WAG 15-08-09.

For community, LTC, and SLF cases, spenddown met day is the day in the month that medical bills and/or receipts meet spenddown. Spenddown met day is the first day of Medicaid eligibility.

To determine the spenddown met day, deduct medical expenses in the following order from the monthly spenddown amount:

  • Charges for DORS Home Services Program services and/or (for AABD Only) DMHDD Community Based Services.
  • Receipts, including any carryover amounts from receipts used in prior months, subject to the 6-month limit on the use of receipts. Use the oldest receipt first.

    NOTE: A receipt for payment of LTC or SLF charges can only be applied to a client's LTC or SLF credit or spenddown in the month the payment is made. 

  • Medical bills, including carryover amounts from bills used in prior months. Use the oldest bill first. Use bills for the current month based on date of service, not billing date.

When charges at the private pay rate are more than the amount needed to meet spenddown, but the Medicaid rate is less than the amount needed, spenddown is considered met but the client is responsible for the entire amount of the bill at the private pay rate. The difference between the private charge and the amount needed to meet spenddown may be used to meet spenddown in a later month.