Table Description
SpendDown: The amount of health care costs a household member must incur (the SpendDown amount) for a defined period in order to qualify for a Medical Assistance program with SpendDown.

SpendDown is a Medical Assistance term used for persons whose income and assets are above the threshold for the state's designated medically needy criteria, but are below this threshold when medical expenses are factored in. An individual can meet the SpendDown amount by submitting allowed medical expenses or pay-ins to reduce/meet the SpendDown amount.

A SpendDown period is the defined length of time for which the client can obtain coverage for Medical Assistance with SpendDown, provided that they meet the SpendDown amount calculated for the budget period. The Budget Period is the time-frame over which the medically needy clients income is calculated. The state determines the amount by which the clients total net countable income exceeds the program eligibility standard for that period. The excess amount is the amount which the client must 'SpendDown' to become eligible for Medical Assistance. This excess amount is known as the SpendDown amount. States may set budget periods of any length from one month up to six months, the length of the Budget period is defined as environment variable within the system, and is defaulted to one month.
Relationship Diagram
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Model Details
Location in Model: Logical View::MetaModel::Curam::Income Support Product::Service Layer::entity::SpendDown::ISPSpendDown::ISPSpendDown
Controlling File: ISProduct\model\Service Layer\entity\SpendDown\ISPSpendDown\ISPSpendDown_cat.efx
Attributes (14)
AttributeStereotypeNullableDescriptionDomain DefinitionCodetableDDL Type
spendDownIDkeynoSystem generated unique identifier for the SpendDown record.ISP_SPENDDOWN_ID SVR_INT64
caseIDdetailsnoUnique identifier for the product delivery case to which the SpendDown details/period applies.CASE_ID SVR_INT64
amountdetails The SpendDown amount calculated by the system for this periodCURAM_AMOUNT SVR_MONEY
startDatedetails The start date for the SpendDown period.CURAM_DATE SVR_DATE
endDatedetails The end date for the SpendDown period.CURAM_DATE SVR_DATE
dateOfApplicationdetails The date on which the client applied for SpendDown coverage for a SpendDown period.CURAM_DATE SVR_DATE
coverageStartDatedetails The date from which coverage for the SpendDown period starts. Coverage for the program is from this date to the end of the period.CURAM_DATE SVR_DATE
outstandingAmountdetails The Amount the client still needs to met in order to get coverage under the SpendDown program.CURAM_AMOUNT SVR_MONEY
metInddetails Indicates if client has met the SpendDown amount for the period.CURAM_INDICATOR SVR_BOOLEAN
statusCodedetails Historical status of the SpendDown period. This indicates whether the SpendDown record has been superseded or whether it is current.ISP_STATUS_CODEISPStatusCodeSVR_STRING<10>
spenddownStatusCodedetails Status of SpendDown period in terms of whether SpendDown has been applied or not.ISP_SPENDDOWN_STATUS_CODEISPSdStatusCodeSVR_STRING<10>
reasonCodedetails The reason that SpendDown was not met for a particular period.ISP_SPENDDOWN_REASON_CODEISPSdReasonCodeSVR_STRING<10>
retroInddetails Indicates if the SpendDown period was applied for retroactively.CURAM_INDICATOR SVR_BOOLEAN
lastUpdatedDateTimedetails The date and time that the record was last updated.CURAM_DATETIME SVR_DATETIME
Foreign Keys (3)
ChildParent
ISPSpendDown.caseIDCaseHeader.caseID
ISPSpendDownMedicalExpenseLink.spendDownIDISPSpendDown.spendDownID
ISPSpendDownPayInLink.spendDownIDISPSpendDown.spendDownID
Indices (1)
Index NameAttributes
IND__108541232caseID
Operations (37)
OperationStereotypeOptionsDescriptionSQL
insertinsertAUTO_ID: spendDownID
Standard Operation 
readread Standard Operation 
modifymodify Standard Operation 
removeremove Standard Operation 
searchSDPeriodsByCaseAndStatusnsmulti Method to search spend down periods by caseID and status.SQL
modifyStatusCodensmodify Modify the status code of the spend down record... "current", "superseded" etc.  
listAllSpendDownPeriodsnsmulti Reads a list of spendDown details.SQL
searchExistingProgramByICStatusIDAndTypensmultiPRE_DATA_ACCESS: yes
 		Searches for programs with one of these statuses: open, approved, rejected, active, superseded.SQL
searchClosedProgramsByICIDAndTypensmultiPRE_DATA_ACCESS: yes
 		Searches existing programs of type "closed" on the Integrated Case. Returns a list of caseIDs. SQL
countCurrentPeriodsByDateAndICnsPRE_DATA_ACCESS: yes
 		 SQL
readCaseStatusAndLastSpendDownMetIndns Reads case status and Met indicator of the last spend down period for the case.SQL
readDateOfApplicationnsread Reads the date of application for a spendDown record. 
readMostRecentPeriodDetailsns Returns details from the most recent SpendDown period for the SpendDown product delivery.SQL
searchByDateRangeAndCaseIDnsmulti Returns a list of spendDown records from a certain period.SQL
readDatesAndCaseIDnsread Reads the start date, end date, and case ID for a specific spendDown record. 
modifyStatusReasonAndMetIndnsmodify Method that modifies the spendDown metInd, reasonCode, and spenddownStatusCode. 
readCurrentPeriodStartDatens Method to read the current spendDown period's start date based on the caseID the current date.SQL
countByStartDateAndCaseIDns Method to count the number of records that have the same start date as the start date entered.SQL
modifyAppliedDetailsnsmodify Method to modify the details of an applied SpendDown record. 
searchByCaseIDStatusCodeOutstandingAmountAndSDStatusCodensmulti Reads all spendDownIDs for a case where spendDown is applied, current, and outstanding amount is reduced to zero.SQL
readOutstandingAmountnsread Reads the outstandingAmount for a SpendDown record. 
modifyOutstandingAmountnsmodify Method to modify the outstanding amount on a SpendDown record. 
searchMostRecentSupersededSpendDownns This method searches for the most recently superseded SpendDown record between a specified start and end date.SQL
searchByCaseIDMetIndAndRetroIndnsmulti Reads date of application and start date of the most recent spend down period after the given date that matches caseID, metInd and retroInd.SQL
searchByCaseIDAndRetroIndnsmulti Reads date of application, start date and metInd of the most recent spend down period after the given date that matches caseID and retroInd.SQL
readClosedProgramLatestEndDatens Searches existing programs of type "closed" on the Integrated Case, except those of type "Cost Sharing". Returns the latest end date. SQL
modifyEndDatensmodify Modifies the end date of a spendDown record. 
searchByCaseIDStatusCodeAndEndDatensmulti List all spendDown periods that are current, and have a endDate later than the endDate entered.SQL
readSDAmtByCaseIDStatusAndMaxLastUpdatedDateTimens Method to read the amount and the last updated date time by case id, status and max last updated date time.SQL
modifyLastUpdatedDateTimensmodify Modify the last updated date time. 
readCaseIDnsread Reads spend down case id. 
readEndDatensread Reads spend down end date. 
countRetroactivePeriodsns This operation counts the number of retroactive periods that exist for a case over a retroactive period.SQL
countCurrentPeriodsByDateParticipantAndICnsPRE_DATA_ACCESS: yes
 		Counts SpendDown periods that exist for the specified period of time for the given person on the integrated case.SQL
SearchByCaseIDMetIndDateRangeAndSDStatusCodensmulti This method returns a list of spend down records within a specified date range based on the case id, met indicator and the spend down status code. The returned list is order based on the start dates of the records.SQL
listCurrentSpendDownPeriodsnsmulti Returns a list of all current SpendDown periods for a case.SQL
searchForSpendDownPeriodOnDatens Method to check if a customer is in receipt of a SpendDown on a given date. If they are the spendDownID, status code and an indicator showing if the SpendDown period is met are returned.SQL
Related Pages (58)
Add Member (CHIPProduct_addAssistanceGroupMember)
Confirm Benefit Group Member (CHIPProduct_confirmAddBenefitGroupMember)
Remove Member (CHIPProduct_removeAssistanceGroupMember)
Remove Member (CHIPProduct_removeBenefitGroupMember)
Assign Expenses (ISP_applyFromExistingMedicalExpense)
Assign Pay In (ISP_applyFromExistingPayInTowardsSpendDown)
Assign Existing Spend Down Evidence Errors (ISP_applyFromExistingSpendDownEvidenceError)
Assign Existing Spend Down Evidence Warning (ISP_applyFromExistingSpendDownEvidenceMedExpWarning)
Assign Existing Spend Down Evidence Warning (ISP_applyFromExistingSpendDownEvidencePayInWarning)
Assign New Expense (ISP_applyFromNewMedicalExpense)
Apply To Period (ISP_ApplyToPeriod)
Approve Spend Down Period Errors (ISP_applyTowardsSpendDownError)
Check Retroactive Spend Down Eligibility (ISP_checkSpendDownRetroactiveEligibility)
Assign New Pay In (ISP_createPayInEvidenceFromApplyNewPayInFromSD)
Retroactive Program Summary (ISP_createRetroactiveProgram)
ISP_listAssignedExpenses
ISP_listAssignedPayIns
Spend Down Periods (ISP_listCurrentSpendDown)
Unassign Expenses (ISP_listExpensesForUnassign)
Retroactive Periods (ISP_listProductDeliveryRetroactivePeriods)
ISP_listReadOnlyAssignedExpenses
ISP_listReadOnlyAssignedPayIns
Retroactive Spend Down Periods (ISP_listRetroactiveSpendDownPeriods)
Spend Down Details (ISP_listSpendDown)
ISP_listSupersededSpendDown
Edit Assigned Expense (ISP_modifyAppliedExpense)
Edit Assigned Pay In (ISP_modifyAppliedPayIn)
Modify Applied Spend Down Evidence Errors (ISP_modifyAppliedSpendDownEvidenceError)
Unassign Expense (ISP_noAssignedMedicalExpense)
Deny Spend Down Period (ISP_reasonSpendDownNotMet)
Unassign Expense (ISP_undoAppliedMedicalExpense)
Unassign Pay In (ISP_undoAppliedPayIn)
Undo Applied Spend Down Evidence Errors (ISP_undoAppliedSpendDownEvidenceError)
Undo Apply To Period (ISP_undoApplyToPeriod)
Confirm Undo Apply To Spend Down Period (ISP_undoApplyToPeriodConfirmation)
Unassign All (ISP_undoApplyTowardsSpendDown)
Unassign All Errors (ISP_undoApplyTowardsSpendDownError)
Unassign Spend Down Period Errors (ISP_validateUndoApplySpendDownMet)
Assign Expenses (ISP_viewAppliedMedicalExpensesForSpendDown)
Retroactive Medical Assistance Eligibility Result (ISP_viewCurrentRetroactiveMedicalAssistanceEligibilityResults)
Retroactive Spend Down Eligibility Result (ISP_viewCurrentRetroactiveSpendDownEligibilityResults)
Medical Assistance with Spend Down Eligibility Result (ISP_viewMedicalAssistanceWithSDEligibilityDetails)
Spend Down Details (ISP_viewReadOnlySpendDownDetails)
ISP_viewReadOnlySpendDownDetails1
Medical Assistance with Spend Down Retroactive Eligibility Result (ISP_viewRetroactiveMedicalAssistanceWithSDEligibilityDetails)
Spend Down Details (ISP_viewSpendDownDetails)
ISP_viewSpendDownDetails1
Close Case (ISPSpendDown_closeProgram)
Medical Assistance with Spend Down Program Summary (ISPSpendDown_createProgram)
Create Program (ISPSpendDown_createRetroactiveProgram)
Home (ISPSpendDown_productHome)
Reuse Program (ISPSpendDown_reuseProgram)
Reuse Program (ISPSpendDown_reuseRetroactiveProgram)
Select Application Date (ISPSpendDown_selectApplicationDate)
Authorize (ProgramRecommendation_confirmAuthorize)
Authorize (ProgramRecommendation_listHouseholdMembersForMA)
SpendDownPreviewPanel
SpendDownProductHomeDetails