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3. The client’s and their ineligible spouses’ bills – spousal income was deemed to the client and used to determine income eligibility; or 4. Both spouses’ bills – husband and wife both meet all eligibility criteria. EXPENSES THAT CAN BE USED TO SATISFY THE SPEND DOWN: Medical expenses paid by an insurance company or other third party cannot be used to meet or reduce the spend down amount. The following expenses can be used to meet or reduce the spend down amount, both prospectively and for retro eligibility: 1. Paid and unpaid medical expenses incurred during the benefit month; 2. Paid and unpaid medical expenses incurred during the three months preceding the benefit month; and 3. Current payments on bills incurred more than 3 months before the benefit month. Note: The paid and unpaid expenses for sections 1-3 must be for the provider or a collection agency for the provider; The bill must still be owed to the provider. Once the provider has been paid in full, the bill is no longer owed to them. If the client used a loan to pay the bill, it has changed form and is no longer an outstanding medical bill, but rather a bill to a lender. A collection agency is not a third party. The bill is still owed to the provider and the collection agency is simply assisting in collecting the debt. NOTE: Current payments on old bills can be used to meet the spend down in the month paid, and in the 3 months following the month paid or until the payment amount is used in full to reduce spend downs, whichever occurs earlier. Institution charges incurred while the client was serving an ineligibility period due to an uncompensated asset transfer cannot be used to reduce the spend down or as incurred medical expenses to reduce the patient liability toward cost-of-care in post-eligibility treatment of income. Medical bills/documentation not received during a time when they can be used to meet or reduce the spend down cannot be used. MEDICAL EXPENSE DEDUCTIONS: Medical expenses used to meet/reduce a spend down must: 1. Not have already been used to meet/reduce another month’s spend down; 2. Not be for a Medicaid-covered service in a month the client was receiving Medicaid, regardless of whether or not the provider accepts Medicaid; NOTE: Medical travel that occurs before the client applies for Medicaid can be used to reduce the spend down; however, medical travel in a Medicaid-covered month is a Medicaid-covered service and cannot be used. Medicaid travel in a non-Medicaid covered month is calculated based on the Medicaid Transportation mileage reimbursement rate of $.33/mile (or current rate verified with MPQH). 3. Not be a Medicare or Qualified Medicare Beneficiary (QMB) covered service incurred during a month of QMB eligibility;