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Example Mr. Marcus (aged 70), who moved to the District on February 6, applies on April 12 for retroactive MA eligibility. He presents to the SSR prescription medication receipts from December, laboratory test receipts from January, a doctor's bill from February, and hospital and doctor bills from March. The retroactive budget period is three months. The SSR determines that his excess income for the three-month retroactive budget period is $1,700; therefore his spend-down deductible amount is $1,700. His expenses are as follows: Amount Total to Date Before January (prescriptions) expenses incurred before the retroactive budget period do not count toward the spend-down deductible January lab tests $150 $150 February doctor $125 $275 March hospital $2,400 $2,675 April doctor $75 $2,750 Because Mr. Marcus was not a resident of D.C. in January, the first month he could be eligible for retroactive MA is February. However, his total to date of allowable medical expenses reached only $275 through February, less than his spend-down deductible amount. His $2,400 hospital bill in March put him over his spend-down deductible amount by $975. Even if his hospitalization occurred at the end of March, Mr. Marcus is certified eligible for MA as of March 1. He is responsible for the first $1,425 of the hospital bill (his spend-down deductible amount less his January-March medical expenses). MA will pay the remainder of his hospital bill and his March doctor bill of $75.

PROSPECTIVE ELIGIBILITY DETERMINATION 7.6

This section details the policies for determining prospective eligibility through spend-down.

Prospective Budget Period 7.6.1

The prospective budget period is the six-month period beginning with the month of application or recertification.

Prospective Eligibility Period 7.6.2

The prospective eligibility period is the portion of the prospective budget period for which the applicant/recipient is eligible for MA though the spend-down provisions. An individual or group may be eligible for no months, some months, or all months of the prospective budget period. If the spend-down deductible is met entirely by unpaid expenses incurred prior to the prospective budget period, prospective eligibility is certified for the full six-month period. Example Ms. Jonelle comes into the service center to apply for MA on March 16. Her six-month prospective budget period would begin on March 1 and end August 31.