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West Virginia Income Maintenance Manual Chapter 24
West Virginia Income Maintenance Manual Page 25 Chapter 24 Long Term Care
These allowable expenses are listed in Section 4.14.4.J.3. Incurred medical expenses, including nursing facility costs (except for nursing facility costs for clients with a community spouse), for which the client will not be reimbursed, are subtracted from his remaining income. When the client becomes eligible for nursing facility services after expiration of a penalty period for transferring resources, nursing facility expenses incurred during the penalty period which are non- reimbursable from another source may be used as a deduction. ➢ Deductible Premiums Deductible premiums include any portion of the Medicare Part D Premium that is not covered by the Low Income Subsidy (LIS). The incurred expense must be the responsibility of the client. The total deduction for medical insurance premiums is given to the person who pays the premium, regardless of which individual carries the insurance coverage. The deduction is not split between the spouses, even if both are receiving nursing facility services. See Chapter 7 for sources of insurance premium verification. Institutionalized Person Carries and Pays Both Premiums Example: An institutionalized individual, Mr. Spruce, carries the insurance and pays the premium for himself and his community spouse. The institutionalized spouse receives a deduction for the full premium amount. Institutionalized Person Pays Premiums But Does Not Carry Insurance Example: An institutionalized spouse, Mrs. Geranium, pays the premium for the insurance coverage that her community spouse, Mr. Geranium, carries for them both. The community spouse, Mr. Geranium, is admitted to the nursing facility. The insurance premium continues to be a deduction for Mrs. Geranium since she pays the premium. ➢ Spenddown For all assistance groups (AG), except those with a community spouse, the amount of the client’s spenddown, if any, is treated as a non-reimbursable medical expense and subtracted from the client’s income along with any other medical expenses the client may have.