It will complete a renewal determination of the individual’s MA eligibility and send information about the case and the third-party coverage to: When the legal action is settled, if the third-party coverage is approved, the CAO must treat the approval as a change in the individual’s situation. The medical bills can be considered an unpaid expense, and a deduction can be given for those medical bills. NOTE: When legal action is being taken for third-party coverage (for example, a Workers Compensation claim has been filed) and the case is not likely to be settled within thirty days, the coverage cannot be considered available for payment of a individual’s medical bills. The expense is not paid by a third party. 361.51 Unpaid medical expensesĪ medical expense is an allowable deduction if the following requirements are met: If the net income of an applicant/recipient group is more than the income limit in Chapter 369, Appendix A, the CAO must allow deductions from net income for certain paid and unpaid medical expenses to reduce the amount of income that is over the limit. Reminder: When determining net income, the CAO must deduct expenses for medical and remedial care for members of an applicant/recipient group that are paid by a public program (other than MA) of a state, including programs run by political subdivisions of the state. For example, a paid medical expense or an expense from a provider who does not accept MA is to be coded as “N.” For example, most hospital bills are to be coded as “B,” especially when seeking retroactive coverage for these bills.Ĭode “P”: This code should be entered for a medical expense that will only be covered if NMP is authorized. For example, most prescription expenses for adults are to be coded as “P.”Ĭode “N”: This code should only be entered for a medical expense that is not covered by MA (NMP or MNO) if MA is authorized. The correct use of these codes is instrumental in the determination of spend-down and patient pay liability. The three codes and their descriptions are as follows:Ĭode “B”: This code should be entered for a medical expense that will be covered by NMP or MNO if MA is authorized. NOTE: There are three Medical Coverage (MCV) Codes to choose from on CAMEDX in CIS or Expenses/Medical in e-CIS. Allowable medical expenses must be in the retroactive period. 361.5 Medical Expense Deductions 361.5 Medical Expense DeductionsĬertain paid and unpaid medical expenses for members of an applicant/recipient group may be deducted from income when determining eligibility for MNO (see Appendix B).
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