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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 26 Chapter 24 Long Term Care

➢ Time Limits and Verification Requirements for Expenses ▪ Applicants A non-reimbursable medical expense may be permitted only for services provided in the month of application and the three months prior to the month of application. This includes nursing facility expenses incurred during a penalty period for transferring resources and nursing facility expenses incurred during the three months prior period when the client was ineligible for Medicaid due to excessive assets. Only a current payment on, or the unpaid balance of, old bills incurred outside the period of consideration may be permitted as an NRME. See Section 4.14.4.J.3. Eligible Ongoing Monthly Payments Example: Mrs. Carnation applies for Medicaid for payment of nursing home expenses in October. She obtained a wheelchair in June and made payments in July, August, and September. She still owes 10 more payments. The payment may be used as a deduction, even though she purchased it prior to the three-month period, since there is evidence of a payment in the three months prior to application. Ineligible Monthly Payments Example: Same situation as above, except that Mrs. Carnation did not make any payments during July, August, or September. Since she did not incur the expense in the three months prior to the month of application or the month of application and made no payments during the three- month period, no deduction is given. ▪ Clients Residing in a Nursing Facility The request for consideration of a non-reimbursable medical expense must be submitted within one year of the date of service(s). Documentation must consist of the following: • An order and statement of the medical necessity from a prescribing physician, dentist, podiatrist or other practitioner with prescribing authority under West Virginia law; and • An itemization of the services provided. When the request to deduct non-reimbursable medical expenses originates from a nursing facility or is presented by the client as a bill EXCEPTION: A deduction may be given if there is evidence of a payment in the three months prior to application, even when the expense was incurred prior to that time.