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MEDICAL SERVICES POLICY MANUAL,SECTION M M-100 Overpayments

M 150 Other Ineligibility

EXAMPLE: Excess Resources – An individual was ineligible for 5 months due to resources. The individual had resources of $2,100, $2,200, $2,300, $2,400, and $2,500 for months 1 through 5, respectively, for the period. Determine the highest level of excess resources for an ineligible month as follows: 1. Select appropriate resource level. $2,000 (1 person) 2. Calculate excess resources for each ineligible month. $2,100 - 2,000 = $100 $2,200 - 2,000 = $200 $2,300 - 2,000 = $300 $2,400 - 2,000 = $400 $2,500 - 2,000 = $500 3. Select highest level of excess. +$500 (month 5) The amount of overpayment claimed for repayment will be limited to the lesser of the highest level of excess ($500) or the amount of medical payments (includes LTC vendor payments, if applicable) made on behalf of the individual in the period of ineligibility.

M-150 Other Ineligibility MS Manual 01/01/14 When the individual is ineligible due to other criteria (e.g., categorical relatedness, citizenship, residency, medical necessity, etc.), the amount of overpayment claimed for repayment will be the amount of medical payments (includes LTC vendor payment) made on behalf of the individual in the month of ineligibility. Refer to MS M-160. M-160 Overpayment Evaluation - Ineligible Individuals (Non - LTC) MS Manual 01/01/14 All paymentsmade on behalf of individuals who are ineligible to be included in a financial eligibility determination for Medicaid will be considered overpayments.

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Page 380

Official source

MEDICAL SERVICES POLICY MANUAL,SECTION M M-100 Overpayments

M 150 Other Ineligibility

EXAMPLE: Excess Resources – An individual was ineligible for 5 months due to resources. The individual had resources of $2,100, $2,200, $2,300, $2,400, and $2,500 for months 1 through 5, respectively, for the period. Determine the highest level of excess resources for an ineligible month as follows: 1. Select appropriate resource level. $2,000 (1 person) 2. Calculate excess resources for each ineligible month. $2,100 - 2,000 = $100 $2,200 - 2,000 = $200 $2,300 - 2,000 = $300 $2,400 - 2,000 = $400 $2,500 - 2,000 = $500 3. Select highest level of excess. +$500 (month 5) The amount of overpayment claimed for repayment will be limited to the lesser of the highest level of excess ($500) or the amount of medical payments (includes LTC vendor payments, if applicable) made on behalf of the individual in the period of ineligibility.

M-150 Other Ineligibility MS Manual 01/01/14 When the individual is ineligible due to other criteria (e.g., categorical relatedness, citizenship, residency, medical necessity, etc.), the amount of overpayment claimed for repayment will be the amount of medical payments (includes LTC vendor payment) made on behalf of the individual in the month of ineligibility. Refer to MS M-160. M-160 Overpayment Evaluation - Ineligible Individuals (Non - LTC) MS Manual 01/01/14 All paymentsmade on behalf of individuals who are ineligible to be included in a financial eligibility determination for Medicaid will be considered overpayments.