WAG 15-05-03-a: At Intake and For Persons Who Report a Change

To determine countable monthly income, anticipate the amount of wages to be received as follows:

1. If the person worked last month, figure the gross amount they earned in the last calendar month.
2. Ask the person if the amount earned is expected to stay the same. (Same hourly wage? Same number of hours?)
3. If the person claims the amount is expected to stay the same, use the last calendar month's wages as the amount to be received in each future month.
4. Project the wages for the rest of the 12-month period. Be sure to budget any periodic extra paychecks for the month of receipt.
5. If the person says the amount is expected to change or they have not received any wages yet, figure the amount of wages expected to be received by asking the person:
   • the hourly wage,
   • the number of hours expected to work, and
   • the number of pays expected.

Regular Medical Cases

1. When a person reports a change, determine that countable income has gone down.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue:
      • Complete Form 2382A.
      •  Update Item 80 and Item 90 codes on Form 552.
      • Review eligibility for cash.
2. Determine that countable income has gone up.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue, compare the new income to the Community Standard by completing Form 2382A.
      • If the case remains Regular, update Item 80 and Item 90 codes on Form 552.
      • If the case is now Spenddown, change the case status for the current submittal month, and update Item 80 and Item 90 codes on Form 552 if the person in the case is age 19 or over, or the person is under age 19 and it is more than 12 months from the Last Medicaid Determination Date.
        • Send the client Form 2434A (with Form 458SPA/SPB attached, if needed).
        • Write in the case record that the case is now Spenddown.

Spenddown Cases in Met Status

1. When a person reports a change, determine that countable income has gone down.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue, complete Form 2382A.
      • If the case remains Spenddown, update Item 80 and Item 90 codes on Form 552.
      • If the case is no longer Spenddown, submit Form 552 coded with TA 31/TAR 57 for the current submittal month.
        • Code medical eligibility for the first day of the month in which the income fell below the Community Standard.
        • Update Item 80 and Item 90 codes on Form 552.
        • Send Form 2434A (with Form 458SPA/SPB attached, if needed) to the client.
        • Write in the case record that the case is now Regular.
2. Determine that countable income has gone up.
   1. If the change in income is not expected to continue, no action is needed.
   2. If the change in income is expected to continue, compare the new income to the Community Standard by completing Form 2382A.
      • Update ASDS and refigure spenddown amount for future months.
      • Send Form 2434A (with Form 458SPA/SPB attached, if needed) to the client.
   3. If the case is no longer in spenddown met status due to the increased income, change the case to unmet status for the current submittal month.
      • Update Item 80 and Item 90 codes on Form 552.
      • Send Form 458SP-1 for each month spenddown is no longer met.
   4. If the case remains in spenddown met status for the period and the client was sent a notice, update Item 80 and Item 90 codes on Form 552.

Spenddown Cases in Unmet Status

1. When a person reports a change, determine if countable income has gone down.
   1. If the change in income is not expected to continue, complete Form 2382A.
      • Send Form 2434A (with Form 458SPA/SPB attached, if needed) to the client.
      • If the client has medical costs for the month of the decrease, see if it will now be met for the month. Use ASDS to refigure spenddown.
        • If spenddown is met, submit a TA 55.
        • Send Form 458SP-1 to the client.
        • If the client has not previously brought in medical costs for the month of the decrease, no further action is needed.
   2. Complete Form 2382A if the change in income is expected to continue.
      • If the client has medical costs for the months of the decrease, use ASDS to refigure spenddown to see if spenddown is now met.
      • If the case remains spenddown, update Item 80 and Item 90 on Form 552.
      • If spenddown is met, submit a TA 55 mercury transaction or a TA 31 regular roll transaction. Send the client Form 458SP-1.
      • If the case status is no longer Spenddown, submit a TA 31 transaction for the current submittal month.
        • Code medical eligibility for the first day of the month in which the income fell below the Community Standard.
        • Update Item 80 and Item 90 codes on Form 552.
        • Send the client Form 2434A (with Form 458SPA/SPB attached, if needed).
        • Write in the case record that the case is now Regular.
2. 2. Determine countable income has gone up.
   1. If the change in income is not expected to continue, do not update Form 552.
      • Complete Form 2382A (with Form 458SPA/SPB attached, if needed).
      • Send Form 2434A.
   2. If the change in income is expected to continue, complete Form 2382A.
      • Update Item 80 and Item 90 on Form 552.
      • Send the client Form 2434A (with Form 458SPA/SPB attached, if needed).