0805.000.00 Eligibility

0805.015.40 Types of Need Determination

IM-08 January 24, 2012

After the participant’s gross income has been determined, and all exclusions, exemptions, and deductions allowed, round the remaining income down to the nearest whole dollar amount to arrive at the adjusted gross income.

To determine eligibility based on need, compare the adjusted gross income to the current income maximum. There are two types of need determinations: non-spend down and spend down.

If the adjusted gross income is equal to or less than the income maximum the case is eligible for MO HealthNet as non-spend down.

Spend down is an eligibility category of MO HealthNet for individuals whose income exceeds the current income maximum for MO HealthNet. If the adjusted gross income is greater than the non-spend down income maximum, the participants must reduce their income to the non-spend down income limit— “spend down” their excess income—to have MO HealthNet coverage. Federal law allows the participants to deduct from their income the amount of incurred medical expenses that are not subject to payment by a third party, or to pay-in to the state the amount of their adjusted gross income that exceeds the non-spend down income limit. This amount is the participants’ monthly spend down obligation.