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DETERMINING SPEND-DOWN DEDUCTIBLE AMOUNT 7.3

Only groups that meet all non-financial MA requirements (Medicaid or Emergency Medicaid services) and resource limits may qualify for MA through the spend-down process.

A group's monthly spend-down deductible is equal to the amount by which the group's net countable income, after all applicable deductions, exceeds the MNIL.

Spend-Down Deductible – Retroactive Budget Period 7.3.1

If a group applies for MA and is found to be over-income, the group may qualify for MA coverage for the retroactive budget period if it meets its spend-down deductible. The three-month period prior to the month of application is called the 'retroactive budget period.' When determining whether the group meets the spend-down deductible for the retroactive budget period, the allowable medical expenses incurred in those three months (see Section 7.4: Allowable Medical Expenses in this Chapter) are compared to the spend-down deductible. If medical expenses exceed the spend-down deductible, the group will be certified eligible for some or all of the retroactive period, depending on when the medical expenses exceeded the spend-down deductible and which method was used (based on which was advantageous to the applicant) to determine eligibility (see Section 7.7: "Two Methods for Determining Eligibility through Spend-Down Process" in this Chapter). The SSR should use the method that is most advantageous to the applicant.

Spend-Down Deductible – Prospective Budget Period 7.3.2

If a group applies or is recertified for MA and is found to be over-income, the group may qualify for MA coverage for the prospective budget period if it meets its spend-down deductible. When determining whether the group meets the spend-down deductible for the prospective budget period, allowable medical expenses incurred prior to the prospective budget period plus paid and unpaid allowable medical expenses incurred during the prospective budget period are compared to the spend-down deductible. If medical expenses exceed the spend-down deductible, the group will be certified eligible for some or all of the prospective period, depending on when the medical expenses exceeded the spend- down deductible and which method was used (based on which was advantageous to the recipient) to determine eligibility (see Section 7.7: "Two Methods for Determining Eligibility through Spend-Down Process in this Chapter". The SSR should use the method that is most advantageous to the applicant.

ALLOWABLE MEDICAL EXPENSES 7.4

Allowable medical expenses are those expenses that may be applied toward meeting the spend-down deductible.

For retroactive eligibility, medical expenses must be incurred or paid during the three-month retroactive budget period to count toward the spend-down deductible. Both paid and unpaid medical expenses incurred during this period can count toward the spend-down deductible. Outstanding medical debt, no Example

Ms. Weaver is age 67 and applies for Medicaid based on her age. She is otherwise eligible, but her income exceeds the SR standards. Her income is $200 per month over the MNIL. Her spend-down deductible is $200 per month.