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AGED, BLIND, AND DISABLED MEDICAID 902-1 HCBS/Waiver Medically Needy Supersedes: MA 1003-1 (02/01/05) Reference: 42 CFR 435.217, ARM 37.40.1401, 1406-.1408, ARM 37.82.101 Overview: HCBS/Waiver clients who have income exceeding the categorically needy income standard for one (ABD 007) are eligible as medically needy, and must meet a monthly spend down. The spend down is the difference between the MNIL (Medically Needy Income Level – CMA 002) for one and the client’s countable monthly income, after CSIMA and/or family maintenance allowance deductions, if applicable. The spend down can be met by: 1. Making a cash payment to the Department equal to their spend down obligation; 2. Incurring medical expenses equal to their spend down obligation; 3. A combination of medical expenses and cash payment. The following expenses may be used to meet the spend down: 1. Paid and unpaid medical expenses incurred during the benefit month; 2. Paid and unpaid medical expenses incurred during the three months preceding the benefit month; and 3. Current payments on the unpaid balances of bills incurred more than three months prior to the benefit month. See CMA 700 for additional medically needy information. PROJECTING EXPENSES: Expenses cannot be projected. This option was eliminated July 1, 2003. WAIVER SERVICES: SLTC establishes waiver services, and services may include: 1. Case Management; 2. Homemaker; 3. Personal care (waiver-related); 4. Adult day care; 5. Respite;