M E M O R A N D U M

IM-73  06/26/98 QUARTERLY REAPPLICATION FOR MA SPENDDOWN


SUBJECT:
QUARTERLY REAPPLICATION FOR MEDICAL ASSISTANCE SPENDDOWN
FORMS MANUAL REVISION #18: IM-2SPDN FORM AND FORM INSTRUCTIONS
 
DISCUSSION:
The current Medical Assistance spenddown reapplication process is burdensome to customers and staff.  To streamline the reapplication process and accelerate the approval of spenddown reapplications, the following changes have been made:
  1. At reapplication, only reported changes need verification.

    2.  
  2. An annual reinvestigation replaces the current practice of quarterly reverification of eligibility factors.

    3.  
  3. MRT decisions are valid until receipt of a new redetermination by MRT.

    4.  
  4. The Quarterly Reapplication for Spenddown (IM-2SPDN) form has been developed.
Apply these changes to spenddown reapplications when there has been no break in eligibility. Use the IM-2SPDN for spenddown customer's reapplying for their 2nd, 3rd and 4th quarter of uninterrupted spenddown eligibility.  Only verify changes reported by the customer. 

This process does not represent any changes in eligibility requirements.  It is still necessary to advise the customer of their spenddown amount (IM31SPDN) and verify medical expenses incurred during the spenddown quarter.  An interview is not required.

Record new information or changes on the most recent IM-38. Customers may report varying amounts in their bank accounts. If a reported change is not above the resource maximum, it is not necessary to reverify.  This process should facilitate immediate approval of spenddown reapplications upon verification of changes and medical expenses.

The annual reinvestigation will begin at reapplication in the 5th quarter.  Use the following methods to assist in the reinvestigation process:

  • Develop a manual tracking system for reinvestigations that are due. 
  • Use the Medical Assistance mailout packet instead of the IM-2SPDN for the reinvestigation.
  • Approve the customer for benefits as soon as verification of reported changes and incurred medical expenses are received.
  • Continue the reinvestigation until all necessary eligibility factors are reverified.
If the customer is cooperating, the process of reinvestigating eligibility factors should not interrupt the receipt of Medicaid. Should the customer refuse to cooperate with the reinvestigation, begin adverse action (IM-80) to notify the customer their Medical Assistance will stop at the end of the month in which the adverse action notice expires.

Conduct re-evaluations of disability determinations when they are due.  Follow procedures currently in place for re-evaluations by MRT. If eligible on all other factors, a customer remains eligible until a MRT determination finds they are no longer disabled.

Timely reapplication and approval of benefits for Medical Assistance spenddown simplifies the process for both customer and worker, and provides efficient service delivery.  County office's are encouraged to develop a procedure to initiate spenddown reapplications by mail. 

Some counties utilize the List of Daily Transactions (FIM31049), a report received by the supervisors.  On payroll closing at the end of the 3rd month, the system electronically closes spenddown cases.  The day after payroll closing the system generates the Daily Transactions Report over the print subsystem (S020) and lists by load number, all spenddown cases that closed.  This tool prompts the worker to generate an IM2SPDN to the customer.  A sample of this report is attached to this memorandum.

Agencies working with spenddown customers may want to have the IM2SPDN form available at their sites.  Make these forms available to them upon request.

If the following circumstances occur, use the guidelines listed below:

  • IM-2SPDN IS RECEIVED UNSIGNED -- return the form to the customer with a request to sign and return.

    •  
  • IM-2SPDN IS SIGNED, BUT INCOMPLETE -- contact the customer by telephone to obtain the necessary information.  If telephone contact is not possible, send a copy of the form to the customer   with a request for its completion. 

    •  
  • IM-2SPDN RECEIVED PRIOR TO THE NEW QUARTER -- reapplications received in the latter part of the 3rd month, such as those mailed out after payroll closing, are acceptable.  Hold and register the application the first day of the new quarter.

    •  
  • IM-2SPDN COMPLETED FOR INITIAL APPLICATION -- register the application and send the customer a Medical Assistance mailout application packet.
 
NECESSARY ACTION:
  • Review this memorandum with all appropriate staff.

    •  
  • Begin using the IM-2SPDN form for Medical  Assistance spenddown reapplications.

    •  
  • Approve spenddown reapplications immediately upon  receipt of necessary verification.

    •  
  • File the IM-2SPDN in the Forms Manual.
AM
Distribution #2

[ Memorandum Table of Contents ]