PM 06-11-02-e: Determining Eligibility and Spenddown

WAG 06-11-02-e

Determine eligibility for persons receiving DHS Community-Based Services in the same manner as persons living in the community. These cases are community MANG cases.

When determining spenddown status, consider the total amount of DHS Community-Based Services as incurred on the first day of the month, regardless of the day the services are actually provided. Apply these services to spenddown first, before any other medical bills or receipts.

If spenddown is not met for the month in which the charge is incurred, the cost can be used to meet spenddown for a later month(s). There is no time limit on the use of these costs. But, once spenddown is met the amount remaining cannot be carried over to a later month.

Room and board costs cannot be used toward meeting spenddown.

Medical eligibility begins effective the first day that spenddown is met. Medicaid pays for covered medical services (excluding DHS Community-Based Services) from the spenddown met date through the last day of the same calendar month.