The household reports a change in household composition

When the household reports a change in household composition (someone moves into or out of the home), the worker needs to recalculate the spenddown for the balance of the base period and giving 10 days advance and adequate notice if this is an adverse action.

Example of someone who moves out of the household

Katie, an SSI-related individual, applies for medical coverage in December. She is married and has a 17 year old daughter Lucy. Her spenddown liability is $300 for a 6-month base period.

In February, Lucy moves out of the home. With Lucy no longer living in the home, Katie's spenddown amount will increase because she loses the child allowance.

If Katie has not yet met spenddown, the worker should recalculate the spenddown amount for March, April and May without the child allowance and send an amended spenddown letter for the new total liability amount.

If Katie has already met spenddown, the worker should terminate MN coverage (giving advance and adequate notice of the adverse action) and generate a new letter showing the increase in additional spenddown liability.

Example of someone who moves into the household, causing household to qualify for CN coverage

Ken is 68 years old and lives alone. He has monthly income of $857 Social Security disability and has a spenddown of $978 with a base period from June through November. In July, he reports that his new wife Valerie moved into his home. Valerie has no income and has a current disability determination. She is applying for medical coverage for herself also.

Recalculate medical eligibility for her and Ken. Based upon their reported income, you determine this household is now CN eligible.

If Ken has already met spenddown, close his MN coverage and screen in a CN medical program for both, effective the first of the month in which he reported the change and in which Valerie applied for medical coverage for herself.

If Ken had not already met spenddown, authorize the CN coverage effective the first of the month in which he reported the change. Recalculate the spenddown liability for the months prior to the CN approval and generate an amended MN spenddown letter showing the reduced liability amount.

Example of the same as previous, except Valerie does not apply for coverage and Ken does not qualify for CN coverage

The facts are the same as the example above, except that Valerie is not applying for medical coverage for herself or is not SSI-related. The worker would still need to redetermine the effect of the change on Ken's medical coverage. Since Valerie is a nonapplying spouse, the worker would reduce Ken's countable income by allocating income to her.

If Ken has not already met spenddown, recalculate eligibility for the months of July through November. With the spousal allocation, he would be eligible for MN without spenddown. The worker would:

Certify S95 coverage for Ken through the balance of the base period,

Recalculate the spenddown liability for June by shortening the base period to the month of June only, and

Send an amended spenddown liability for this month.

Ken will need to meet the new spenddown amount before June coverage could be approved.