MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual – Table of Contents

0810.010.10.05  Notification of Spend Down on New Approvals

IM-#8, January 24, 2012, IM-159,  November 26, 2002, IM-106,  September 10, 2002

On new approvals, FAMIS sends the approval letter, FA 460 MO HealthNet Action Notice, notifying the participant they have been approved for spend down, but MO HealthNet coverage will not begin until the spend down is met. The letter will inform the participant of the spend down amount and the months for which they can receive coverage by meeting spend down.

If the eligibility specialist has already received bills to meet spend down for the month of approval or prior quarter months, the eligibility specialist must send a Spend Down Notification form IM-29(SPDN) to notify the participant of coverage dates. If the eligibility specialist has received proof of incurred expenses but the participant has not met  spend down, the eligibility specialist must send the Spend Down Notification form IM-29(SPDN)  to notify the participant of countable medical expenses that have not met their spend down and the amount they have left to meet their spend down.

When a new approval is entered in the FAMIS system, MHD will send separate invoices for the month of approval and the month following approval.  These invoices are sent on the day after the approval is entered.  The participant will not receive invoices from MHD for the three months prior to the month of application. The participant has to provide documentation of incurred medical expenses that are not subject to payment by a third party for the prior quarter months to meet spend down.