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Medical Services – Glossary

MS Manual 09/01/26

Medical Necessity – When a medical service is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life, cause suffering or pain, result in illness or injury, threaten to cause or aggravate a handicap or cause physical deformity or malfunction and there is no other equally effective (although more conservative or less costly) course of treatment available or suitable for the beneficiary requesting the service. Medically Needy – Individuals whose income and resources exceed the levels for assistance established under a State or Federal plan for the categorically needy, but are insufficient to meet the cost of health and medical services. Non-Covered Services – Services not medically necessary, services provide for the personal convenience of the patient or services not covered under the Medicaid Program. Non-Qualified Alien – An alien who is not lawfully admitted and not lawfully given the privilege of residing permanently in the United States (U.S.) or one who is lawfully admitted to the United States but who has not resided in the U.S. for 5 years or one who is not exempted from the 5 year requirement. Notice of Estate Recovery – An initial notice of intent to recover from the estate of individuals who received Medicaid services in an institution or a waiver program will be given at the time of application for services. A second notice, DHS-20 - Notice of Estate Recovery, will be sent to the personal representative of the deceased’s estate or to a distributee of the estate who has signed an “Affidavit for Collection of Small Estates”. The notice will inform the individual of the intent to recover, of the hardship and cost effectiveness provisions, and of appeal rights. The notice will be mailed by the Third Party Liability Unit (TPL). Nursing Facility – A facility that provides intermediate or skilled nursing care and ICF/IID facilities.

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