Page 105

COMAR 10.09.24.01-.16 1705 State of Maryland Medical Assistance Manual Revised July 2012

(4) If, after application of the disregards in §D(2) of this regulation, the person's income equals or is less than the projected cost-of-care, eligibility exists and may begin on the first day of the period under consideration. The amount remaining after application of the disregards in §D(2) of this regulation is available income to be applied to the person's cost-of-care. Certification is established under Regulation .11D of this chapter.

(5) If, after application of the disregards in §D(2) of this regulation, the person's income exceeds the projected cost-of-care, eligibility may be established under §D(6) of this regulation.

(6) Spend-down Eligibility.

loading…

Page 105

Official source

COMAR 10.09.24.01-.16 1705 State of Maryland Medical Assistance Manual Revised July 2012

(4) If, after application of the disregards in §D(2) of this regulation, the person's income equals or is less than the projected cost-of-care, eligibility exists and may begin on the first day of the period under consideration. The amount remaining after application of the disregards in §D(2) of this regulation is available income to be applied to the person's cost-of-care. Certification is established under Regulation .11D of this chapter.

(5) If, after application of the disregards in §D(2) of this regulation, the person's income exceeds the projected cost-of-care, eligibility may be established under §D(6) of this regulation.

(6) Spend-down Eligibility.

(a)In determining spend-down eligibility, documented…#

(a) In determining spend-down eligibility, documented medical expenses incurred during the time periods and meeting the conditions specified in this section shall be considered.

(b)Medical expenses incurred before the month of…#

(b) Medical expenses incurred before the month of application shall be considered if the expenses:

(i)Were not considered in any retroactive certification;#

(i) Were not considered in any retroactive certification;

(ii)Were not used to establish spend-down eligibility for a…#

(ii) Were not used to establish spend-down eligibility for a prior certification;

(iii) Have not been paid for by any third party, including a family member or an insurer, and are not required to be paid for by any third party, such as an insurer;

(iv) Were not incurred during a penalty period;

(v) Remain the obligation of any person whose income and resources are considered in determining eligibility; and

(vi)Have not been forgiven by the provider of the services,…#

(vi) Have not been forgiven by the provider of the services, as evidenced by account statements dating up to 3 months before the month of application.

(c) Medical expenses incurred at any time during or after the month of application and before the end of the period under consideration shall be considered if they:

(i) Were not paid for by any third party, including a family member or an insurer; (ii) Are not required to be paid for by any third party, such as an insurer; (iii) Were not incurred during a penalty period; and

(iv) Have not been forgiven by the provider.

(d) Each medical bill verifying expenses shall include a statement of the service and the date the service was rendered. For purchases of medicines and medical supplies or equipment, the