PM 15-08-09-b: Spenddown Met - Multiple Expenses

WAG 15-08-09-b.

When a client provides multiple bills and/or receipts for medical services that exceed spenddown, determine which expense meets spenddown. To determine which one meets spenddown, use the expenses in the following order:

1. Health insurance deductibles, including Medicare and other coinsurance charges;
2. All copayments incurred or paid on spenddown met day;
3. Expenses for medical services and/or items not covered by the Medicaid Program;
4. For AABD cases, cost share amounts incurred for in-home care services received through the Department on Aging (DOA);
5. For AABD cases, expenses incurred for in-home care services received or purchased from private providers;
6. Expenses incurred for medical services or items covered by the Medicaid Program. If more than one covered service is received on spenddown met day, consider the charges in order of amount, using the bill for the smallest amount first, etc.