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MEDICAL SERVICES POLICY MANUAL,SECTION O O-100 Medically Needy Program O 166 Spend Down Entitlement Period
EXAMPLE: A man deserts his family on July 1st. His wife makes AFDC-MN application on July 21st for herself and their children. She requests medical assistance for June, July, and August. Due to a heavy workload, the caseworker does not complete the certification until September 2nd and, prior to certification, she learns the family moved from the state on September 1st. Given these circumstances, a 2 month Spend Down (July and August) will be worked, as eligibility does not exist for June (no deprivation) or for September (non- residence).
O-166 Spend Down Entitlement Period MS Manual 01/01/14 The Spend Down entitlement period is a “fixed” period of Medicaid eligibility beginning either the first day of the Spend Down period if excess income is obligated by insurance premiums, copayments and/or uncovered incurred expenses (Re. MS O-742) or the day that the coverable medical expenses exceed the remaining excess income (Re. MS O-743) and ending the last day of the period. An entitlement period may cover up to one, two or three month(s). Both beginning and ending dates of eligibility must be entered in ANSWER at certification. The only effect date specific eligibility has on the entitlement period is that the end date for a period (last day of a month) may be changed after certification if a county worker becomes aware that an individual or family is no longer eligible for the remainder of the period, e. g., someone has inherited or has been awarded a large sum of money.
O-167 Unmet Liability (Date of SD) MS Manual 01/01/14 The remaining excess income which is exceeded by deducting a daily total of incurred medical expenses included in the chronological spend down is the applicant’s unmet liability (Re. MS O- 741). This amount, rounded to the next lower dollar, is entered in ANSWER for the individual(s) who has medical expenses on the Spend Down date (Re. MS O-800). All claims for services incurred on the date of Spend Down will be processed against unmet liability until the liability has been satisfied (i.e., unmet liability is treated like a deductible). The applicant is responsible for payment of the unmet liability amount.