenddown amount has been calculated, the individual may become eligible for CN coverage. See Change of circumstances for more information.
MN coverage for persons in institutions is determined according to WAC 182-513-1395 . See the long-term care section of the manual for more information.