Spend Down Medical Expense Evidence

In the Cúram Spend Down eligibility process, business rules are applied to the medical evidence captured on an individual or household to determine if the medical expense can be used towards the Spend Down amount. The system will automatically validate, classify and define the sort order of the expenses available for use for a period. Not all medical expenses can be used towards Spend Down.

To enable the system to perform these functions, the case worker must enter the following additional information on the Spend Down Medical Expense:

• Who received the service to which the Medical Expense relates and indicate if the service recipient lives at home with the person responsible for payment of the expense
• Indicate if the service is medically necessary
• Indicate if the service is for a service covered under Medicaid
• Indicate if there is any third party liability related to the expense
• Indicate if service recipient has HMO
• Indicate if the service is of a type which is state covered

Classification of the expense can be entered by the caseworker at time of entry. If this field is populated, the system will not attempt to classify the expense. If the field is left blank, the system will automatically classify the expense. This can be subsequently overwritten by the caseworker.