AABD Medicaid Spenddown Legal Referral Pathway Now Open
Avisery and Legal Aid Chicago are excited to announce that they are partnering together to open a legal referral pathway for AABD Spenddown cases in Cook County. This initiative is in response to increased trends in processing issues with AABD Medicaid Spenddown cases. After piloting this program in Cook County, we hope to expand to other areas of the state at a future date.
Background
The AABD Spenddown program offers an opportunity for individuals with countable income and assets over the Medicaid limits to access Medicaid coverage on a month-to-month basis, provided they either make monthly payments or regularly submit proof of medical expenses. Continuous Medicaid Eligibility provisions that were put in place during the Covid-19 Public Health Emergency (PHE) paused this complex approval process. Since the re-initiation of standard Spenddown procedures in April of 2023, however, many professionals in the field report difficulty getting information about denied Spenddown cases and/or resolving these cases directly with IDHS. In response, Avisery and Legal Aid Chicago are launching an AABD Spenddown legal referral pathway to address denials of apparently eligible Spenddown cases in Cook County.
How to Submit a Referral
We are currently accepting legal referrals for AABD Spenddown cases in Cook County with the following types of issues:
Waiver services not applied to AABD Spenddown
Example: A client enrolled in HCBS waiver services can use the cost of those services to meet a Spenddown. Avisery has seen that these expenses are not always consistently applied towards an individuals’ spenddown case, particularly with older adults utilizing CCP services.
AABD spenddown application not processed within 60 days of application
Example: an ABE application and medical expenses were submitted, and a decision has not been made within 60 days
Submitted medical expenses not applied to AABD spenddown case when processed.
Example: A hospital bill was submitted but not counted towards the decision
To submit a referral, please contact avisery@ageoptions.org with the email title “AABD Spenddown Legal Referral.” Avisery will screen the information, assess its appropriateness for legal referral, then either attempt to resolve the matter internally or facilitate a referral to Legal Aid Chicago. Legal Aid Chicago will then call the beneficiary. Note: Referring professionals should prepare their clients to accept direct communication from Legal Aid Chicago.
If you have any questions or need help counseling older adults and adults with disabilities on Medicare, Medicaid, or other health benefits programs, reach out to Avisery's "Ask the Expert" service for professionals at avisery@ageoptions.org
Avisery by AgeOptions provides tools and support to professionals serving older adults and people with disabilities, enabling them to help their clients access healthcare coverage that allows them to thrive as they age.
AgeOptions, 1048 Lake Street, Suite 300, Oak Park,IL,60301,United States,(800) 699-9043
