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Last updated: December 2009
Persons who would qualify for Medicaid under AABD or TANF but for excess income and/or assets may still be eligible to receive medical assistance under the Spend-down program. DHS Policy Manual 15-08-00 et. seq. To get a medical card, the person needs bills or receipts for medical care, drugs, or supplies in an amount that HFS calls the spend-down amount. This spend-down amount works like an insurance deductible.
The spend-down period is one month for excess income. The spend-down period for excess assets under all spend-down programs is six months. HFS Policy Memorandum (5-26-89).
As an example, for a person with excess income, the spend-down amount is calculated by subtracting the monthly MANG level from monthly countable income (See MANG section): the remainder is the spend-down amount.
Persons who apply for and are given a spend-down amount are enrolled in the program for six months. At any time during the six months, if the person incurs bills equal to or in excess of the spend-down amount, she can qualify for medical coverage. At the end of six months, case will be reviewed to see if client has met spend-down in any one of the last three months. If spend-down has been met in any one of the three months, HFS will keep the case active. If not, a notice of termination will be sent to the client with a reapplication attached. Clients who believe this determination is erroneous should file an appeal as well as a new application in order to preserve appeal rights.
There are several basic rules in the spend-down program:
If a person enrolled in the spend-down program has medical bills or receipts equal to or in excess of his spend-down amount, he takes the bills and receipts to his local HFS office. The HFS caseworker has two days to determine if the person meets his spend-down amount and is qualified for medical assistance. If the person qualifies, the caseworker notifies HFS’ Springfield office. The medical card is then mailed to the recipient from Springfield. This procedure can take several days.
If the person needs the medical card immediately, he or she should ask the local HFS office to issue a temporary medical card that is effective until he or she receives the regular medical card in the mail. The HFS office has two days to prepare the temporary medical card after the person is found qualified. DHS Policy Manual 02-01-00 et. seq. However, preparation of the card is not difficult and the office should be able to prepare the card quickly.
The Pay-In Spend down program lets eligible Illinois residents pay their entire spend-down amount, or a portion thereof, to qualify for medicaid. They can pay this amount instead of having of having to send in receipts for the entire spend-down amount. They also have the option of sending in some medical receipts and then paying the difference to reach their spend-down amount.
The Pay-In spend-down program benefits include:
In general, Aid to the Aged, Blind and Disabled (AABD) community MANG clients qualify for the Pay-In Spend down program.
If you have any questions about whether you qualify, you should talk with the Illinois Department of Human Services ("IDHS"). See DHS Policy Manual 15-08-15: Pay-In spend-down, or call the IDHS Health Benefits Hotline: (800)-226-0768.
The medical card usually will not provide for payment of bills used to meet the spend-down. However, HFS can "split" the bill and pay the remainder of the bill over the spend-down amount if the bill is submitted to HFS in the month in which the services were received. DHS Policy Manual 15-08-00 et. seq.
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