Doing Medicaid Spend Down?

[somarco]

https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11249-P.pdf

 

[Chazm]

Some fokes qualify for full Medi-cal. Others, because of income, qualify for "Share of cost". This is what they pay out of pocket each month before Medi-cal pays. I had a man in last week. His share of cost was going up to $400/month. By selling him an " insurance product", (dental plan $78/month), that let him retain full Medi-cal. We are legally "playing the game" to benefit the Medi-cal beneficiary.

Oh cool haven't heard of anyone doing that in FL yet. I typically just put them on a D-SNP.

 

[G.Gordon]

Oh cool haven't heard of anyone doing that in FL yet. I typically just put them on a D-SNP.

Why in the heck would you put someone with a spend down on a D-SNP? Are you serious?

 

[Fisher]

Some fokes qualify for full Medi-cal. Others, because of income, qualify for "Share of cost". This is what they pay out of pocket each month before Medi-cal pays. I had a man in last week. His share of cost was going up to $400/month. By selling him an " insurance product", (dental plan $78/month), that let him retain full Medi-cal. We are legally "playing the game" to benefit the Medi-cal beneficiary.

I do not understand this strategy at all. How does writing him an 'insurance product' do away with the spend-down? Is that a California thing or am I just not aware of something?

 

[DS4]

I do not understand this strategy at all. How does writing him an 'insurance product' do away with the spend-down? Is that a California thing or am I just not aware of something?

I only write med supps within 25 miles of my office in N. Calif. Not sure how this "spend down" is handled in the other 57 states.

 

[Fisher]

Ok, so when you write an 'insurance product within 25 miles of your office in northern Cali it somehow does away with the spend-down amount?

 

[Chazm]

Why in the heck would you put someone with a spend down on a D-SNP? Are you serious?

Not sure if I'm understanding the spend down correctly. I'm thinking its Share of Cost. If it is, then the better question is why wouldn't I put them on a DSNP? They go from having to meet a SOC to having zero copays and deductibles

 

[DS4]

Ok, so when you write an 'insurance product within 25 miles of your office in northern Cali it somehow does away with the spend-down amount?

Yes, the "insurance product" tips the scale. Monthly "share of cost" vanishes

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If it is, then the better question is why wouldn't I put them on a DSNP?

No SNP's in my area

 

[Chazm]

Yes, the "insurance product" tips the scale. Monthly "share of cost" vanishes ---------- No SNP's in my area

I wasn't saying you should of done a SNP. I was asked why would I put someone on a DSNP. I explained why.

 

[wehotex]

Yes, the "insurance product" tips the scale. Monthly "share of cost" vanishes

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No SNP's in my area

Yes!!! That makes a lot of sense. I had an Altadena, Calif mb call me recently who had to get a dental plan that costs at least $121 to get an in-home provider. This trick might be limited to Calif. I've never heard the term "share of cost" in Texas.