Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 70 - MO HealthNet Division
Chapter 4 - Conditions of Participant Participation, Rights and Responsibilities
Section 13 CSR 70-4.100 - Preventing Medicaid Payment of Expenses Used to Meet Spenddown

(1) Aged persons (over sixty-five (65) years), blind persons, or people with disabilities with income above limits established under section 208.151.1(24), RSMo, for old age assistance benefits, permanent and total disability benefits, or aid to the blind benefits, as amended, are allowed to deduct from income incurred medical expenses (that is, spenddown) to become eligible.

(2) Spenddown eligibility shall be calculated on a monthly basis.

(3) The MO HealthNet program (Medicaid) will only reimburse enrolled Medicaid providers for covered medical expenses that exceed a recipient's spenddown amount. Medicaid does not pay the portion of a claim used to meet the applicant's spenddown obligation. For example, for the first day of coverage, the MO HealthNet Division denies or splits (partially pays) a claim or claims until the applicant's spenddown liability is reduced to zero (0).

(4) After the MO HealthNet Division has reduced the participant's liability to zero (0) for the first day of coverage, other claims submitted for that day of spenddown coverage and claims for the time remaining in the month are paid up to the Medicaid rate.

(5) Participants shall have the option to pay their monthly spenddown requirement to the MO HealthNet Division, much like a premium payment, in order to have continuous Medicaid coverage. Participants may also arrange to make the monthly spenddown payment through electronic funds transfer (EFT) from a bank account.