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1. The client(s) incurs and verifies allowable medical expenses equal to the spend down amount; or 2. The Fiscal Bureau receives a cash option payment in the spend down amount. Fiscal Bureau staff complete the Medicaid authorization process after they receive the cash option payment. DATE MEDICAID COVERAGE BEGINS: Medicaid-covered expenses are paid: 1. Medical Expense Spend Down: from date the spend down obligation is met through month end; or 2. Cash Option: after s/he pays amount due, for the full month. Effective Date: March 01, 2017