463-2 Waiver Recipients with a Spenddown

Effective Date: August 1, 2020

Introduction

Individuals eligible under the following waivers must spenddown to the medically needy income limit when their income exceeds 300% of the SSI payment rate. (Table II-A)

· New Choices Waiver

· Physical Disabilities Waiver

· Community Transitions Waiver

A. Calculate a Spenddown

1. To determine the spenddown a waiver individual must pay to receive Medicaid, follow the income policy rules for the Aged, Blind or Disabled medically needy program.

· Count only the individual's income.

· Do not count income from a spouse, or from the parent of a minor child.

· Do not count income that is excluded for people who are aged, blind or disabled.

2. Apply the applicable unearned and earned income disregards (431-2, 431-5, 419-5)

· Do not use the $125 earned income disregard applicable to other long-term care individuals. Instead, individuals receive the earned income disregard of $65 and 1/2 of the remainder.

· Add remaining unearned income to remaining earned income.

3. Deduct health insurance premiums (431-1.3)

4. Deduct 100% of the FPL for one person to determine the spenddown amount.

B. Meeting Spenddown

Waiver individuals who owe a spenddown may meet the spenddown with a cash payment to Department of Workforce Services or use medical bills they owe to meet the spenddown. Individuals may also use old medical bills to reduce the spenddown and meet the remainder with cash. When a individual does not meet the spenddown for 2 months, close the waiver program.