Page 199

UPDATED: NOVEMBER 2009

296

INCOME

EXCESS

Types of bills that can be used to meet the Excess/ Spenddown: a) Medicare and other health insurance deductibles or other coinsurance charges; b) Necessary medical and remedial services that are recognized under State law but are not covered by Medicaid, e.g. chiropractic care; and c) Necessary medical and remedial services that are covered under the Medicaid Program (See REFERENCE MEDICAID COVERED SERVICES).

Such expenses include: • Medical Expenses • Medical Transportation • Prescription Drugs • Surgical Supplies/Medical Equipment/Prosthetic Devices • Non-Participating Provider Services (Once Medicaid coverage is authorized, the recipient MUST receive services from Medicaid providers in order for the Medicaid payment to be made. Credit or refunds will NOT be provided for covered services rendered to the recipient by non-participating providers.) • Over-the-counter drugs when ordered by a physician • Medical expenses paid/incurred by a public program, e.g. ADAP and EPIC • Copays • Non-covered services • Medical expenses for an individual for whom the A/R is legally responsible • Medical expenses from a legally responsible relative whose income is available to the A/R

When the A/R presents a combination of bills, the local district uses its judgment in selecting the most appropriate alternatives in order to satisfy program requirements.

(MRG)

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Page 199

Official source

UPDATED: NOVEMBER 2009

296

INCOME

EXCESS

Types of bills that can be used to meet the Excess/ Spenddown: a) Medicare and other health insurance deductibles or other coinsurance charges; b) Necessary medical and remedial services that are recognized under State law but are not covered by Medicaid, e.g. chiropractic care; and c) Necessary medical and remedial services that are covered under the Medicaid Program (See REFERENCE MEDICAID COVERED SERVICES).

Such expenses include: • Medical Expenses • Medical Transportation • Prescription Drugs • Surgical Supplies/Medical Equipment/Prosthetic Devices • Non-Participating Provider Services (Once Medicaid coverage is authorized, the recipient MUST receive services from Medicaid providers in order for the Medicaid payment to be made. Credit or refunds will NOT be provided for covered services rendered to the recipient by non-participating providers.) • Over-the-counter drugs when ordered by a physician • Medical expenses paid/incurred by a public program, e.g. ADAP and EPIC • Copays • Non-covered services • Medical expenses for an individual for whom the A/R is legally responsible • Medical expenses from a legally responsible relative whose income is available to the A/R

When the A/R presents a combination of bills, the local district uses its judgment in selecting the most appropriate alternatives in order to satisfy program requirements.

(MRG)