*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2014 |
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24.05 - Spenddown Standards |
Archived: June 1, 2016 (Previous Versions) |
Clients in the community, whose total net income is greater than the applicable Federal Poverty Guideline (FPG), must have their eligibility calculated using a FPG spenddown standard.
Which FPG spenddown standard to use is based on the client’s basis of eligibility and method of calculating income. There are two spenddown standards:
l 133% FPG: People using a families and children basis of eligibility must spend down to the 133% FPG standard.
l 75% FPG: People using a blind, disabled, or age 65 or older basis of eligibility must spend down to the 75% FPG standard.
Note: There is no spenddown standard for the Medicare Savings Programs or people using an adults without children basis of eligibility. These programs do not allow a spenddown.
Change to the appropriate FPG spenddown standard based on the client’s basis of eligibility when the net income exceeds the FPG non-spenddown standard.
Example:
Mildred, age 67, has an age 65 or older basis of eligibility. Her net income of $950 exceeds the 100% FPG standard for a household of one.
Action:
Since Mildred’s net income is over the 100% FPG standard for a household of one, use the 75% FPG standard for a household of one to determine the amount of her spenddown.
Example:
Joe applies for health care coverage for his five-year-old son, Nick. Nick has a basis of eligibility as a child under age 21. Joe’s monthly income is $4,000. Joe's income exceeds the Nick's 275% FPG standard for a household of two.
Action:
Since the income is over the 275% FPG standard, use 133% FPG standard for a household of two to determine the amount of Nick's spenddown.