MA Spenddown
Help Hub staff explain what a Medical Assistance spenddown is, who has one, how it works each month, and what happens when payments are missed.
Article 1: What Is a Medical Assistance Spenddown?
Purpose:
Help Hub staff explain what a spenddown is, who it affects, and why someone might have one.
Q&A:
Q: What does “spenddown” mean for Medical Assistance?
A: A spenddown is like a deductible. It lets people with income slightly above the Medical Assistance (MA) limit qualify for MA by paying or using some of their own money for medical expenses.
Q: Who might have a spenddown?
A: People with disabilities, seniors, parents, pregnant people, or children whose income is higher than MA limits.
Q: What types of spenddowns are there?
A:
- Medical Spenddown: For people living in the community.
- Institutional Spenddown: For people living in nursing or long-term care facilities.
Q: Can someone on MA with a spenddown still get health coverage?
A: Yes. Once they meet their spenddown for the month (or six-month period), MA starts paying for covered services.
Internal Notes:
- Reference: EPM 2.3.3.4 – MA-ABD Medical Spenddowns.
- For callers, use “like a deductible” as a relatable explanation.
Article 2: How a Monthly Spenddown Works
Purpose:
Explain how monthly spenddowns are calculated and when MA coverage starts.
Q&A:
Q: How does a monthly spenddown work?
A: DHS compares your monthly income to the MA spenddown standard. The difference is your monthly spenddown amount. MA pays for covered services after you reach that amount in medical costs each month.
Q: Does the spenddown reset every month?
A: Yes. A new monthly spenddown is calculated for each month of your six-month eligibility period.
Q: What happens once the spenddown amount is met?
A: MA coverage begins for the rest of the month and pays for covered services above your spenddown.
Internal Notes:
- Use examples when explaining: “If your spenddown is $100 and you have a $120 bill, MA starts paying after that first $100.”
- Reference: What is a Spenddown (DHS-3017).
Tags: MA, Spenddown, Monthly, Eligibility
Article 3: Ways to Pay a Monthly Spenddown
Purpose:
Help Hub staff explain the three main methods for paying or meeting a monthly spenddown.
Q&A:
Q: How can someone pay or meet their spenddown each month?
A: There are three main ways:
- Potluck Processing: The spenddown is taken from the first provider’s claims submitted to DHS. The provider bills the person for that amount.
- Client Option: The person pays their spenddown directly to DHS each month.
- Designated Provider Option: The person pays the same provider (such as a PCA or waiver provider) each month.
Q: When is the Client Option payment due?
A: Payments are due by the 20th of the month before the coverage month. Example: May’s spenddown is due by April 20.
Q: Where do Client Option payments go?
A:
Mail to:
DHS – Client Option Spenddown
P.O. Box 64834
St. Paul, MN 55164-0834
Q: What if someone pays more than they owe?
A: DHS sends a refund after an 18-month reconciliation if payments exceed the actual cost of services.
Internal Notes:
- Refund details are in the 18-Month Reconciliation Letter from DHS.
- Potluck = automatic deduction from first claim; Client Option = direct prepayment; Designated Provider = direct monthly provider payment.
Tags: MA, Spenddown, Client Option, Designated Provider, Potluck
Article 4: Six-Month Spenddowns
Purpose:
Explain how six-month spenddowns differ from monthly ones and when they’re used.
Q&A:
Q: What’s the difference between a monthly and a six-month spenddown?
A: A six-month spenddown lets people use paid medical bills from the past six months to meet their spenddown amount all at once.
Q: When does MA start paying for services under a six-month spenddown?
A: MA begins paying for covered services after the spenddown is met for that six-month period.
Q: Can someone use unpaid medical bills for a six-month spenddown?
A: No. Only paid bills count toward a six-month spenddown.
Internal Notes:
- Six-month spenddowns are often used for retroactive eligibility or when someone applies mid-period.
Tags: MA, Spenddown, Six-Month, Eligibility
Article 5: Institutional Spenddowns
Purpose:
Help Hub staff explain spenddowns for people living in nursing or long-term care facilities.
Q&A:
Q: What is an institutional spenddown?
A: It applies to people living in long-term care or nursing facilities. Their available income, after allowed deductions, is paid directly to the facility each month.
Q: How is this different from a medical spenddown?
A: The entire spenddown amount goes to the facility, not multiple providers or DHS.
Q: Does this affect Elderly Waiver (EW) participants?
A: Yes — it works similarly to a waiver obligation under EW.
Internal Notes:
- The person’s worker determines the income contribution amount.
- Reference: EPM 2.3.3.4.3 – MA Institutional Spenddowns.
Tags: MA, Institutional, Spenddown, Long-Term Care
Article 6: Medical Expenses That Count Toward a Spenddown
Purpose:
List examples of allowable medical costs that can be used to meet a spenddown.
Q&A:
Q: What types of bills can be used toward a spenddown?
A:
- Health and dental insurance premiums (including Medicare)
- Co-pays or deductibles
- Medically necessary services
- PCA (Personal Care Assistance) services
Q: Can someone use unpaid bills?
A: For a monthly spenddown, yes — as they occur. For a six-month spenddown, only paid bills count.
Internal Notes:
- Always confirm with the person’s county worker if they’re unsure which bills qualify.
Tags: MA, Spenddown, Medical Expenses, Eligibility
Article 7: Spenddowns and SNBC Plans
Purpose:
Help staff explain how spenddowns affect SNBC (Special Needs BasicCare) enrollment.
Q&A:
Q: Can someone with a spenddown be in an SNBC plan?
A: No — people with a medical spenddown cannot newly enroll in SNBC.
Q: What if someone develops a spenddown after joining SNBC?
A: They can stay in SNBC as long as they pay their spenddown in full each month.
Q: What happens if they don’t pay it?
A: If they miss three months of payments (not necessarily in a row), they’re automatically disenrolled.
Q: Can they rejoin SNBC later?
A: They can re-enroll if they pay DHS all owed spenddowns within 90 days.
Internal Notes:
- Reference: SNBC and Medical Spenddowns (DHS-5373).
- If caller needs to confirm payment status, refer to DHS Billing (651-431-3205).
Tags: SNBC, Spenddown, Managed Care, MA
Article 8: Who to Contact About Spenddowns
Purpose:
Help staff route callers to the correct contact based on their spenddown type or question.
Q&A:
Q: Who can tell me how my spenddown was calculated?
A: Contact your financial worker at your county or tribal human services office.
Q: I think my spenddown is wrong — who can fix it?
A: Only your financial worker can review or adjust your spenddown amount.
Q: What if I want to know what claims my spenddown payments went toward?
A: Call Health Care Consumer Support at 651-297-3862.
Q: Who handles billing questions for Client Option payments?
A: Contact DHS Billing at 651-431-3205.
Internal Notes:
- Staff can find county contacts in the MHCP County and Tribal Directory.
Tags: MA, Spenddown, Contact, Billing, Financial Worker
Article 9: Where to Learn More About Spenddowns
Purpose:
Provide Hub staff with official reference materials on MA spenddowns.
Q&A:
Q: Where can I find official information on spenddowns?
A:
- DB101 – Disability-Based MA: What You Pay
- What Is a Spenddown (DHS-3017)
- SNBC and Medical Spenddowns (DHS-5373)
- EPM 2.3.3.4 – MA-ABD Medical Spenddowns
- EPM 2.3.3.4.2 – MA-ABD Health Care Expenses
Internal Notes:
- These are reference tools for staff, not for callers.
- Provide callers only with DHS factsheets (like DHS-3017) or DB101 link for public use.
Tags: MA, Spenddown, Resources, DHS, DB101
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