Nonapplying spouse applies for medical coverage after applying spouse receives MN coverage

In many cases involving a married couple, individuals have to choose who will receive health care coverage because of the effects of income deeming. Couples may choose the same person for each base period or may alternate who gets coverage. However; there are some situations when MN coverage has already been certified for one spouse and the other spouse has a medical emergency where they also need coverage during the same base period. The following example explains the steps and calculations needed to determine eligibility for the new applying spouse.

Example

Jim and Carla are a married SSI-related couple. They have a 6-month base period from January through June. They both have income and the spenddown liability when both of them apply is too high for them to meet. However, when only one applies for coverage, their spenddown liability is reduced to $100 per month ($600 for six months). They opt to apply for MN coverage for Jim since he has a chronic ongoing health condition and he has no other coverage.

They present medical expenses to the agency in January, and they meet his spenddown liability of $600 on January 10.

On March 18, Jim calls his case worker and tells him that Carla was admitted to the hospital on March 3 and they need to apply for medical for her also. She was in the hospital for 4 days, and they now have a bill for $45,000 which they cannot pay.

The worker would do the following:

Terminate MN coverage for Jim effective March 31.

Screen in a new S02 AU with both Jim and Carla as applicants with a request date of March 1.

Shorten the base period to match the original S99 certification through the end of June.

Recalculate the spenddown liability for the period March through June (4 months) and send them a new letter showing the increased spenddown amount which includes both Jim and Carla's income.

Since Jim has already paid for his share of the 4 full months remaining in his base period, credit them $400 towards the new higher spenddown liability (4 months x the original $100 per month liability).

Code the $400 as a paid 'MU' expense in ACES so that it is credited towards the new spenddown amount.

Use the $45,000 hospital bill incurred on March 3 to meet the spenddown for both.

They will be responsible for the spenddown amount, but the agency will be able to pay on the balance of the bill for them.

For more information on income deeming and allocation, see SSI-Related - Income - Allocation and Deeming .