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State of Maryland Medical Assistance Manual Revised April 2014

1. Calculate the total income for the entire period under consideration. For current eligibility, total income for the period will be the total monthly income as determined above multiplied by six. For the retroactive eligibility, any consecutive months are one period under consideration and the income considered will be that actually received during the retroactive period. 2. Determine the total amount of allowances for the period under consideration. These are limited to Personal Needs Allowance, and Spousal/Family or Dependent Allowance, and Residential Maintenance Allowance. Subtract the total allowance from the total income (as determined in Step 1). The result is the available income for the period under consideration. 3. Determine projected cost of care by multiplying the number of days in the period under consideration by the private per diem rate. Subtract the projected cost of care from the available income (as determined in Step 2). The result is the excess available income. This is the amount that the person must spend-down in order to become eligible for MA.

1000.8 Determine Spend-Down Eligibility

Deduct the following from the excess available income;

1. Medical expenses incurred before the month of application which: • Were not used in establishing eligibility for any prior certification; • Are not subject to the third party payment or reimbursement (this may not include medical expenses from a period when the person was determined eligible for MA that were not submitted for coverage.); • Do not represent the patient contribution to cost of care for any prior period; and • Remain the person’s obligation. These may include medical expenses from a period for which the person has previously applied for Medical Assistance but was found ineligible, and may include expenses for a period prior to application for MA. For retroactive spend-down, these may include expenses incurred during the retroactive period, but not prior to that period. 2. Medicare premiums; 3. Other health insurance premiums as paid or incurred; 4. Deductibles and co-insurance charges; 5. Expenses incurred for necessary medical care or remedial services that are recognized under State law but not covered under the State Plan; 6. Expenses incurred for necessary medical care or remedial services that are covered under the State Plan.