WAG 17-02-04.

An applicant who meets nonfinancial factors of eligibility for AABD Cash or TANF, and who has enough income to meet basic needs, may qualify for one of the Family Health Plans or AABD Medical.

A long term care applicant who has more income than the income standard and/or more nonexempt assets than the asset limits is to be approved as spenddown, unless they stated in writing that they do not want to be enrolled for spenddown.

A Family Health Plans applicant who has more income than the income standard, or an AABD community spenddown applicant who has more income than the income standard and/or more nonexempt assets than the asset limits, is to be approved as spenddown if they meet certain conditions. The conditions for approval of a community spenddown case are:

  • spenddown is met for at least one month of the 12-month enrollment period, or
  • the case is regular for at least one month of the 12-month enrollment period, or
  • a person is on a waiting list for a transplant, or would be put on a waiting list for a transplant if they were enrolled in spenddown.

An approved spenddown client is not eligible for payment of medical expenses until they have medical bills (paid or unpaid) that equal or exceed their monthly spenddown amount. When this happens, they have met spenddown and they get a MediPlan card. Allowable medical expenses are paid by HFS beginning the day spenddown is met.