Page 198

UPDATED: JUNE 2010

295

INCOME

EXCESS

03 OMM/ADM-4

01 OMM/ADM-6

96 ADM-15 91 ADM-11 87 ADM-4

Interpretation: A/Rs who meet their excess income on a monthly basis are eligible for Outpatient Coverage only. A/Rs who meet a six month excess are eligible for both Inpatient and Outpatient coverage. Any A/R with excess income requesting coverage of an inpatient bill must first meet a six month excess.

The use of medical expenses to offset excess income is known as “spenddown”. The direct payment of excess income to the local district is known as “Pay-In”.

A/Rs who can participate in the Excess Income Program include: • Individuals who are in a federally participating category (SSI-related, ADC-related or a child under the age of 21) and SSI-related are who also eligible under the appropriate Medicaid Resource Level.

NOTE: SSI-related individuals eligible to participate in the Excess Income Program who also have excess resources may spend down their excess resources (See RESOURCES EXCESS RESOURCES). Bills must be applied to excess resources first. Any remaining bills or portions of bills may then be used to reduce excess income.

When the income of a legally responsible relative is counted in the eligibility determination process, medical expenses, which are the legal responsibility of the relative, may also be used to offset any excess income of the applicant. Such expenses may include the medical expenses of the legally responsible relative as well as medical expenses of other family members for whom such relative is legally responsible.

Excess Income or Spenddown is met by:

Showing the LDSS either a paid bill or an incurred bill.

(MRG)