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UPDATED: NOVEMBER 2009 302

INCOME EXCESS

SIX-MONTH

Verification: Expenses for acute in-patient care may be verified by:

(1) Seeing hospital bills;

(2) Seeing Medicare or insurance explanation of benefits;

(3) Clearing with the medical provider.

Documentation: Sufficient to establish an audit trail: (1) Date, length of stay, amount of charge and name of medical facility;

(2) Date and type of service, amount of charge and name of provider;

(3) If a third party insurer is involved, the amount of the third party payment or the denial of benefits, and the net amount of the A/R's responsibility. Disposition: Once an A/R with excess income has paid or incurred a charge for acute in-patient care, his/her six-month excess income is computed. Medicaid is authorized for all or any part of the cost of acute in-patient care, which is greater than the A/Rs’ spenddown amount. Once the A/R has incurred expenses equal to or greater than his/her excess income for a six-month period, s/he is eligible for Medicaid coverage during this period.

If income and/or household composition (See OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION) changes during this six-month period, the amount of the excess is recomputed prospectively and the appropriate notice is sent to the A/R. NOTE: If the A/R is covered by Third Party Health Insurance (e.g., Medicare, Blue Cross/Blue Shield, etc.) the amount of health insurance available for medical bills does not reduce the liability of the A/R. S/he is personally liable for medical bills equal to the amount of his/her excess.

(MRG)