Medicaid LTSS · state
Apple Health Medically Needy (Spenddown)
WA Health Care Authority
The Medically Needy (MN) program is a federal- and state-funded Apple Health program for individuals who are aged, blind, disabled, pregnant, or a child with income above the applicable Categorically Needy (CN) limits. MN provides slightly less health care coverage than CN and requires greater financial participation. Enrollees are given a base period (typically three or six months) during which they incur medical expenses equal to the amount their income exceeds the MN income standard ('spenddown'). Once spenddown is met, MN coverage activates for the remainder of the base period. MN is also the path for institutionalized individuals whose income exceeds the LTSS Special Income Level (program codes L95/L99).
Who qualifies
Aged 65+, blind, or disabled (or pregnant/child) with income above the relevant CN limit but otherwise resource-eligible. Specific MN program codes: F99 (kids), G95/G99, K95/K99 (institutional MAGI), L95/L99 (institutional aged/blind/disabled), P99 (pregnant), S95/S99 (SSI-related). Resource limit: $2,000 single / $3,000 couple (1/1/2026), rising +$50 per additional household member.
What it covers
MN scope of care: covers most CN services with some restrictions. Available for all CN-covered service categories except some (e.g., personal care services not covered for adult MN; school-based services and orthodontics covered only for children).
Cost
Example from HCA 22-315: 67-year-old with $1,207 SS income; after $20 disregard = $1,187; over MNIL ($994) by $193. 6-month spenddown = $1,158. Source: HCA 19-0096 (1/1/2026 standards).
How to apply
Apply through Washington Connection (washingtonconnection.org), in person at a DSHS Community Services Office, or by paper using HCA Form 18-005.