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State of Maryland Medical Assistance Manual Revised April 2014

Medicare premiums are deducted in the first two months of MA eligibility. Beginning with the third consecutive month of MA eligibility, State Buy-In becomes effective. This means that the State will pay the Medicare premium for the eligible person beginning the third month of MA eligibility; therefore, the Medicare premium may no longer be allowed as a deduction from the person’s income. Buy-In continues as long as the person remains eligible for MA and is only terminated or cancelled on-line via the Certification/Turnaround Document (C- TAD). When Buy-In is interrupted by a period of ineligibility it will be two months before recertification resumes. The delay is caused by the processing time between the Department of Health and Mental Hygiene and the Centers for Medicare and Medicaid Services. Premiums withheld due to the processing delay will be refunded to the recipient by the Centers for Medicare and Medicaid Services. Health insurance premiums are an allowable deduction only if paid from the income of the institutionalized person for coverage of the institutionalized person. The amount of the deduction is based on the most recent bill. If the bill is paid monthly, the amount of the bill is deducted each month. If the premium is paid quarterly, semi-annually, or annually, the premium is prorated to arrive at a monthly cost. This cost is deducted each month. Semi- annual and annual premiums may be deducted on a one-time-only basis if proration of the premium and accumulation of the funds may result in excess resources. 6. Medical Care or Remedial Service This is an allowance for those medical or remedial items or services that are recognized under State law but not covered by the State Plan. These are expenses such as dentures, hearing aids and prosthetic devices. Refer to Appendix II in Section 900 for a more complete list of items and services not covered by the Medicaid State Plan. These expenses are usually documented by a bill or a paid receipt. A person may be in need of an item such as dentures or eyeglasses, but unable to obtain it without a guarantee of payment to the provider. A written and signed contract with the provider that obligates the person to pay in a lump-sum or installments is acceptable documentation to allow the deduction from the recipient’s available income. For a Medicaid application, a deduction from available income for cost of care may also be made for medical or remedial services covered by Medicaid (e.g., nursing facility) but not covered for the recipient because the recipient was not Medicaid eligible as of the service date. The recipient’s incurred expenses may only be deducted if the services were received during any months in the three-month period prior to the month of the current Medicaid application, in which the recipient was determined not Medicaid eligible. Incurred expenses may also be deducted for any months that the recipient was ineligible between the month of application and the effective date of Medicaid eligibility. The bill must still be unpaid and remain the recipient’s obligation to pay, as verified by a current detailed bill from the provider. Unpaid bills for medical or remedial services received before the three-month period may not be deducted from the recipient’s available income for the cost of care.