625.07 Offsetting the Spenddown (MAM)

Previous Policy

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Offset the spenddown by using allowable unpaid medical expenses and currently obligated medical debt incurred by the assistance group or by individuals the recipient is liable for. 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. Do not allow expenses that were used for the Life Insurance Offset. See Chapter 400, Resources.

Allowable Medical Expenses...	Offset in the following order...
. 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.
. Health Insurance Premiums	. apply on the first day of the month in which the premium is due.
. Uncovered Medical Expenses	. apply on the first day of the month in which the expense is incurred.
. Current Medical Expenses which are or would be covered by medical assistance.	. apply in chronological order after uncovered medical expenses.
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

. APTD In and Out application dated April 8

. $500 one-month spenddown, with the following bills submitted:

Date Incurred	Type of Medical Expense	Amount of Expense
March 6	Unpaid Hospital Bill	$400
April 3	Prescription	$20
April 10	Doctor Visit	$100
April 15	BC/BS Premium	$50
April 20	Dental Visit (uncovered service)	$50

Determine when the one-month spenddown is met:

April 1	Unpaid prior debt (march hospital bill)	$400
April 1	Health insurance premium (BC/BS)	50
April 1	Uncovered medical expense (dental)	+ 50
	In and Out medical assistance begins April 1.	$500