Appendix E: Home and Community Based Services (HCBS) Spend-Down Notice Text

Eligible for HCBS in a Monthly NMP Spend-Down Category (PA/PJ/PM 21):

You qualify for Medical Assistance (MA) and payment of Home and Community Based Services (HCBS) in the _____ Waiver from ___ to ___.  You qualify for these benefits with a “monthly spend-down”.  This means you must incur $___in medical expenses each month to be eligible for the rest of the calendar month. See the Spend-down section for more details on what medical expenses were used. A MA benefit card (PA ACCESS card) will be sent to you unless you were given one before.

The service provider will notify you when your HCBS will begin.

55 Pa. Code §§ 141.71, 178.1, 181.1, 181.13

Eligible for HCBS in an Ongoing NMP Spend-Down Category (PA/PJ/PM 22):

You qualify for Medical Assistance (MA) and payment of Home and Community Based Services (HCBS) in the _____ Waiver. You qualify for these benefits because you have medical expenses that are used to “spend-down” your income. See the Spend-down section for more details on what medical expenses were used. A MA benefit card (PA ACCESS card) will be sent to you unless you were given one before.

The service provider will notify you when your HCBS will begin.

55 Pa. Code §§ 141.71, 178.1, 181.1, 181.13

Eligible for HCBS in a MNO Spend-Down Category (TA/TJ 22):

You qualify for Medical Assistance (MA) and payment of Home and Community Based Services (HCBS) in the _____ Waiver.  You qualify for these benefits because you have medical expenses that are used to “spend-down” your income. See the Spend-down section for more details on what medical expenses were used. A MA benefit card (PA ACCESS card) will be sent to you unless you were given one before.

The service provider will notify you when your HCBS will begin.

55 Pa. Code §§ 141.71, 178.1, 181.1, 181.14

Updated March 12, 2012, Replacing December 2, 2005