0840.010.10  NON-spend down TO spend down

If a change results in the claimant no longer being eligible for Medical Assistance on a non-spend down basis, the case must be changed to spend down effective the first day of the month following the month the change is entered in the IMU5 system. NEVER CLOSE an MA case in order to change it to spend down. Use the following procedure to change the MA case to spend down:

1. Send an Advance Notice of Adverse Action (IM-80) notifying the claimant they will become spend down the month after the IM-80 expires.
2. After the IM-80 expires, change the case to MA-spend down with a Title XIX begin date of the first date of the next month.
3. When the change is entered in the system send a Notice of Case Action (IM-33) to notify the claimant of the change.
4. The day after the change is entered DMS will send the claimant an initial invoice for the first month of the case is eligible on a spend down basis.

Note:  The same procedures are used to change an MA-WD premium or non-premium case to MA spend down.  DO NOT CLOSE AN MA-WD CASE AND REGISTER A NEW APPLICATION TO CHANGE THE CASE MA spend down.

0840.010.15  spend down TO NON-spend down OR MA-WD NON-PREMIUM

If, as a result of a change, the claimant no longer has to meet the MA spend down or MA-WD premium provisions, transfer the case to either MA non-spend down or MA-WD non-premium once the eligibility for either category has been verified. Make the change effective the month the change is reported, if it is determined the claimant was eligible on a non-spend down or non-premium basis for that month. The change could be a decrease in income, a person becoming MA-WD eligible, a person becoming HCB eligible, etc.

The Division of Medical Services will automatically refund any spend down or premium amount the claimant paid-in for months that are changed to MA non-spend down or MA-WD non-premium.