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To determine the amount of a decreased deductible: 1. Add together the monthly excess income of the months of the Medicaid deductible period that have already gone by. 2. Subtract the medically needy income limit from the new monthly income. This will give the excess income for the month when the income changed. 3. Using prospective net income, find the excess income of the months in the deductible period after the month when income changed. 4. Add the results of #1, #2, and #3. Example 1: Cicely applied for Medicaid in July. She had excess income of $20 a month. Her Medicaid deductible was $120. In November she reports a pay decrease of $10 a month. Now you must recalculate her Medicaid deductible. 1. Add together the excess income of months July through October. The result is $80. 2. Calculate her November excess income. The result is excess income of $10. 3. Prospective income for December is $10. 4. Cicely's new Medicaid deductible: $80 + $10 + $10 = $100. If the income change results in lower excess income in the month of change, the applicant can choose to: 1. Recalculate the Medicaid deductible, or 2. Create a new deductible period. Example 2: Winston goes from full time to part time employment in the fourth month of his Medicaid deductible period. He still has excess income, but it is lower than in the previous three months. He can choose either to recalculate his Medicaid deductible or to have a new deductible period. If he recalculates, the resulting deductible will be lower than the previous one. His other choice is to begin a new 6-month deductible period. He may want to do this if the new deductible is even lower than the recalculated one. If he makes this choice, he will forfeit any eligibility he might have acquired in the previous deductible period if he had met the previous deductible. If the income change results in no excess income the applicant has an additional choice: 1. Recalculate the deductible. 2. Create a new deductible period. 3. Begin eligibility immediately. Example 3: If Winston has no excess income in the month his income drops, and if his prospective monthly income shows no excess income, he can choose to begin eligibility immediately. In choosing this, he will forfeit the eligibility he would have had in the prior deductible period if he had met the prior deductible. 24.6.2 Group Size Changes When the group size is different on the last day of the month from what it was on the last day of the previous month, you must recalculate the deductible if the result is a decrease in the deductible amount. Beginning July 1, 2020, the deductible amount may no longer be increased when an unmet deductible assistance group has a change in group size. Once a deductible period and deductible amount are established, the deductible amount will never increase during the same deductible period. Deductible amounts may be decreased due to changes in group size. Compare the new group's income with the new group's medically needy income limit. If there is excess monthly income, recalculate the deductible in the same way as for income changes (see SECTION 24.6.1 INCOME OR DEDUCTION CHANGES).