Regular to Spenddown
When a change is processed that causes an increase in spenddown the change will be effective for the first regular roll month.
- (FCRC) When a case changes from Regular to Spenddown, the caseworker will enter the changes in a timely manner and rerun eligibility and send Form 360C. Form 360C tells the client that they will no longer receive a medical benefits and that they are enrolled for spenddown because of excess monthly income and/or resources.
- (FCRC) Enroll the client for spenddown for the first month for which medical benefits can be stopped (see WAG 18-05-04).
- (IES) For AABD Medical, the resource will be added.
- (IES) Show spenddown status as unmet.Example 1: Mary reported on 05/10 that her SSA income increased in May. The increase caused her spenddown obligation to be higher. The increased spenddown obligation will be effective for the first regular roll month possible. Form 360C is sent centrally to notify the client of a change in the spenddown amount.
5. (IES) Establish a spenddown record in IES.
Spenddown to Regular
When a change is processed in IES that results in a decrease in spenddown the change will be effective the month the change occurred.
Take the following action for a spenddown case, whether in met or unmet status, when a case changes from Spenddown to Regular.
- (IES) Run eligibility in IES if sufficient time remains in the approval period (see WAG 18-05-02).
- (FCRC) If the Spenddown case is centrally ended before it can be changed to Regular, reopen case for the month for which the Spenddown case has been ended, approving a Regular case (see WAG 15-08-10).Example 2: On 06/20, John reported that his SSA income decreased beginning in May. The decrease in income made him eligible for medical with no spenddown. The change will be effective the month the change occurred. Form 360C is sent centrally to notify the client of a change in the spenddown status.
Example 3: Mary is pregnant and applies for medical benefits on 04/15/16. She is employed and her income is over the income limit for Moms and Babies so she is enrolled in Pregnant Women program with a spenddown. On 07/01/16 she reports that she is no longer employed. Due to the loss of income she is eligible for Moms and Babies (no spenddown).
Do not ask the client to complete an application form to establish the Regular case.