617.05 Offsetting the Spenddown SR 95-11, 03/95 (FAM-A) |
Offset the spenddown by using allowable unpaid medical expenses and currently obligated medical debts. All medical expenses incurred by the budgetary unit, as defined in Section 611.04, Determining Budgetary Units for Medical Assistance Programs, are pooled to meet the spenddowns for each member of that budgetary unit. Include the allowable medical expenses of the members of the budgetary unit who are liable for the accumulated spenddown. The allowable amount of the expense is the amount remaining after any third-party payment. A medical expense may be used only once to offset the spenddown.
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Allowable Medical Expenses |
Offset in the following order |
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• Unpaid Prior Medical Debt - does not have to be in sequential order or prioritized, and - may be prorated over several months, if the total amount of the debt exceeds the spenddown amount. |
• apply on the first day of the month of the In and Out period. |
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• Health Insurance Premiums |
• apply on the first day of the month in which the premium is due. |
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• Uncovered Medical Expenses |
• apply on the first day of the month in which the expense is incurred. |
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• Current Medical Expenses which are or would be covered by medical assistance. |
• apply in chronological order after uncovered medical expenses. |
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Treat current medical expenses, uncovered medical expenses, or health insurance premiums as unpaid prior medical debt, if they remain unpaid, currently obligated, and have not already been applied toward a spenddown. |
Example
A Medicaid In and Out application was dated April 8. The one-month spenddown amount was $500; the following bills were submitted:
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Date Incurred |
Type of Medical Expense |
Amount of Expense |
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March 6 |
Unpaid Hospital Bill |
$400 |
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April 3 |
Prescription |
$20 |
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April 10 |
Doctor Visit |
$100 |
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Aril 15 |
BC/BS Premium |
$50 |
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April 20 |
Dental Visit |
$50 |
Determine When the One-Month Spenddown Is Met:
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April 1 |
Unpaid Prior Debt (March Hospital Bill |
$400 |
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April 1 |
Health Insurance Premium (BC/BS) |
50 |
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April 1 |
Uncovered Medical Expense (Dental) |
+ 50 |
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In and Out medical assistance begins April 1. The household is responsible for the $500 spenddown in April. |
$500 |
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