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COMAR 10.09.24.01-.16 1697 State of Maryland Medical Assistance Manual Revised July 2012
(iii) Expenses incurred for necessary medical care or remedial services that are covered under the State Plan.
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COMAR 10.09.24.01-.16 1697 State of Maryland Medical Assistance Manual Revised July 2012
(iii) Expenses incurred for necessary medical care or remedial services that are covered under the State Plan.
(c) Retroactive spend-down eligibility is established when the incurred medical expenses exceed the excess income.
(d) The medical expense used to establish retroactive spend-down eligibility may not be: (i) Reimbursed by the Medical Assistance Program; or (ii) Used for any subsequent eligibility determination.
(e) Retroactive spend-down eligibility is not established when the incurred medical expenses are equal to or less than the excess income.
C. Current Eligibility.
(1) When the countable net income and resources are equal to or less than the medically needy income and resource levels, eligibility exists as medically needy.
(2) When the countable net income is greater than the medically needy income level and the countable resources are equal to or less than the medically needy resource level, eligibility may exist under the spend-down provision as specified in §C(4) of this regulation. Spend-down eligibility is established when the amount of the incurred medical expenses equals or exceeds the excess income.
(3) Excess Resources. Eligibility does not exist when the countable resources are greater than the medically needy resource level.
(4) Spend-Down Eligibility.
(a) In determining spend-down eligibility, documented medical expenses incurred during the time periods and meeting the conditions specified in §C(4)(b)—(d) of this regulation shall be considered.
(b) Medical expenses incurred before the month of application shall be considered if: (i) The expenses were not considered in any retroactive certification; (ii) The expenses were not used to establish spend-down eligibility for a prior certification; and
(iii) The expenses are not paid for by any other person, remain the obligation of the person whose income and resources are considered in determining eligibility, and 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.