17-1730.1

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HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1730.1
MEDICALLY NEEDY SPENDDOWN
Subchapter 1 	General Provisions
§17-1730.1-1 	Purpose
§17-1730.1-2 	General requirements
§§17-1730.1-3 to 17-1730.1-7 	(Reserved)
Subchapter 2 	Eligibility Requirements
§17-1730.1-8 	Purpose
§17-1730.1-9 	Basic requirements
§17-1730.1-10 	Categorical requirements
§17-1730.1-11 	Income requirements
§17-1730.1-12 	Asset Requirements
§17-1730.1-13 	Spenddown calculation for continued
eligibility
§§17-1730.1-14 to 17-1730.1-18 	(Reserved)
Subchapter 3 	Freedom of Choice, Enrollment,
Benefits, and Disenrollment
§17-1730.1-19 	Purpose
§17-1730.1-20 	Freedom of choice
§17-1730.1-21 	Enrollment
§17-1730.1-22 	Benefits
§17-1730.1-23 	Disenrollment from a health plan
§§17-1730.1-24 to 17-1730.1-28 	(Reserved)
Historical Note: 	This chapter is based substantially
upon repealed chapter 17-1730. 	[Eff 12/27/97;

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am 07/06/99; am 06/19/00; am 12/03/01; am 05/10/03; am
01/31/09; am 06/11/09; am 09/10/09; R 09/30/13]
SUBCHAPTER 1
GENERAL PROVISIONS
§17-1730.1-1 	Purpose. 	This chapter describes the
spenddown of excess income for children under age
nineteen years, pregnant women, and aged, blind or
disabled (ABD) individuals with incurred medical
expenses to qualify for medical assistance who are
ineligible to participate in a coverage group
established under the provisions of the Affordable Care
Act of 2010, or the mandatory or optional categorically
needy coverage group under Title XIX of the Social
Security Act. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42
C.F.R. §§435.2, 435.301, 435.310, 435.320, 435.322,
435.324) (Imp: 	HRS §346-14; 42 C.F.R. §§435.2,
435.301, 435.310, 435.320, 435.322, 435.324)
§17-1730.1-2 	General requirements. 	The
confidentiality, administrative appeal, fraud, medical
assistance recovery, application, eligibility review,
and adverse action provisions described in subtitle 12
shall pertain to an individual who applies or is
eligible under this chapter. 	[Eff 	09/30/13] 	(Auth:
HRS §§346-14, 346-29, 346-44; 42 C.F.R. §§431.200,
431.206, 431.221, 431.230, 431.300, 435.116, 435.201,
435.907, 435.916, 455.1) (Imp: 	HRS §§346-14, 346-29,
346-44; 42 C.F.R. §§431.200, 431.206, 431.221, 431.230,
431.300, 435.116, 435.201, 435.907, 435.916, 455.1)
§§17-1730.1-3 to 17-1730.1-7 	(Reserved).
SUBCHAPTER 2
ELIGIBILITY REQUIREMENTS
§17-1730.1-8 	Purpose. 	This subchapter describes
the requirements for participation under this chapter.

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[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R. §§435.2
435.301, 435.811) (Imp: 	HRS §346-14; 42 C.F.R. §§435.2
435.301, 435.811)
§17-1730.1-9 	Basic requirements. 	An individual
shall meet the basic eligibility requirements which
include but are not limited to, citizenship, state
residency, verification of identity, not residing in a
public institution, and the provision of a social
security number, as described in chapter 17-1714.1.
[Eff 	09/30/13] 	(Auth: 	HRS §§346-14, 346-29; 42
C.F.R. §§435.110, 435.400, 435.910) (Imp: 	HRS §§346-
14, 346-29; 42 C.F.R. §§435.110, 435.400, 435.910)
§17-1730.1-10 	Categorical requirements. 	An
individual eligible to participate under this chapter
would otherwise be eligible under chapters 17-1715, 17-
1716 or 17-1719 except for having income in excess of
the applicable income standard but is insufficient to
meet incurred medical expenses which are likely to be
required on a continuing basis. 	[Eff 	09/30/13]
(Auth: 	HRS §346-14; 42 C.F.R. §§430.25, 435.301,
435.310, 435.320, 435.322, 435.324) (Imp: 	HRS §346-14;
42 C.F.R. §§430.25, 435.301, 435.310, 435.320, 435.322,
435.324)
§17-1730.1-11 	Income requirements. 	(a) 	The
maximum allowable countable income, prior to spenddown,
determined under the provisions of chapter 17-1724.1
for eligibility under this chapter is:
(1) 	Three hundred percent of the Federal Poverty
Level for a child, or pregnant woman; or
(2) 	For an aged, blind, or disabled individual,
no maximum shall be considered. 	Unlimited
for an aged, blind, or disabled individual.
(b) 	The amount of the individual’s monthly
countable income that exceeds the medically needy
income standard of a household of applicable size shall
be the excess income amount.
(c) 	The medically needy income standard as
determined by the department in compliance with federal
regulations related to the financial assistance
program, shall serve as the maximum retainable income
for an individual or household of applicable size.

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[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R. §§435.2
435.602, 435.811, 435.814, 435.831; 45 C.F.R. 233.20)
(Imp: 	HRS §346-14; 42 C.F.R. §§435.2 435.602, 435.811,
435.814, 435.831; 45 C.F.R. 233.20)
§17-1730.1-12 	Asset requirements. 	The countable
assets of an individual shall follow the personal
reserve requirements described in chapter 17-1719 and
the provisions under chapter 17-1725.1 for a household
of applicable size. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-
14; 42 C.F.R. §§430.25, 435.602, 435.840, 435.843,
435.845) (Imp: 	HRS §346-14; 42 C.F.R. §§435.2,
435.602, 435.840, 435.843, 435.845)
§17-1730.1-13 	Spenddown calculation for
continued eligibility. 	(a) 	An individual’s excess
income is the countable income which exceeds the
medically needy income standard for the household of
applicable size.
(b) 	Medical expenses incurred by an individual
or financially responsible relative not subject to
payment by a third party shall be deducted from the
excess income in the following order:
(1) 	Expenses for Medicare and other health
insurance premiums, deductibles or
co-insurance charges including enrollment
fees and co-payments. 	Payments made
quarterly or for longer intervals shall be
pro-rated on a monthly basis.
(2) 	Necessary medical and remedial services
recognized under State law but not included
in the department’s medical assistance plan
to include expenses prior to the month of
application not previously considered that
remain a liability.
(3) 	Necessary medical and remedial services that
exceed the department’s medical assistance
plan in regards to amount, duration or scope
of services to include expenses prior to the
month of application not previously
considered that remain a liability.
(c) 	An employer’s contribution to a health plan
and any premium voluntarily paid in whole or in part

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by someone other than the individual shall not be
deducted from excess income.
(d) 	Evidence of medical services received shall
be required to determine eligibility for a given
month.
(e) 	The number of unborn child(ren) shall be
included in the household for a pregnant woman only.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§435.2, 435.831) (Imp: 	HRS §346-14; 42 C.F.R.
§§435.2, 435.831)
§§17-1730.1-14 to 17-1730.1-18 	(Reserved).
SUBCHAPTER 3
FREEDOM OF CHOICE, ENROLLMENT, BENEFITS, AND
DISENROLLMENT
§17-1730.1-19 	Purpose. 	This subchapter addresses
and refers to the provisions of freedom of choice,
enrollment, benefits, and disenrollment for an
individual who is eligible in accordance with this
chapter. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42
C.F.R. §435.2) (Imp: 	HRS §346-14; 42 C.F.R. §430.25)
§17-1730.1-20 	Freedom of choice. 	(a) 	An
eligible child or pregnant woman, described in section
17-1730.1-11(a)(1), and an aged, blind and disabled
individual described in chapter 17-1719 with the
exception of those described in section 17-1735.1-2(a)
shall be provided a choice of a health plan and a
provider as described in chapter 17-1720.1.
(b) 	An eligible aged, blind or disabled
individual described in section 17-1735.1-2(a) shall
choose a department approved provider described in
section 17-1736-3.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§435.2, 431.51, 438.52, 447.51) (Imp: 	HRS §346-14; 42
C.F.R. §§435.2, 431.51, 438.52, 447.51)

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§17-1730.1-21 	Enrollment. 	(a) 	The effective
date of coverage or enrollment is the date on which the
spenddown amount was met.
(b) 	An individual eligible in accordance with
this chapter, with the exception of an individual
identified in section 17-1735.1-2(a), shall be enrolled
in a health plan as described in chapter 17-1720.1.
(c) 	An eligible individual described in section
17-1735.1-2(a) shall not be enrolled into a health plan
and services shall be provided on a fee-for-service
basis. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§435.2, 431.10, 438.50) (Imp: 	HRS §346-14; 42 C.F.R.
§435.2, 431.10, 438.50)
§17-1730.1-22 	Benefits. 	(a) 	An individual
eligible in accordance with this chapter, with the
exception of those described in section 17-1735.1-2(a),
shall be provided a standard benefits package by a
participating health plan and other services when
appropriate as described in chapter 17-1720.1.
(b) 	An eligible individual described in section
17-1735.1-2(a) shall be provided benefits under the
fee-for-service provisions described in chapter 17-
1737, with the exception of services identified in
section 17-1735.1-3(b). 	[Eff 	09/30/13] 	(Auth: 	HRS
§346-14; 42 C.F.R. §§435.2, 431.10, 438.6, 440.1) (Imp:
HRS §346-14; 42 C.F.R. §§435.25, 431.10, 438.6, 440.1)
§17-1730.1-23 	Disenrollment from a health plan.
An enrollee shall be disenrolled from a health plan
under the provisions as described in chapter 17-1720.1.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R. §§435.2
431.40, 438.56) (Imp: 	HRS §346-14; 42 C.F.R. §§435.2
431.40, 438.56)
§§17-1730.1-24 to 17-1730.1-28 	(Reserved).