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Questions? | Policy Manual | Training Information

Clients requesting services through a disability waiver (CADI, CAC, DD and BI) and certain non-SIS-EW clients have a medical spenddown. A medical spenddown is the income in excess of the income standard upon completion of the community income calculation. As with basic MA, an MA-LTC client with a medical spenddown must meet the spenddown amount with health care expenses, which includes the cost of services received through a waiver program.

An LTC spenddown is the amount of income remaining upon completion of an LTC income calculation.

• Clients residing in a long-term care facility (LTCF) are obligated to pay their LTC spenddown to the facility.

• Certain non-SIS-EW clients are obligated to pay their LTC spenddown to a variety of providers using potluck processing ("first bills submitted -- first bills rejected," up to the LTC spenddown amount).

A waiver obligation is the amount of income remaining upon completion of an LTC income calculation for an SIS-EW client. SIS-EW clients are obligated to pay their waiver obligation to their home and community-based services providers.