Section 210-RICR-40-05-2.3 - Spenddown CalculationA. For a person who has income above the income standard across applicable eligibility pathways, the spenddown standard for their eligibility coverage group is applied. For example, the appropriate spenddown standard for parents/caretakers is one hundred thirty-eight percent (138%) of the FPL (ceiling for MACC eligibility when five percent (5%) disregard is applied) and two hundred sixty-six percent (266%) of the FPL for children (MACC ceiling including disregard). The appropriate spenddown standard for elders and adults with disabilities is the medically needy income limit adjusted for household size. 1. Spenddown Amount - The spenddown amount is calculated as follows:a. The beneficiary's anticipated monthly net income for each month of the eligibility period based on the criteria appropriate for the specific coverage group using the SSI methodology.b. Net income for all six (6) months.2. FPL Comparison - The applicable six (6) month FPL standard is subtracted from the beneficiary's six (6) month net income. If the result is: a. Equal to or less than the FPL standard, the applicant is eligible for Medicaid without a spenddown, even if they exceed the monthly FPL standard in one (1) or more months of the six (1) month period. No further calculation is necessary.b. Greater than the FPL standard continue, further calculations are required.3. Six-month Spenddown Amount - The six (6) month spenddown amount is determined by subtracting the applicable six (6) month FPL spenddown standard from the total six (6) month net income. The result is the six (6) month spenddown amount.4. Application of Allowable Expenses - Allowed health care expenses are applied to the six (6) month spenddown amount. If the applicant will incur bills to satisfy the spenddown after the date the application is processed, the final processing will be delayed until after the applicant has received the health care services. Pre-approval of certain remedial and Medicaid LTSS services is required if the MN beneficiary does not qualify for an LTSS preventive level of care.210 R.I. Code R. 210-RICR-40-05-2.3
Amended effective 10/5/2021
Amended effective 3/30/2022