ABD-MA Income Standards

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Description of ABD- MA Income Standards The Code of Maryland Regulations (COMAR), Title 10, Department of Health and Mental Hygiene, Subtitle 9, Medical Care Programs delineates specific income eligibility standards for Maryland Medicaid Program participation. COMAR refers to Medicaid applicants as “MAGI” or “MAGI Exempt”. MAGI applicants are those applicants whose income will be evaluated using the modified adjusted gross income standard in accordance with the Affordable Care Act (ACA). MAGI Exempt applicants are those, like ABD candidates, to whom ACA income standards do not apply. COMAR§G holds that all income not explicitly identified as excluded in section J will be counted to establish total gross income. This section…show more content…
The agency implemented the provision to allow an applicant who has been denied ABD Medical Assistance because their gross income is more than the program limit to still become eligible. This is done by submitting medical bills or expenses to reduce or “spend-down” the excess amount to a number that is within program income eligibility limitations. This process is comparable to submitting payments towards a deductible before a service can be rendered. Following this analogy, the payments are the medical bills, the deductible is the spend-down amount, and the service is Medicaid. Because a spend-down consideration period spans six months, the spend-down amount is determined by multiplying the gross monthly income by six, multiplying the total MA income limit for the household size by six, and taking the difference. The following example shows how spend-down eligibility is calculated for a single adult ABD…show more content…
Obvious problems with the program include the unlikeliness off a client to be able to produce appropriate evidence of medical expenses and the unlikeliness of a client to meet a spend-down amount for two or more consecutive certification periods. The former issue pertains to the mere fact that many medical providers require proof of insurance/payment before services are provided. The implications for our client is that they will (1) not be able to receive service (2) not obtain bills to help reduce the spend-down amount. The latter issue pertains to a client who is able to meet a spend-down during the initial certification period. If said client is awarded coverage through October 31, 2015, when they reapply in November, they will have no unpaid medical bills because medical expenses through October 31, 2015 will have been covered during the previous certification period. This implies that a client must be so medically needy that they are able to accrue medical bills in excess of the spend-down amount in relatively small time frame. This time frame, in reality is shorter than six months because within those months, the client must accrue and submit expenses that will not be paid, receive a medical assistance number, and accrue more expenses that will be billed to and

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