spenddown - Processing
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spenddown - Processing

Revised May 12, 2008


Enter Spenddown Medical Expenses

Set the Spenddown Base Period

Update and Confirm Spenddown Information


Spenddown - Processing

  • If a client's excess income makes them ineligible for Categorically Needy Medical, ACES considers eligibility for Medically Needy Medical and calculates the AUs spenddown liability.
  • To process a spenddown case the AU must be processed and finalized through options P and Q, with the AU in M, Pending Spenddown status. See Process Application Month and Finalize Application.

NOTE:

The case is in M (Pending Spenddown) status at the AU level but A (Active) at the client level.

For all spenddown cases, except retroactive medical, ACES automatically establishes a six-month base period. If the base period is going to be shortened override the system generated  letter when finalizing the AU through Option Q - Finalize Application.

Enter Spenddown Medical Expenses

  • An AU may have more than one spenddown period in effect at the same time, so it is very important to enter expenses into the correct base period.
  • This is important as eligibility may change depending upon spenddown amounts entered.

To enter spenddown medical expenses:

  1. Enter Option A - Assistance Unit / Client, in the Selection field on the WMEN.
  2. <TRANSMIT> and the AMEN displays.
  3. Enter Option U - Spndwn Med Expnse, Inquiry in the Selection field on the AMEN.

OR

Enter Option T - Spndwn Med Expnse Update in the Selection field on the AMEN.

  1. Enter the [AU ID] in the AU ID field.

  2. To enter expenses for 'a spenddown period containing the ongoing benefit month', leave the Benefit Month field blank on the AMEN.

  • ACES will automatically use the ongoing benefit month as a default.

  1. To enter expenses for 'a different spenddown period', enter the [month and year of a benefit month in the desired spenddown period] in the Benefit Month field.

  1. ACES displays the SDME screen for the head of household of the AU and period selected on the AMEN.

  2. Review all information on the SDME. Each client in the AU has a SDME  so be sure to enter the [medical expenses] associated with the correct client.

  3. The way medical expenses are entered on the SDME determines the begin date of medical coverage for all medical coverage groups that have spenddown.

  4. The expense type codes entered here are specific based on policy so that medical expenses are deducted in the correct order and so the begin date of assistance is set correctly.  See EA-Z Manual - Spenddown - WAC 388-519-0110.

  5. Medical bills incurred prior to the beginning of the base period that can be used to reduce spenddown must be entered using an Expense Type code [PB].

  • Using any code other than PB will result in the prior bill not being used to reduce spenddown.

  1. Enter [Y]in the Emer Ind field if the expense was due to an emergency. This will allow for the expense to be used as a deduction for the MI coverage group.

  2. Enter the [total amount of the bill submitted] in the Amt field.

  3. Enter the [appropriate verification code] in the V field.

  4. Enter the date the medical expense was incurred in the Date Incurred field. If using expense type PB, the date incurred must be prior to the spenddown period.

  • For any other expense type, the date incurred must be within the spenddown period. ACES will not allow a bill to be entered if the date incurred is in the future.

  1. Certain prospective medical expenses can be used to reduce spenddown liability.

  • To enter these items such as prospective Medicare premiums, prospective health insurance premiums etc., determine the amount per month and combine it into one total and enter it using a current date.

  1. Enter the [amount paid by a third party] in the TPL Amt field.

  2. If the client has paid the bill, enter [P] in the Exp Paid field.

  3. If the client has not paid the bill, enter [U] in the Exp Paid field.

  4. Enter the [name of the provider of medical services] in the Provider Name field.

  5. Enter the [provider ID] in the Provider ID field, if available.

  6. If additional space is needed to enter expenses, enter [Y] in the More Med Exp field.

  7. If more than one client in the AU is pending spenddown enter [the client pointer for that client] in the Client Pointer field at the top right corner of the screen.

  8. <TRANSMIT> and theSDDE screen displays.

  9. Review the results of the calculation.

  10. <TRANSMIT> to return to the AMEN.

Set the Spenddown Base Period

To shorten the spenddown base period:

  1. Enter Option V - Spndwn Authorization, in the Selection field on the AMEN.
  2. <TRANSMIT> and the SPBP displays.
  3. On the SPBP change the SPENDDOWN PERIOD THRU date so the base period is correct.
  4. ACES calculates the spenddown based on income entered in the system from the month of application through the ongoing month.
  5. ACES cannot calculate net income beyond the ongoing benefit month. The system assumes income for months beyond the ongoing month is constant unless changed here.
  6. If you know the income will change in any future months that is part of the current base period, calculate the net income and enter [that amount] in the AU Net Income field on SPBP.
  7. <TRANSMIT> and the SPAU screen displays.
  8. The spenddown base period, spenddown amount, spenddown liability, and months should all reflect the information as it was changed on the SPBP.
  9. Review this information carefully. If it is correct <TRANSMIT>.
  10. An ELIG and MAFI displays for each month in the base period.
  11. If the base period was changed DO NOT override the system generated letter on the MAFI or no spenddown letter will be sent.
  12. Enter [Y] in the Confirm field on the SPAU to commit the new base period and spenddown amount.
     


Update and Confirm Spenddown Information

  1. Enter Option V - Spndwn Authorization, in the Selection field on the AMEN.
  2. Enter [the AU ID] in the AU ID field for ACES to calculate a spenddown authorization.
  3. To calculate results for a spenddown period containing the ongoing benefit month, leave the Benefit Month field blank.
  4. To calculate results for a different spenddown period, enter [the month and year of a benefit month in the desired spenddown period] in the Benefit Month field.
  5. <TRANSMIT> and theSPBP screen displays.
  6. ACES cannot calculate net income beyond the ongoing benefit month. The system assumes income for months beyond the ongoing month is constant unless changed here.

  7. The SPBP  allows input of future month's income in the spenddown period.

  8. If you know the income will change in any future months that is part of the current base period calculate the net income and enter [that amount] in the AU Net Income field on the SPBP.

  9. <TRANSMIT> and theSPAU screen displays.

The SPAU  is used to confirm the spenddown calculations performed by ACES and authorize MA benefits for the spenddown period, if appropriate.

  1. This screen must be accessed each time medical expenses are updated on the SDME.

  2. Updating medical expenses and accessing the SPAU prompts ACES to perform eligibility determination and benefit calculation for the spenddown period and sends an updated letter to the client.

  3. Validate both the HOH Name and the Spenddown Period From and Thru fields.

  4. <TRANSMIT> and the ELIG  for the first month of the base period displays.

  5. Review the non-financial eligibility results.

  6. <TRANSMIT> and the MAFI  for the first benefit month in the spenddown period displays.

  7. Review the financial results.

  8. Repeat this process for all months displayed.

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Modification Date: May 12, 2008
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