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Families and Children Manual; Section: Financial Eligibility; Policy Manual Number: 010.050; Chapter: MEDICALLY NEEDY SPENDDOWN

Legal Authority: 42 CFR 435.4; 42 CFR 435.301; 42 CFR 435.308; 42 CFR 435.602; 42 CFR 435.603; 42 CFR 435.831 1. Policy Statement Federal regulations provide that otherwise eligible individuals with net income greater than the Medically Needy Income Standard (MNIS) may achieve TennCare Medicaid eligibility if the applicant and her financially responsible relatives spend down the amount of the excess income on a monthly basis for medical expenses. Excess monthly income is the difference between total net income and the MNIS based on Eligibility Determination Group (EDG) size. 2. Spenddown Period The spenddown period is the month of application and the 3 preceding months. 3. Incurred Medical Expenses The following medical and remedial expenses may be used to satisfy the spenddown requirement:

a. Expenses incurred during the month of application, whether paid or unpaid; b. Expenses paid during the month of application, regardless of when such bills were incurred (only count the portion paid); and c. Expenses incurred during the 3 calendar months prior to the month of application, whether paid or unpaid. 4. Continuous Medically Needy Eligibility Medically Needy enrollees must continue to meet the spenddown requirement at redetermination, if the EDG income remains over the MNIS. Current Medically Needy individuals may use the following medical and remedial expenses to meet a spenddown requirement:

a. Expenses incurred during the month of application, whether paid or unpaid; b. Expenses paid during the month of application, regardless of when such bills were incurred (only count the portion paid);