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February Medicare B $20 $390 transportation $40 $430 March prescription $40 $470 Ms. Muriel does not reach her spend-down deductible with only her outs Her prospective budget shows her Medicare Part B premiums and her r costs. If Ms. Muriel has no additional medical expenses during the next eligible or MA in March when she reaches her spend-down liability of $ Ms. Muriel's Medicare Part B premium for March is not used towards the she meets her spend-down for March and will be eligible for reimburse for that month.

RETROACTIVE ELIGIBILITY DETERMINATION 7.5

Eligibility through spend-down is determined differently for retroactive and prospective periods.

Retroactive Budget Period 7.5.1

The retroactive budget period is the three-month period prior to the month of application. Months in which an individual lived outside the District of Columbia can be included in the retroactive budget period and medical expenses incurred during such months can count toward the spend-down limit. However, retroactive eligibility cannot be granted for months in which the individual resided outside the District of Columbia for the entire month. Similarly, months in which an individual would have been ineligible for MA for a reason other than being over-income can be included in the budget period and medical expenses incurred during this period can count toward the group's spend-down deductible. However, retroactive eligibility cannot be granted for a month in which an individual was ineligible for MA for a reason other than being over- income.

Retroactive Eligibility Period 7.5.2

The retroactive eligibility period is the portion of the retroactive budget period (the three months prior to the month of application) for which the applicant/recipient is eligible for MA though the spend-down provisions. A group may be eligible for only one month, for two months, or for all three months of the retroactive budget period. During the retroactive eligibility period, the MA program for which the group became eligible through spend-down will pay bills for medical expenses incurred in excess of the spend- down deductible. The retroactive eligibility period may not include months in which the applicant/recipient was not a resident of the District of Columbia or months in which the applicant/recipient was ineligible for MA benefits for some reason other than excess income. Example Ms. Reynolds applies for Medicaid in June and is found to meet all Medicaid eligibility requirements except that she is over-income. She wishes to use her medical expenses over the past three months toward retroactive eligibility. In March, Ms. Reynolds exceeded the resource limit. Medical expenses incurred in March can count toward her spend-down deductible. She cannot be determined eligible for March, even if her medical expenses exceed her spend-down deductible because she was ineligible for Medicaid in March for a reason other than being over-income.