The household reports a decrease in income

If the individual reports a decrease in income that brings their income below the CN income standard:

Close the medically needy assistance unit,

Screen the individual for the categorically needy (CN) program,

Recalculate the spenddown liability for the months prior to the approval for CN medical by shortening the base period, and

Send an amended spenddown letter to reflect the new liability amount for this prior period.

Example

Josie, a pregnant woman has income over 193% FPL at the time of her application for pregnancy medical. Her baby is due in July. In April, she reports and verifies she is no longer working and her income is now below the CN standard. The worker would approve Josie for CN medical (Apple Health for Pregnant Women) effective April 1 (the first of the month in which she reported her change and was found CN eligible). She is now continuously eligible for CN coverage through the birth and the 2 months post partum period.

The worker would also recalculate the spenddown amount for the prior months and send an amended letter to advise her of the lower amount. If she incurred medical expenses through March that were more than the recalculated spenddown amount, she would qualify for MN coverage and the agency would cover her medical expenses for the time period after she met her recalculated spenddown and before she became eligible for CN coverage.