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Mo. Medicaid “Spend Down” Under Investigation

Natalia Allen, KMOX Capitol Bureau
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JEFFERSON CITY , Mo. (KMOX)- A senate committee continued its investigation of possible fraud within Medicaid ‘spend down’ eligibility requirements. The Senate Government Accountability Committee heard testimony from directors of the Family Support Division and Department of Social Services about issues with Medicaid ‘spend down’ documentation.

‘Spend down’ is a mechanism used to determine individuals eligibility for Medicaid.  Individuals with low-income, a disability, or are 65 and older are eligible for Medicaid.  However, individuals whose income is greater than the eligibility criteria can spend down their income to become Medicaid eligible and receive benefits.  The spend down amount is the difference between the individuals income and the amount of medical bill expenses.

The investigation began because Department of Social Services employees failed to obtain proper documentation of medical bill payments.

“It is in the incurred cost method where our staff were not applying our policies correctly,” said Director of the Family Support Division, Alyson Campbell. “They were, in some cases, accepting documentation that did not indicate the individuals personal responsibility for whatever portion of the bill.”

Sen. Rob Schaaf, R-St. Joseph – the only physician in the Missouri Senate – was added to the Senate Government Accountability for this investigation.  Individuals may qualify for  Medicaid ‘spend down’ and may not need these funds if he or she has other methods of payment such as private insurance or Medicare said Schaaf.

An individual is required to use and report all methods of payment made towards medical bills prior to receiving the spend down money to cover medical bill costs said Acting Direct of Social Services, Brian Kincaid

“Medicaid is always the payer of last resort.  Any other [payment] form is superior to Medicaid,” said Kincaid.

“Some of the problem is that they [patients] incur the [medical] bill but nobody expects them to pay it,” Schaaf said.  Another problem is determining who is responsible for medical bill payments Schaaf said.

The investigation is ongoing.

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