MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to provide clarification of policy for MO HealthNet for Disabled Child (MHDC) spend down.  The Centers for Medicare and Medicaid Services (CMS) has clarified that when parental income is used in determining the child's eligibility, the incurred medical expenses not subject to third party payment of the parent/s whose income is used in the determination should also be allowed toward meeting the child's spend down.

Prior to this clarification, policy stated:

If the disabled child is eligible as a spenddown case, only allow the medical expenses of the disabled child to meet the spenddown amount.

The policy manual is revised as follows:

For MHDC spend down, incurred medical expenses, not subject to payment by a third party, of the following may be used to determine if the disabled child meets spend down:

• the disabled child, and
• the disabled child's natural or adoptive parent/s whose income is used in determining eligibility.

NOTE: This does not include a stepparent because under Missouri law stepparents are not legally liable for the support of step children.

The examples in this manual section have also been updated to reflect the current Supplemental Security Income (SSI) maximums.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Allow toward MHDC spend down, incurred medical expenses, not subject to payment by a third party, of the disabled child and of parent/s whose income is used in the MHDC eligibility determination.

AC/ha