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b. If Medicaid does not cover a medical expense because of a transfer of assets sanction, the expense cannot be deducted from income as an unmet medical need when determining the patient monthly liability (pml). Refer to MA- 2240, Transfer of Assets.

3. The expense must be either: a. For a service received in a long term care budgeting month; or b. An agreed upon payment that is due in a long term care budgeting month. It can be a medical expense incurred in a month before or during Medicaid eligibility. Get a copy of the contract or agreement and a description of each expense to verify amount and due date. The expense cannot be for the cost of care due to an imposed transfer of assets sanction period. This does not affect active LTC cases with contracts in place prior to November 1, 2007.

4. The expense must be for goods and services the a/b received and for which they must pay. It must not be covered by Medicare, private insurance or other third party, such as a family contribution.

a. The a/b may be billed directly; or

b. A third party may be billed if they have been or will be reimbursed by the a/b.

c. Do not allow the charge until third party payment is verified.

d. Deduct only the portion of the charge for which the a/b has payment responsibility when the third party benefits are verified.

5. The expense has not been used to meet a deductible while the a/b was budgeted as PLA for Medicaid.

6. The expense has not been deducted previously as a UMN.

7. The expense is not a previous patient monthly liability.

8. The expense was not used to reduce reserve.

9. The expense must be reported by the end of the 6 month period following the certification period in which it was incurred.

B. Prescription Drug Charges

Medicare/Medicaid beneficiaries have no prescription drug coverage through Medicaid. For Medicaid beneficiaries, and/or Medicare/Medicaid beneficiaries the cost of prescription drugs may be deducted as unmet medical needs when they are not covered by Medicaid because they exceed the monthly Medicaid prescription limit, or the Medicare Part D Plan does not cover the drugs or the pharmacist does not take Medicaid. The charges must meet the criteria in VIII.A., above.

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493