Page 197

UPDATED: NOVEMBER 2009

294

INCOME

EXCESS

• First Prospective Period- the first accounting period that includes the month of application; o Medical expenses paid in the retro period that exceed the A/R’s excess income may be carried forward into the first prospective period; • Current Period- an accounting period that occurs after the first prospective period.

There are a variety of factors that affect the ability to apply/use bills in the eligibility determination including: timeframes, paid vs. unpaid bills (viability), the type of bill, the prioritization of the bill and the accounting period.

In addition to other medical bills, not paid by the A/R, bills that are paid by a public program of the State (such as EPIC or ADAP) or its political subdivisions may be used to meet an A/R’s excess income liability.

A/Rs who meet their excess income must spend down to the appropriate Medically Needy Income Level or Medicaid Standard whichever is higher. A/Rs are not permitted in any instance to spend down income to the Federal Poverty Levels. This includes applicants applying for coverage under the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD).

A/Rs with income in excess of the applicable Family Health Plus (FHPlus) standard cannot meet their excess to attain FHPlus eligibility. Applicants who are ADC-related, SSI-related, under age 21 or pregnant who have medical expenses which would allow them to meet their excess to obtain coverage under Medicaid, and who are eligible for FHPlus, complete an application and enrollment form, and are given the choice of participating in either in the Medicaid Spenddown Program or FHPlus. Persons eligible for both Medicaid spenddown and FHPlus are informed of the differences in services provided by each program and all the Medicaid requirements.

References: SSL Sect.

366(1)(a)(12) & (13)

366 (2)(b)

369-ee

Dept. Reg.

360-4.8

ADMs

04 OMM/ADM-5

(MRG)