Spenddown Eligible

If the A/R’s monthly countable income is greater than the AMNIL, the excess amount is called the spenddown.

This spenddown must be met before the A/R can be approved for Medicaid under AMN.

The spenddown is met by subtracting allowable medical expenses from the spenddown amount until the spenddown reaches zero.

When the spenddown is met, the A/R is considered spenddown eligible, and the A/R is approved for Medicaid effective the day spenddown is met through the end of the month.

The following individuals' medical expenses can be used in meeting the spenddown:

the A/R

the A/R’s legal ineligible spouse

the A/R’s non-legal ineligible spouse only if the second potential spenddown is used as the AMN spenddown

the A/R’s ineligible child

the A/R’s ineligible parent if the A/R is a child

the deceased spouse or child of the A/R if the A/R remains liable for payment of the bill

the child of the A/R who has reached 18 years of age if the child was under 18 at the time the medical expense was incurred, and the A/R remains liable for the bill. The child does not have to be currently living in the home with the A/R.

Medical expenses are used to meet the spenddown if they meet all of the following conditions:

The bill is unpaid as of the first day of the month or is incurred or paid during the budget period.

The A/R or deemor is legally obligated to pay the expenses of the people listed on page 2150-2.

There is no third-party liability (TPL) that is liable for payment of the expense. Refer to Special Considerations in this section and Chart 2150.1 – Allowable Medical Expenses for AMN . VA Aid and Attendance is NOT a TPL.

The bill is medically necessary. Any expense ordered or prescribed in writing by a medical practitioner recognized under state law is medically necessary. Doctor and hospital services are considered medically necessary.

The spenddown may be met using medical expenses incurred prior to the month. If this occurs, the A/R is eligible from the first day of the month.

If the spenddown is not met by previously incurred bills, the case is placed in suspense until enough bills are incurred to meet the spenddown or until the end of the month, whichever occurs first.

If the spenddown is met during the month, a first day liability (FDL) is computed for the day the spenddown is met. The A/R is responsible for paying this FDL. Form 400, Medically Needy First Day Liability, is used to inform the provider that the A/R is responsible for the FDL.

If an A/R submits a medical expense after the expiration of the budget period, the bill can be used to meet or adjust the SD for the expired budget period only if it is submitted within three months of the expired period, unless Good Cause exists.

If an A/R becomes eligible under another COA during a month while the case is in suspense, change the COA and begin eligibility effective the first day of that month.