Implementation Guides

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CS16 – Spenddown(s)
Statute: 2102(b)(1)(A) of the SSA
Regulation: 42 CFR 457.320(a)(5)

INTRODUCTION

This state plan page (fillable PDF) applies only to states with separate child health assistance
programs.
In this state plan page, states indicate whether they apply spenddown and, if so, provide
information as to their application of spenddown. This state plan is required only of states which
apply spenddowns. States which do not apply spenddowns need not submit this state plan page.

BACKGROUND

States have the option of applying spenddown with respect to determining financial eligibility for
CHIP.

TECHNICAL GUIDANCE
PREREQUISITES:
State plan pages for any covered group to which the spenddown applies (CS7, CS8, CS9, CS10,
CS11 or CS12) must have been provided prior to or concurrently with state plan page CS16.
State plan page CS15 - MAGI-Based Income Methodologies must also have been submitted
prior to or concurrently with state plan page CS16.
Review Criteria
If state plan pages for the covered group or groups to which spenddown is applied and CS15
(MAGI-Based Income Methodologies) are not approved, state plan page CS16 cannot be
approved.
This state plan page includes a Yes/No question for the state to indicate if it applies a spenddown
process for any of the covered population groups whose household income exceeds the CHIP
qualifying income limit.
Note: Only states which apply spenddowns need to respond to this question.
If the answer is yes, the state enters a description of the types of spenddowns used in CHIP and
how they are applied.
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CS16 – Spenddown(s)
Review Criteria
The state must enter a description or this state plan page cannot be approved. The description
should be sufficiently clear, detailed and complete to permit the reviewer to understand what
expenses are allowed as spenddowns and how the state treats them in the income calculation
for determining eligibility. The description should include, at a minimum, the population(s) to
whom spenddown is applied; types of medical expenses used; the budget period; the
calculation used to determine the spenddown amount; and the FPL level, if applied to
individuals below a specified income level.

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