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UPDATED: NOVEMBER 2009

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INCOME

EXCESS

A Prioritization/Hierarchy is applied to bills when evaluating the spenddown: • Bills not payable by the Medicaid Program such as: o Paid bills- Bills paid in the pre-retroactive period (the period prior to the first day of the third month prior to the month of application) cannot be used to grant eligibility. Paid expenses are “anchored”/deducted from the income in the accounting period in which it is paid. Exception: An exception is made for expenses incurred and paid in the three-month retroactive period. When no part of the retroactive period is included in the first prospective accounting period, expenses incurred and paid during the retroactive period, which have not been used previously to establish eligibility can be deducted from income in the first prospective accounting period.

Credit for paid bills may be carried forward for no more than six months, or until there is a break in coverage.

o Non-covered services o Non-participating providers o Medical Expenses from a legally responsible relative whose income is available to the A/R o Co-pays • Unpaid medical bills o Must be viable (the provider continues to seek payment and has not “written-off” the expense) and not previously used to establish eligibility. o Credit can be given in a subsequent accounting period if the individual’s liability is met in an accounting period without deducting all incurred, unpaid expenses and the bill is NOT payable by the Medicaid program.

(MRG)