IM-22 April 11, 2024; IM-56 July 2, 2012; IM-08 January 24, 2012; IM-106 September 10, 2002
Effective October 1, 2002, eligibility for MO HealthNet Spend Down is determined on a monthly basis. If the participant is eligible for MO HealthNet (MHN) as a spend down, coverage for the month begins with the date on which the spend down is met and ends on the last day of that month. The MO HealthNet Division’s (MHD) system prevents payment of medical services equal to the participants spend down liability on the date that MHN coverage is started.
MHN coverage will begin and end without the case closing at the end of the monthly spend down period. As long as the participant remains eligible on all factors, except having met spend down, the case will remain active.
The participant may choose to meet their spend down by either of the following options:
- Submitting incurred medical expenses not subject to payment by a third party to the Family Support Division (FSD).
- Paying their monthly spend down amount to the MO HealthNet Division (MHD).
- Submitting incurred medical expenses not subject to payment by a third party to FSD and paying in the remainder of their spend down amount to the MHD Premium Collections.
Prior Quarter MO HealthNet Spend Down Coverage
To meet spend down in the three months prior to the month of application (prior quarter), the participant must submit verification of allowable incurred medical expenses that are not subject to payment by a third party. The participant is not allowed to pay-in their spend down for the three months prior to the month of application. Refer to manual sections 0810.010.15 Meeting Spend Down With Incurred Expenses and 0810.010.15.01 Documentation of Incurred Medical Expenses.
Approval Month and Future Months Coverage
In the month of approval and future months participants have the option of changing the method in which they meet their spend down each month. Participants make the choice by sending the payment to MHD Premium Collections or submitting bills for medical expenses not payable by a third party (that the participant is personally responsible to pay) to FSD. The participant may combine incurred expenses with partial payment to MHD Premium Collections. Refer to Manual Sections 0810.010.15 Meeting Spend Down With Incurred Expenses; 0810.010.20 Spend Down Pay-In Option; and 0810.010.20.17 Combination of Incurred Medical Expenses and Pay-In.
Note: For those months that participants do not pay-in, submit incurred medical expense or combine incurred medical expenses and partial payment to meet spend down liability, they do not have MO HealthNet coverage. Refer to Manual Section 0810.010.15 Meeting Spend Down With Incurred Expenses.
Continuous Eligibility for Children (CEC)
For children (under age 19) that are eligible for MO HealthNet Spend Down, FSD will provide continuous eligibility for 12 months.
- The start date of the child’s CE period begins on the first day of the month in which the application is received.
- Coverage of an eligible child, determined by MHD, begins the month in which the spend down is met.
- Increasing the spend down amount is not allowed during the CEC period.
- Decreasing the spend down amount is allowed during the CEC period, as well as moving to MO HealthNet Non-Spend Down.
Note: Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) in the MAGI Manual.