Page 349

Example 19 Roberta’s deductible period is from March 1st through August 31st. The total Medicaid deductible amount is $1,500. She submits an outstanding bill from January 10th for $500. On August 15th, she submits payment of $1,000. Roberta’s Medicaid eligibility begins March 1st. 24.7.3.4 Calculation Errors If any portion of the deductible is paid and it is determined that the amount was wrong due to agency error, the amount incorrectly paid shall be refunded and reported on CARS. 24.7.3.5 Insufficient Funds If the deductible is paid with a check that is returned for insufficient funds, the person is no longer eligible. This page last updated in Release Number: 26-02 Release Date: 04/15/2026 Effective Date: 04/15/2026 24.8 Order of Bill Deduction When applying medical bills to the deductible, start with the earliest service date. If more than one bill has the same service date, use the bill with the highest amount first, then the next highest and so on down to the lowest bill with that same service date. 24.8.1 Hospital Bills Hospitals do not always itemize the cost of their services according to the day and time of day the patient received the services. It is difficult sometimes to know when the patient met the deductible. For this reason, if the patient’s hospital bill for one continuous stay in the hospital is equal to or above whatever the deductible was on the date of admission, count the deductible as having been met on the date of admission. Set that date as the begin date of Medicaid certification. Apply the hospital bill to the deductible first before counting any other medical costs that were incurred during the hospital stay. Example 1: Linda submits a $2,000 bill toward her deductible, for hospitalization from July 12th through July 14th. She also submits a physician bill for $2,500 with a date of service of July 12th. Apply the $2,000 hospital bill to the deductible first. 24.8.2 Pregnancy Fees Many providers charge a flat fee for pregnancy related services. The single-fee includes all prenatal care, office visits, delivery, and postnatal care. In determining whether these "global" pregnancy fees meet the deductible, treat them the same way as you would a hospital bill. If the "global" pregnancy fee is equal to or above the deductible, count the deductible as having been met as of the date an agreement was signed. This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008