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State of Maryland Medical Assistance Manual Revised April 2014

j. Deduction of Non-covered Medical or Remedial Services from an Institutionalized Person’s Available Income for the Cost of Care (Policy Alert 10-12) Certain deductions are allowed when calculating an institutionalized person’s available income for the cost of care in a long-term care (LTC) facility or waiver program. One of the allowable deductions is for the individual’s unpaid, incurred expenses for necessary services recognized under State law as medical or remedial care but not covered by the State’s Medical Assistance (Medicaid) program.

In two circumstances, non-covered services may be used as a deduction from a recipient’s contribution towards the cost of care (patient resource amount): A. The individual was enrolled as a Medicaid LTC or waiver recipient for the date of service, but the necessary medical or remedial services are not covered under the Medicaid State Plan.

For example, services that are only covered by Maryland Medicaid for children younger than 21 years old (e.g. private duty nursing, eyeglasses, dental care, dentures, or hearing aids) may be deducted from an adult LTC or waiver recipient’s available income for the cost of care. Deductions for non-covered assisted living services may not include room and board, just expenditures for the types of medical or remedial services covered for waiver enrollees

B. The recipient is not Medicaid-eligible for the service date, and the service was received:  During the three-month period prior to the month of the current application; or  During any period between the month of the current application and the first month of current eligibility.

For example, unpaid bills for nursing facility services received by a recipient during ineligible months in the three month period prior to the month of the current application (e.g., when the recipient was still resource over scale) may be deducted from the recipient’s available income for the cost of care.

Note: Although there is no retroactive period associated with a waiver application, waiver applicants residing in Assisted Living Facilities are entitled to have unpaid medical bills incurred during the three months prior to the month of the current application deducted from their available income for the cost of care.

1. When the applicant or authorized representative indicate they have unpaid medical bills at application, first the CM determines the A/R’s eligibility for Medicaid Long Term Care (MA- LTC). Note: If the A/R indicates they have unpaid medical bills at application that were incurred in the last three months, an eligibility determination must be made for these months prior to sending a request to DHMH to determine any pre/post- eligibility medical expense deductions. 2. When the recipient or authorized representative indicates they have unpaid medical bills at redetermination, first the CM redetermines eligibility for Medicaid Long Term Care (MA-LTC).

Rev. 10/2013

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