State Readies for Third Round of Standard Spend Down

Wednesday, August 31, 2011 | 12:44pm

PHONE LINES WILL OPEN 6 P.M. CST SEPT. 12

NASHVILLE – The TennCare Standard Spend Down program will again offer open enrollment opportunities to new applicants on Monday, Sept. 12, 2011 beginning at 6 p.m. CST.

Standard Spend Down is available through a waiver to the Medicaid program for a limited number of qualified low income individuals, or those with high, unpaid medical bills who are aged, blind, disabled, or the caretaker relative of a Medicaid eligible child. Eligible individuals must have enough unpaid medical bills to meet the “spend down” threshold to qualify for coverage.

“We are pleased to again work in this collaborative effort with several entities including TennCare, the Tennessee Department of Human Services (DHS), the Tennessee Hospital Association, advocacy groups and the federal government in offering Standard Spend Down,” said DHS Commissioner Raquel Hatter. “This program offers additional assistance to qualified low-income individuals or those with very high medical bills who are not already on TennCare.”

A special call-in phone line through DHS has been set up for interested applicants. The only way to request an application is by calling the toll-free number -- 1-866-358-3230 -- which will be open between 6:00 p.m. and 8:30 p.m. CST on Sept.12. The phone lines will be open from 6:00 p.m. to 8:30 p.m. on subsequent weekdays until 2,500 interested applicants call in.

Prospective applicants are encouraged to check eligibility qualifications before calling in. More information on the Standard Spend Down program and more detailed eligibility criteria are available here.

The toll-free number system is used to ensure equal access to Tennessee citizens interested in this program. After the first 2,500 calls are taken, the phone lines will be closed. The Tennessee Department of Human Services will send applications to all callers who are not already on TennCare and will review their eligibility for any open Medicaid categories and the newly opened Standard Spend Down category. Advanced notifications will be made to the public and other stakeholders prior to subsequent openings of the application request line.

Legislation called for the "expansion of the Standard Spend Down category for TennCare enrollment up to a maximum of seven thousand (7,000) individuals in FY 2010-2011.” The program will continue to open and close on a rolling basis.

The Standard Spend Down category first opened to applicants on Oct. 4, 2010. It was opened a second time on Feb. 22, 2011. The 2,500 call limit was reached in approximately one hour during both enrollment periods.

Standard Spend Down Eligibility:

  • In addition to being aged (65 or older), blind*, disabled,* or a caretaker relative,
  • An individual must meet certain income restrictions, or be able to “spend down” qualifying unpaid medical bills to that limit. (*To be considered blind or disabled, an individual must meet standards set by the Social Security Administration.)

The following chart shows the income limits:

Household Size

1

2

3

4

5

6

Monthly Income

$241

$258

$317

$325

$392

$408

Applicants also must not have resources that:

  • Exceed $2,000 for a family of one and $3,000 for a family of two with an additional $100 added per additional individual in the family.
  • A person’s unpaid medical bill must have been accrued within the past 90 days. Medical bills paid by the applicant within the past 30 days may count towards meeting an applicant’s spend down requirement.

Pregnant women and children still are eligible for the Medically Needy Spend Down program which has never closed and does not have an enrollment cap.

The ONLY way to request an application for the TennCare Standard Spend Down Program is through the toll free number (1-866-358-3230). Those wishing to apply for other TennCare categories should contact their local Department of Human Services county office, call the Family Assistance Service Center at 1-866-311-4287 during normal business hours.

More information on the Standard Spend Down program and more detailed eligibility criteria are available here.