Shortened Spenddown (Archive)

A shortened spenddown is calculated only when a six-month spenddown is interrupted.

Shortened Spenddown Situations.

Steps to Determine a Shortened Spenddown.

Shortened Spenddown Example.

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Shortened Spenddown Situations

A shortened spenddown must be calculated whenever a six-month spenddown is interrupted, including but not limited to the following situations:

l  MA eligibility is closed.

l  MA certification period is being aligned with another program such as a cash program, Food Support or MinnesotaCare.

l  New household member is added who increases the household size.

l  MA client becomes eligible for automatic MA due to receipt of a cash program.

l  Applicant is eligible for automatic MA due to receipt of a cash program requests retroactive MA.

l  Client’s income calculation changes from a community income calculation to a LTC income calculation.

l  MA client becomes eligible for MA-EPD, TMA, or TYMA.

For information about when a certification period must be interrupted, see Certification Period.

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Steps to Determine a Shortened Spenddown

Follow these steps when a six-month spenddown is interrupted and a shortened spenddown must be determined:

1. Determine the shortened spenddown period. Include in this shortened period the first month of the certification period through the month before the change takes effect.

Example:

Delbert and Norma receive MA with a six-month spenddown. Their certification period is February through July. They report they moved out-of-state on April 6.

Action:

MA is closed effective May 1. The shortened spenddown period is February through April.

2. Recalculate the total net countable income for the months of the shortened period.

3. Recalculate the shortened spenddown standard by totaling the monthly FPG standard for each month of the shortened period.

4. Determine the shortened spenddown amount by subtracting the total net countable income (Step 2) from the shortened spenddown standard (Step 3).

Note:  If a client’s total net countable income is less than the shortened spenddown standard, the client does not have a spenddown for those months. Go to Step 6.

5. Apply the same health care expenses used to calculate the original spenddown following the order listed in Six-Month Spenddown.

Recalculate the satisfaction date and recipient amount based on the application of the health care expenses.

6. Determine if action is needed. If the result is:

l  No spenddown for the shortened period. Go to Step 7.

l  An earlier satisfaction date The date on which the client has incurred medical costs that meet or exceed the medical spenddown amount. or decreased recipient amount The amount of medical costs an enrollee must incur and be responsible to pay on the satisfaction date before MA will begin payment of other medical expenses., adjust the spenddown. Go to Step 7.

l  A later satisfaction date or an increased recipient amount on the original date of satisfaction, do not adjust the spenddown. Go to Step 9.

7. Update MMIS with the changes benefiting the client.

Note:  Do not make changes to MMIS if the shortened spenddown results in a later satisfaction date or an increased spenddown on the original satisfaction date.

8. Notify the household of changes resulting in a decreased spenddown amount, an earlier satisfaction date and/or a decreased recipient amount.

MMIS will automatically reprocess claims when the client's spenddown amount decreases. If a client is eligible for additional days before the original spenddown date, the client should notify the providers to bill for the additional days. MMIS will automatically reprocess claims for the original spenddown date.

Providers should not rebill or submit duplicate claims.

Note:  Do not send the household a notice if the shortened spenddown results in a later satisfaction date or an increased spenddown on the original satisfaction date.

Medical spenddown increases require 10-day advance notices.

9. Document the results in case notes.

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Shortened Spenddown Example

Roger receives MA with a six-month spenddown and an income certification period of May through October. Roger, who is single, entered a long-term care facility (LTCF) on September 12.

Roger’s net monthly income is $1000, and his monthly FPG standard is $800. He has a six-month spenddown amount of $1200 with a satisfaction date of May 8 and a recipient amount of $100. He meets the spenddown amount with the following health care expenses:

Action:

The certification period is interrupted for MA due to his admittance to the LTCF. The LTC spenddown will begin in October. Determine a shortened spenddown.

1. The shortened spenddown period is May through September.

2. Roger’s total net countable income for the shortened period is $5000.

$1000 net monthly income X 5 months in shortened period = $5000.

3. Roger’s shortened spenddown standard for the shortened period is $4000.

$800 monthly FPG X 5 months in the shortened period - $4000.

4. Roger’s shortened spenddown amount is $1000.

$5000 income - $4000 FPG standard = $1000.

5. Using the same health care expenses, Roger meets his shortened spenddown with the $1000 M bill. His satisfaction date is now May 1 and his recipient amount is $0. All covered services incurred on or after May 1 will be covered by MA.

6. Determine if action is needed. The spenddown amount, satisfaction date and recipient amount have all changed to Roger’s benefit. His eligibility information must be updated.

7. Update the new spenddown period, spenddown amount, satisfaction date and recipient amount in MMIS.

8. Notify Roger of the updated spenddown information so that appropriate providers can bill MA for the additional days before the original satisfaction date. MMIS will automatically reprocess claims for the original satisfaction date.

9. The actions taken are documented in case notes.

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