WAG 18-05-14: Change in Spenddown Status (Canceled Case)

Use a blank Form 552 to change the spenddown status of a canceled community or long term care spenddown case from unmet to met only if spenddown has been met for each month that remained in the enrollment period. The case must be canceled with an unmet code 390 or 391. This action can only be entered once for an enrollment period. It cannot be taken to change an already existing spenddown met day.

NOTE: Use a TA 55 to approve medical for a canceled case in unmet status when the monthly spenddown is met for one or more months but not for every month remaining in the enrollment period.

This action can only be taken if no other actions, such as registration, restoring, or denial, have been entered in the computer after the cancellation. If a subsequent action has been entered, send Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958) to the Exception Processing Unit in Springfield to request coverage.

1. Complete a blank Form 552:

  • Items 1, 5, & 6 -Complete.
  • Item 2 -Enter the first month of the enrollment period the spenddown is being changed to met.
  • Item 3 -Enter 39.
  • Items 8 - 10 -Enter the name and address as it currently exists in the Client Database.
  • Item 32 -Enter the last month and year eligibility is authorized. This can be no later than the last day and month of the enrollment period for the first month and year shown in Item 2.
  • Item 33 -Enter 37.
  • Item 77 -Enter the beginning eligibility date. This is the date spenddown was met. This date can be any date between the first day of the month and year shown in Item 2 and the last day of the month and year shown in Item 32.
  • Item 80 -Enter 390 or 391 and the amount, as appropriate, with a met indicator (1 or 3).

changed textThe system generates a MediPlan Card and produces a turnaround Form 552 to confirm issuance of the card. The card shows coverage starting on the day in Item 77 and ending on the last day of the month in Item 32. The following message appears on the card when code 1 is used: