Medicaid in Georgia- the adult medically needy program [Jan. 2001]

DIVISION OF FAMILY AND CHILDREN SERVICES ABD :MEDICAID UNIT 2 PEACHTREE STREET
ATLANTA, GEORGIA 30303

:MEDICAID IN GEORGIA- THE ADULT :MEDICALLY NEEDY PROGRAM

Georgia offers a Medicaid program called Adult Medically Needy (AMN), also known as spend down. Congress designed this program as a safety net, so to speak, for those people with medical bills who fall between the cracks of the other Medicaid programs. AMN is a limited program, both in time and in benefits. Medicaid eligibility under AMN is determined by the county Department of Family and Children Services (DFCS) in the county where a person lives.

AMN is for people who have too much income to qualify for regular ongoing Medicaid, but who have medical bills for which they need help paying.. In this situation, the caseworker for the county Department of Family and Children Services (DFCS) can deduct unpaid medical bills from an individual's income until the bills reduce the income to the qualifying limit. The individual is responsible for paying all bills used to reduce his/her income to that limit, and Medicaid will pay for any bills incurred after that point through the end of the month. This is known as a "spend down." It works on much the same principal as a deductible for health insurance. With insurance, the individual is responsible for paying all the bills up to the amount of the deductible, and then the insurance pays any bills in excess of the deductible. Spend down in AMN works much the same way.

Eligibility for Medicaid under the AMN program is for one month at a time. That means that the individual will have to meet the spend down every month. For every month in which the individual has enough bills to meet the spend down, Medicaid will pay for any bills from the point the spend down is met through the end of the month. At the beginning of the next month, the spend down must be met again. It may be that an individual has enough medical bills to meet a spend down for two or more months; in that case, we can approve Medicaid for however many months for which the spend down has been met.

To be eligible, the individual must have enough bills to reduce his/her income to the qualifying limit, known as the Medically Needy Income Limit (MNIL). The MNIL is $317 a month. As an example, he~e is how the budget works for an individual who has $700 a month income.

mmus mmus equals

$ 700

Gross monthly income

- 20 General Deduction

- 317 MNIL

$ 363

Spend down amount per month

In this example, the individual must have $363 a month in medical bills to be eligible for Medicaid. Once he/she is eligible, Medicaid will pay for any bills incurred after that date until the end of the month. So, for example, if the person went into the hospital on July 10 and had no medicalbills before going into the hospital. The hospital bill is for $10;000 bill. This person would be responsible for the first $363 of the hospital bill, Medicaid would pay the rest of the hospital bill, and then he

would have Medicaid coverage for any other bills through the last day of July. Then in August, the individual must have another $363 in medical bills to be eligible in August.
When DFCS takes an AMN Medicaid application, that application is good for six months. Medicaid can be approved for any or all of the six months for which the individual meets the spend down. At the end of six months, a new application has to be filed, and the whole process starts all over again. The budget process, furthermore, is just one step in the entire eligibility process. The individual must also meet all the other eligibility criteria for the Medicaid program, such as being over 65 years old or being totally and permanently disabled.
To determine spend down, we can deduct any bill related to the health care of the applicant, including health insurance premiums, prescriptions and supplies. The bills must either be unpaid, or must have been paid in the month which we are considering. We must verify with the provider that the bill is still owed, and we can only deduct the amount of the bill that is not covered by Medicare or other insurance.
As you can see, AMN is a complicated and a limited program. The caseworker in the county DFCS office will explain the program in greater detail, and work a budget to determine the exact spend down amount for each applicant.