WAG 15-04-01

For AABD Medical Units living in the community, when nonexempt New Textresources exceed the resource limit for the unit size, the case is eligible for enrollment in spenddown if the requirements in PM 17-02-04 are met. Only use the resources of persons included in the income standard.

For an NH or SLF resident, if nonexempt resources or countable income exceed NH/SLF charges at the greater of the private pay rate or the HFS rate, the case is a spenddown case. If resources or countable income are less than NH/SLF charges, the case is a credit case. A person may have a spenddown amount based only on excess resources.

For community, NH, and SLF cases to qualify for Medicaid coverage, excess resources do not have to be reduced to the resource limit.

Do not pend an application for the reduction of resources. If resources are reduced during the application process, use the verified reduced amount.

If medical eligibility includes a backdated month, use the verified amount of nonexempt resources New Textavailable on the first day of each individual month that backdating is requested.  New textEligibility for each month of medical backdating is determined separately.  Do not use the resource amount as of the day of decision for any backdated month.

For the application month, use the amount of nonexempt resources on the date of decision.

If a person acquires a new nonexempt resource that alone, or together with other nonexempt resources, exceeds the resource limit, determine spenddown using the new resource for the month following the month of change. Revised TextLump sum payments are considered available income for the month of receipt.  Any amount remaining after the month of receipt is a nonexempt resource, subject to the resource limit.

Once medical expenses or receipts are presented to meet spenddown, do not consider the excess resources until REDE or reapplication, regardless of whether or not the excess amount has actually been reduced.