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UPDATED: JANUARY 2011

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INCOME

EXCESS

Description: Excess income or “spenddown” is available net income in excess of an individual’s Medicaid level or standard. When determining Medicaid eligibility for A/Rs who are SSI-related, ADC-related, under age 21 or pregnant, any available monthly income in excess of the Medically Needy Level or Medicaid Standard whichever is higher is considered available to meet the cost of medical care and services. Policy: When the available income of the A/R is greater than the Medically Needy Level or Medicaid Standard whichever is higher, the excess is considered available to meet the cost of medical care and services. In order to become eligible for Medicaid, ADC-related, SSI-related, under age 21 or pregnant A/R(s) may:

• pay or incur medical expenses equal to or greater than their excess income; or • pay the amount of the excess income directly to a local district; or • use a combination of paid or incurred medical bills and pay directly to the local district.

There are two types of Medicaid Coverage available under the Excess Income Program:

• Outpatient Coverage- Provided to an A/R who meets his/her spenddown on a monthly basis. • Inpatient and Outpatient Coverage- Provided to an A/R who meets a six-month excess. To meet either the one or six-month excess, the A/R must demonstrate that he/she has either paid or incurred the amount of the excess income toward a medical need (met the excess income). This is done by submitting paid or incurred medical bills or by paying the excess amount to the LDSS.

The amount and type of the medical bill(s) submitted by the A/R determines the length of time for which the Medicaid coverage (either outpatient-only, or inpatient and outpatient coverage) is granted. In determining an individual’s eligibility, local districts use accounting periods: • Accounting Period- a period of time from one to six months, over which medical bills are applied to excess income;

(MRG)