0810.010.10  Notification of Spend Down Amount

IM-#8, January 24, 2012, IM-106,  September 10, 2002

The MO HealthNet Division (MHD) mails a monthly invoice to active spend down cases on the second working day of each month. The invoice is for the next month's spend down amount, for example, the 10/02/02 invoice is for the November 2002 spend down. The invoice gives the participant the option of paying in their spend down amount to MHD or submitting bills to the eligibility specialist. The invoice instructs the participant to call the MHD Premium Collections Unit at 1-877-888-2811 for questions about a payment.

NOTE:  The MPNI inquiry screen provides information regarding invoices for MHK CHIP premium, Ticket to Work Health Assurance Program (TWHA) premium and MO HealthNet Spend down cases. Refer to memorandum IM-28 February 19, 2003 for instructions on the MPNI screen. Since conversion to FAMIS, the identifier for spend down cases on MPNI is AF.

MHD will stop mailing monthly invoices if the participant does not meet spend down for 6 consecutive months.  An invoice is still created in the system and can be viewed on the MPNI screen.  The system will continue to create invoices as long as the case remains open as spend down.  A case cannot be closed simply because the participant has not met spend down for 6 or more months.  MHD will resume mailing invoices the month following the month in which the participant meets spend down by bills or pay-in for one of the preceding 6 months. The procedure for authorizing spend down coverage based on incurred expenses is the same whether or not the participant was mailed an invoice (refer to Section 0810.010.15.10).

0810.010.10.05  Notification of Spend Down on New Approvals

IM-#8, January 24, 2012, IM-159,  November 26, 2002, IM-106,  September 10, 2002

On new approvals, FAMIS sends the approval letter, FA 460 MO HealthNet Action Notice, notifying the participant they have been approved for spend down, but MO HealthNet coverage will not begin until the spend down is met. The letter will inform the participant of the spend down amount and the months for which they can receive coverage by meeting spend down.

If the eligibility specialist has already received bills to meet spend down for the month of approval or prior quarter months, the eligibility specialist must send a Spend Down Notification form IM-29(SPDN) to notify the participant of coverage dates. If the eligibility specialist has received proof of incurred expenses but the participant has not met  spend down, the eligibility specialist must send the Spend Down Notification form IM-29(SPDN)  to notify the participant of countable medical expenses that have not met their spend down and the amount they have left to meet their spend down.

When a new approval is entered in the FAMIS system, MHD will send separate invoices for the month of approval and the month following approval.  These invoices are sent on the day after the approval is entered.  The participant will not receive invoices from MHD for the three months prior to the month of application. The participant has to provide documentation of incurred medical expenses that are not subject to payment by a third party for the prior quarter months to meet spend down.