Complete Form 552

  • Item 2 -Enter the current processing month and year.
  • Item 3 -Enter 31.
  • Item 33 -Enter 57.
  • Item 44 -See WAG 27-44-00.
  • Item 80 -Enter 390 SPD. In the AMOUNT column, enter the dollar amount of the spenddown.
    • Enter the indicator 2 - unmet in the PERSONS column.
    • For AABD, enter 392 AST. In the AMOUNT column, enter the amount of excess assets. If none, enter zero.

When the client meets the monthly spenddown, or the monthly spenddown is met through carryover for time not including the current processing month, see WAG 15-08-10-a for a one-month only MediPlan card.