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Effective: December 1, 2006 |
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24.10.10arc1 - Manual Monthly Spenddown (Archive) |
Archived: January 1, 2010 |
A manual monthly spenddown is one type of medical spenddown.
The manual monthly spenddown amount is the difference between the actual total net countable income a client receives in a month and the applicable Federal Poverty Guidelines (FPG) for a single month. Each month of the certification period is determined separately.
For the steps to calculate a manual monthly spenddown, see Manual Monthly Spenddown Calculations.
Clients may not use a manual monthly spenddown if they are members of a family on MinnesotaCare where one member has been hospitalized.
Clients may use a manual monthly spenddown if they meet one of the following:
l Their income varies.
Note: This includes situations in which net income varies during a certification period due to changes in disregards or deductions.
l Their medical expenses vary.
l Their medical expenses are non-reimbursable by MA/GAMC.
l The client does not have enough medical expenses to satisfy a six-month spenddown.
Example:
Phoebe applies for MA for herself and her two children. She is employed part-time and is paid bi-weekly. Phoebe is determined to have a spenddown for both a monthly and six-month basis.
Phoebe incurred health care expenses in the month of application. The expenses exceed the monthly spenddown amount but are less than the six-month spenddown.
Action:
Use a manual monthly spenddown due to fluctuating income, and not meeting a six-month spenddown.
Clients must use a manual monthly spenddown if any of these conditions applies:
l Their spouse or children choose a manual monthly spenddown.
l The spenddown is met, in whole or in part, with bills paid by state-funded (non-FFP) MinnesotaCare for other family members. See MinnesotaCare Expenses for more information on how these expenses are processed.
Note: Bills paid by MinnesotaCare for people for whom DHS receives FFP cannot be used to meet an MA spenddown for other family members.
l Income varies. The client must use a manual monthly spenddown rather than an automated monthly spenddown.
Note: This includes situations in which net income varies during a certification period because of changes in disregards or deductions.
l The client does not have regular expenses to meet the spenddown.
Eligibility is determined separately for each month of the certification period using actual income received and expenses incurred during that month, or with old, unpaid expenses.
l Eligibility for a month is determined in the following month.
Note: If the client does not request retroactive coverage, eligibility for the application month cannot be determined until after the last day of the application month.
Example:
Suri applies for MA in October and requests one month of retroactive coverage. She is determined to have a manual monthly spenddown.
Action:
Suri’s eligibility for September may be determined in the month of application, October. October’s eligibility will be determined in November using Suri’s actual income and health care expenses.
l Eligibility may be intermittent during the certification period.
Example:
Suri is determined eligible using a manual monthly spenddown for September. In November October’s eligibility is determined. Suri does not have any health care expenses to apply to her spenddown. In December November’s eligibility is determined. Suri is able to meet her spenddown with a doctor bill incurred in November.
Action:
Eligibility is denied for October and approved for November.
l If clients are eligible in the month of application or any of the retroactive months using a manual monthly spenddown, approve the case for the entire certification period beginning with the first month of eligibility.
Example:
Suri is determined eligible using a manual monthly spenddown for September. In November October’s eligibility is determined. Suri does not have any health care expenses to apply to her spenddown.
Action:
Suri is not eligible for MA in October, however her case remains active throughout the certification period to allow for eligibility to be determined for the remaining months.
l Do not close MA before the end of the certification period even if available information indicates the client will not meet a spenddown in the remaining months.
Example:
Bill applies for MA on November 28. He has fluctuating income. He is determined to have both a six-month spenddown and a monthly spenddown.
Bill incurred a large hospital bill and related charges earlier in November. Bill indicates he does not anticipate ongoing health care expenses. Bill meets the monthly spenddown.
Action:
Approve MA eligibility using a manual monthly spenddown as Bill has varying income and varying health care expenses. Leave the case open for the entire six-month period regardless of whether Bill meets the spenddown in subsequent months.
l Clients must report and verify income and health care expenses on a monthly basis using a Household Report Form (HRF) (DHS-2120). If the client does not return a HRF, eligibility will be closed for the remainder of the certification period.
If varying income changes to non-varying income, calculate the ongoing spenddown as an automated monthly spenddown for the remaining months in certification period.
If circumstances change and you can anticipate that the client will have no client spenddown amount for the remaining months in the certification period, change from a manual monthly spenddown to no spenddown.
Do not change a manual monthly spenddown to a six-month spenddown during the certification period.