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the medically needy maintenance income limit for the number of dependents. The remainder is the allocation amount for dependents. b. If the total gross income is equal to or greater than the medically needy income limit allowance for the number of dependents, do not allocate any amount to the dependents. 2. If the dependent family member receives WFFA/ Food and Nutrition Services, use the DSS-8194 to notify the WFFA Food and Nutrition Services caseworker of the allocated income. VIII. UNMET MEDICAL NEEDS ALLOWANCE When determining an a/b’s patient monthly liability an amount can be deducted to pay for medical expenses for which they are responsible. These expenses are referred to as unmet medical needs (UMN). In this section we will tell you how to determine the amount of income to deduct for UMN. When a transfer of assets sanction period has been imposed, do not allow as an unmet medical need the cost of care for these months or the fractional amount in the last month of the sanction. A. General Rules To be considered an unmet medical need, a medical expense must meet all of the following criteria.

1. Be an allowable medical deduction for federal income taxes (see IRS Publication Number 502). UMN cannot include: a. Premiums for life insurance policies, b. Premiums for policies providing payment for loss of earnings, c. Premiums for policies for loss of life, limb, sight, etc., or d. Premiums for policies that guarantee an amount each week for a stated number of weeks hospitalized for sickness or injury. e. An insurance premium paid by the Health Insurance Premium Program (HIPP) as an UMN. This is an expense paid by Medicaid.

2. The expense must not be payable or covered by Medicaid. a. The LTC facility is required to provide many medical supplies and services. These supplies and services are covered by Medicaid as part of the facility's reimbursement rate. (1) Refer to the LTC Provider's Manual, Scope of Services Section, and MA- 2905, Medicaid Covered Services, VII., Nursing Facility Services, for a detailed list of items included in the facility's reimbursement rate for beneficiaries in LTC facilities. (2) If it appears that the facility is charging the patient for services covered by the per diem, this should be documented and reported to DHB, Program Integrity Section, 919-647-8000. Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493