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Effective: December 1, 2006 |
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24.10ar1 - Spenddown Types (Archive) |
Archived: January 1, 2010 |
Some people may be eligible for more than one medical spenddown type. This section of the manual will discuss the types of medical spenddowns and what to take into consideration when determining the spenddown type.
Which Medical Spenddown Type to Use.
There are three medical spenddown types:
l Six-Month.
n A six month spenddown is used when:
m The client’s net six-month countable income total exceeds the six-month income standard for the household size.
m The client has medical expenses that equal or exceed the six-month spenddown amount.
n Clients who have a six month spenddown interrupted may have a shortened spenddown.
A manual monthly spenddown is used when any of the following conditions apply:
n Client has varying income.
n Client has non-recurring health care expenses.
n Client cannot meet a six-month spenddown.
n Client does not meet the criteria for using an automated monthly spenddown.
An automated monthly spenddown, which is the same amount each month, is used if both of the following are met:
n Client’s income is consistent, or does not vary. Examples include RSDI, SSI or Veteran’s Administration (VA) benefits.
n Client has recurring medical expenses that equal or exceed the monthly spenddown amount.
Which Medical Spenddown Type to Use
Take the following into consideration when determining the medical spenddown type:
l The type of spenddown in which the household will be responsible for the least amount of health care expenses. Follow these steps:
1. Determine the spenddown amounts for each type of spenddown for which the client meets the criteria.
Note: Clients who have a monthly spenddown but who do not have a six month spenddown are eligible for MA without a spenddown.
2. Determine if the client is able to meet each of the spenddown amounts by comparing each spenddown amount to the amount of health care expenses the client has to meet each of the spenddowns.
3. Determine which spenddown type allows for MA to pay for more of the household health care expenses.
Example:
Mark, age 20, and his wife Melissa, age 19, apply for MA for themselves on October 5th and are not requesting retroactive coverage. Melissa must pay for an inhaler each month, which costs $45. She also has an emergency room bill from October 2 due to a severe asthma attack. The cost of the bill is $500.
After completing each of their income calculations it is determined that they meet the criteria for the following spenddown types with the listed spenddown amounts:
n Automated Monthly Spenddown - $25 each month.
n Six-Month Spenddown - $75 for the total six-month period.
Action:
Following the steps provided:
2. Determine if the client meets each of the spenddown amounts.
m The $25 automated spenddown amount can be met with recurring prescription costs or with the unpaid hospital bill.
m The $75 six-month spenddown is met with the $500 hospital bill.
3. Determine which spenddown type allows more of the client’s health care expenses to be paid.
m Automated Monthly Spenddown: Mark and Melissa would be responsible for $150 total ($25 X6) for the certification period.
m Six-Month Spenddown: Mark and Melissa would be responsible for $75, the total six-month spenddown amount, for the six-month period.
Mark and Melissa would benefit from a six-month spenddown because they will be responsible for a lesser amount of their health care expenses.
l All household members with a spenddown must use the same spenddown type for the entire certification period.
Exception: A spouse not living in the community or who is receiving Elderly Waiver (EW) does not have to have the same spenddown type as the spouse living in the community who is not EW.
n Clients do not have to meet both a six-month and a monthly spenddown to be eligible for MA.
n Some household members may not have a spenddown for a certification period. Those with a spenddown must choose to use the same type of spenddown as other members with a spenddown.
n The spenddown amount and satisfaction date may vary for each household member.
n See Associated Recipients for information on how health care expenses of other MA/GAMC household members' expenses are used to meet the spenddown.
Example:
Alicia and Erik apply for MA for themselves and their two children, ages three and four. The children do not have spenddowns. Alicia and Erik’s net countable income exceeds the income standard.
Action:
Alicia and Erik may choose either a six-month or a monthly spenddown. Both must use the same spenddown type.
l Clients with income over 100% FPG who do not receive MA-EPD and who receive waiver services through one of the following must use a monthly spenddown and with a spenddown standard of 75% FPG.
n Community Alternative Care (CAC).
n Community Alternatives for Disabled Individuals (CADI).
n Developmental Disabilities (DD).
n Traumatic Brain Injury (TBI).
l MinnesotaCare may be a better program for the client or household. Compare the household premium amount to the household spenddown amounts to make that determination.
Note: Some households may benefit from a combination of programs. For example, the household may need retroactive and current MA coverage but benefit from changing to MinnesotaCare for the future months.