PM 06-11-02-e

Determining Eligibility

  1. Determine countable monthly income and nonexempt assets as follows:

    For applicants, AIS compares the person's countable monthly income to the Community MANG Income Standard and their nonexempt assets to the asset limit for the unit size.

    For active cases, use the AABD MANG Computation Sheet - Community Case (Form 2382A) to compare income and assets to the standards. 

  2. Complete the Form 552:
    Item 20 - Enter code 18 to identify spenddown clients receiving DHS Community-Based Services.
    Item 80

    - Enter code 158 CI with total countable monthly income. Code 158 CI is a required entry for approvals, REDEs, and when Item 90 income is changed.

    - Enter code 390 SPD with the amount of excess monthly income.

    - Enter code 392 AST with the amount of nonexempt assets in excess of the asset limit.

    - If spenddown is met, enter code 396 E SPD with the spenddown met ending date (MM/YY) under PERSONS. The date may be up to 12 months in the future.


Using DHS Services to Meet Spenddown

When determining if spenddown is met using DHS Community-Based Services, the following rules apply.

  • Apply the cost of DHS Community-Based Services first, before any other medical bills or receipts.
  • DHS expenses are incurred the first day of the month, regardless of the day the services are actually provided.
  • If the cost of DHS services equals or exceeds the spenddown amount, spenddown is met. If the cost of these services does not meet spenddown, apply the cost of other allowable medical expenses to the spenddown.
  • Do not issue split bill forms for any DHS Community-Based Services.

When using only DHS Community-Based Services to meet spenddown, enter code 3 in the PERSONS column with Item 80 code 390 SPD. Do not enter a split bill indicator.

  • If spenddown is not met for the month in which the DHS expense is incurred, the cost can be used to meet spenddown for a later month(s).

For cases that meet spenddown solely with the cost of DHS Community-Based Services, in Item 80 code 396 E SPD enter the date that is 12 months from the current month. At REDE, update the code for 12 months.

Example: Mr. A is enrolled for Medical with a monthly spenddown of $200. Effective 09/01/97, Mr. A receives DHS Community-Based Services. Monthly charges are $600 as reported on Form 2653.

Place the case in spenddown met status, effective 09/01/97, using TA 31/TAR 55. Enter code 18 in Item 20. Enter 09/98 in Item 80 code 396 E SPD. Continue to use the $600 monthly charge to meet spenddown until a Form 2653 is received reporting a change.

For cases in which DHS Community-Based services and other medical costs are used to meet spenddown, enter a date in Item 80 code 396 E SPD that is not more than 6 months in the future.

Example: Mr. B is enrolled for Medical with a monthly spenddown of $1,000. Effective 08/01/97, Mr. B receives DHS Community-Based Services. Monthly charges are $500 as reported on Form 2653. Mr. B presents a medical bill, incurred in 1994, with a billing date of 08/15/97 and a current liability of $5,000.

Place the case in spenddown met status, effective 08/01/97, using TA 31/TAR 55. Enter 02/98 in Item 80 code 396 E SPD. Since DHS costs by themselves did not meet spenddown, the date entered in code 396 E SPD cannot be more than 6 months in the future.

If spenddown is not met, use costs for DHS Community-Based services for later month(s) until spenddown is met. There is no time limit in the use of these expenses. But, once spenddown has been met for a month, any remainder cannot be carried over to a later month.

Example: Mr. C is enrolled for Medical with a monthly spenddown of $400. Effective 08/97, Mr. C receives DHS Community-Based Services. Monthly charges are $300 as reported on Form 2653. He has no other medical expenses.

Spenddown is not met for 08/97, but the $300 incurred in 08/97 can be used for 09/97. Spenddown is met effective 09/01/97 using the $300 expense from 08/97 and the $300 expense for 09/97. Do not carry over the $200 remaining after spenddown is met.