0810.000.00 MO HealthNet Coverage

0810.015.10 Prior Quarter (PQ) Spend Down

IM-117 November 15, 2021IM-08 January 24, 2012; IM-106 September 10, 2002

For spend down cases, the MO HealthNet eligibility date is the first day of the first month of the PQ in which the participant was eligible on all factors except meeting spend down. MO HealthNet coverage begins on the first day in which spend down is met in each of the prior months. Each of the three prior month’s medical expenses will be compared to that month’s spend down separately. The participant may be eligible for one, two, or all three months.

Individuals may apply or reapply for PQ for up to one year after the application. They may apply for PQ in person, by telephone, or in writing.

Process new MHABD applications, where the applicant has provided documentation of incurred medical expenses to meet spend down, within normal application processing time frames provided all other eligibility criteria is met. Staff cannot enter incurred medical expenses for a PQ month on the MSPA screen until the first working day after the approval is entered in the eligibility system. Then, staff should complete the MSPA entry of incurred medical expenses that meet spend down if the amount of any third-party liability and personal responsibility has been determined.

Staff must not wait for the participant to meet the present month’s spend down or to meet spend down in any other months of the PQ.

EXAMPLE:  Ms. Green applies on April 15th. On May 23rd, staff determine she was eligible on factors except meeting spend down starting in February, she was ineligible on available resources until February 3rd. Her spend down for each month is $200. She has presented incurred medical expenses for March in the amount of $100 on March 2nd and $150 on March 4th, but no bills for any other month. On the MSPA screen enter the date of service and participant’s liability. MSPA will determine the participant’s liability of $100 on March 4th with an end date of March 31st.