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542 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services
Weight management programs if used under the direction of a physician. The deduction may not exceed $50.
Payments on past-due bills from a nursing facility or community-based facility during a time period when an individual was not on Medicaid. For amounts owed to a CBC, allowable costs only include the service portion. If the CBC can or will not itemize or break down the room and board amount from the service amount, then deduct the current Medicaid CBC room and board amount to determine the allowable deduction.
A medical deduction is allowed for a lift chair if it was medically necessary and prescribed. Note: If an individual’s medical provider indicates that an individual needs a nutrition supplement such as Ensure or Boost, the cost should not be considered a medical deduction. It could be considered as a special diet. See Medical Related Payments to determine whether the individual is eligible for a special need for the cost of the diet. The following costs are not deductible: • A cost paid by someone outside the filing group through a reimbursement, vendor payment or in-kind benefit. • A cost that is paid by a person or company outside the filing group or that is written off by a medical facility. These are referred to as third-party payments. • The cost for a service provided by someone in the filing group, such as childcare provided by the father while the mother works. • A cost used as an income deduction in one budget month or averaged over several months cannot be used again. • A cost that the individual incurred while the individual was serving a disqualification from Medicaid for a transfer of assets for less than fair market value. How to use medical costs For individuals who have stable costs, these costs can be anticipated over the eligibility period. For individuals whose costs change monthly, costs must be reported, and liability should be adjusted each calendar month. Prescriptions that are consistently filled every 60 or 90 days can be converted to a monthly amount by dividing by 2 or 3, respectively, and applied as an ongoing, anticipated monthly cost until the next renewal, when it should be reviewed. If an individual has both stable and unstable costs, more than one payment duration can be used. The payments are coded with the appropriate end date. Once the end date has passed, the deduction will no longer be used in the liability calculation and the liability will increase. Medicare Part D There are two categories of Medicare Part D related costs that may be used to reduce the liability: the individual’s premium costs and prescription co-payments. • Premiums: The amount of the plan premium that is above the “low average premium” (e.g. “above the benchmark”) is an allowable deduction. This is an anticipated cost and should be reviewed at renewal. • Prescription co-payments for drugs that could be covered by the Part D plan, but not offered in the plan’s