1. Complete Form 552:

  • Item 2 -Enter the current processing month and year.
  • Item 3 -Enter 31.
  • Item 33 -Enter 55 - Spenddown obligation met.
  • Item 44 -See WAG 27-44-00.
  • Item 77 -Enter the date medical eligibility starts.
    • NOTE: This is the month, day, and year spenddown is met. 
  • Item 80 -Line out the indicator 2 - unmet in the PERSONS field and enter 3 or 1 - met. Enter 396 E SPD followed by the last date (MM/YY) spenddown is met in the PERSONS field. The system automatically enters the MM/DD entered in Item 77 by the Family Community Resource Center in the TOTAL COST column. The first centrally generated MediPlan card shows coverage starting the date entered in Item 77 and ending on the last day of the current processing month.

NOTE: Do not use this to approve medical eligibility for canceled cases or cases that meet the monthly spenddown but not for the current processing month. See WAG 18-05-10 for canceled cases or WAG 15-08-14-a for a one-month only MediPlan card.