Medicaid program; deduction of incurred medical expenses (spend down)--HCFA. Proposed rule.
These proposed rules would permit States to revise the process by which medical expenses are considered in determining Medicaid eligibility. This process is commonly referred to as "spend down." Spend down applies when an individual's income level during a budget period would ordinarily preclude eligibility, except that incurred medical expenses reduce income to the eligibility level. These proposed revisions would permit States, as allowed by law, to: (1) Consider projected institutional expenses at the Medicaid reimbursement rate as incurred medical expenses, and deduct those expenses from income in determining eligibility; (2) Combine the retroactive and prospective medically needy budget periods; (3) Except for current payments on older bills not previously deducted in any budget period, exclude from incurred medical expenses those bills for services provided more than 3 months prior to the month of application; (4) Deduct incurred medical expenses from income in the order in which the services are provided or in the order each bill is submitted to the agency; and (5) Except for health insurance premiums, deductibles and coinsurance charges, limit deductible medical expenses to services covered under the State plan.
D014487:Centers for Medicare and Medicaid Services, U.S.; D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D014481:United States