PM 15-08-15-c
Reconciliation Refunds on Payments Used to Meet Spenddown
Example 1: (Income Spenddown Paid-in): Ms. Pebbles pays-in an income spenddown of $100 per month for July, August and September 2009. In December 2010, the case is automatically reconciled. The monthly pay-in amounts are compared to the claims paid for each review month as follows:
| Review Months |
Pay-in Payment |
Claims paid by HFS for Review Month |
Refund due |
| Jul '09 |
$100 |
$300 |
$0 |
| Aug '09 |
$100 |
$75 |
$25 |
| Sep '09 |
$100 |
$90 |
$10 |
|
|
|
Total = $35 |
The Pay-in Spenddown Unit sends a refund of $35 to Ms. Pebbles for the quarter of July - September 2009.
Example 2: (
Resource Spenddown Paid-in): Mr. Granite has a $500 resource spenddown and no income spenddown. He pays-in $500 for July 2009. Effective August 2009, the case becomes regular (non-spenddown) AABD MANG. Mr. Granite's regular MANG case is canceled effective 12/09. In March 2011, the case appears on a reconciliation report. The Pay-in Spenddown Unit will complete a manual reconciliation. The report indicates that the total medical claims that HFS paid for Mr. Granite for July through December 2009 was $475. Since the total amount of claims paid is less than the resource spenddown amount paid, Mr. Granite is entitled to a $25 refund.
Example 3: (Both Income and Resource spenddown Paid-in): Mr. Bedrock has been enrolled in Pay-in Spenddown since July 2009. He had a $2,000 resource spenddown and a $200 income spenddown. A manual reconciliation is done by the Pay-in Spenddown Unit in December 2010 with the following information:
| Review Months |
Pay-in Payment |
Cumulative Income Pay-in Payment |
Claims paid by HFS for review month |
Cumulative claims paid |
Refund due |
| Jul '09 |
$2,200 |
$200 |
$500 |
$500 |
$0 |
| Aug '09 |
$200 |
$400 |
$1,700 |
$2,200 |
$200 |
| Sep '09 |
$200 |
n/a |
$50 |
n/a |
$150 |
|
|
|
|
|
total = $350 |
Step 1: Reconcile the resource spenddown payment. The asset spenddown payment can be reconciled for the review month of August 2009 because the cumulative claims paid by the Department ($2,200) met or exceeded the amount paid-in to meet the resource spenddown ($2,000) as of August 2009. A refund of the resource spenddown payment will not be due.
Step 2: Reconcile the income spenddown payment for the month the resource spenddown payment was reconciled. Subtract the asset spenddown amount from the cumulative claims paid amount ($2,200 - 2,000 = $200). Then compare the difference of $200 to the cumulative paid-in amount of $400. An income payment refund of $200 is due for August because the paid-in amount of $400 exceeds the excess claims paid amount of $200 .
Step 3: A refund of $150 is due for September 2009 since the income spenddown payment of $200 exceeds the $50 claims paid for that month. A total refund of $350 is issued for July - September 2009. The case will be reconciled automatically starting with the October - December 2009 review quarter.
