Spenddown is met and Medicaid eligibility begins on the day in the month that total LTC/SLF costs at the private rate, plus allowable medical expenses not used when determining countable monthly income, meets the spenddown amount. LTC
and SLF costs are considered as incurred on the first day of the calendar month in which the service is given. When spenddown is met, eligibility continues only through the last day of the calendar month.
Medical expenses for LTC and SLF spenddown cases are treated the same as for community cases. But, a receipt for payment of LTC or SLF charges at the private pay rate can only be applied to a client's spenddown or credit in the month
the payment is made.
When countable monthly income and/or assets are greater than LTC or SLF charges at the private pay rate or the HFS rate, whichever is greater, or hospice charges at the private pay rate, always consider the charges as incurred at the
private pay rate. Charges are considered as incurred for the month, from the first day of the month or from the first day of stay through the last day of that month. Use LTC and SLF charges incurred during the month of
discharge toward meeting the community spenddown.