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West Virginia Income Maintenance Manual Chapter 4
West Virginia Income Maintenance Manual Page 201 Chapter 4 Income
• Medical Processing in the Bureau for Medical Services (BMS) accesses the eligibility system to determine the date on which the spenddown is met. Additional electronic notification to BMS is required only when a change is necessary to add additional medical expenses after the spenddown is met and will result in an earlier period of eligibility (POE). The client's eligibility begins the day the amount of incurred medical expenses at least equals his spenddown amount. • If the client does not submit sufficient medical bills by the application processing deadline, the application is denied. The application is denied when the applicant indicates there are no medical bills or anticipated medical expenses in the 30-day application period that may be used to meet the spenddown for the Medicaid AG member(s). 4.14.4.J.2 Whose Medical Expenses Are Used The medical bills of the following persons who live with the AG member(s) are used to meet the spenddown. There is no limit on the amount of one individual's bills that can be used to meet another individual’s spenddown. • The aged, blind, or disabled individual • The spouse of the eligible individual who lives with him • The children under age 18 of the eligible individual and spouse, when the children live in the home with them The AG member must be responsible for the bill at the time it was incurred and remain responsible for payment. Because the individuals whose medical expenses are used to meet a spenddown may be in separate AGs, the same medical bill is used to meet the spenddown in each AG containing one of the persons identified above. NOTE: Although eligibility begins on the date of service of the medical bills that bring the spenddown amount to $0, expenses incurred on that date that are used to meet the spenddown, as indicated in the eligibility system, are not paid by Medicaid. NOTE: The past medical bills of any of the individuals listed that were incurred while the individual lived with an AG member(s) may be used for spenddown, even if the individual no longer lives with the AG member, is deceased, or is divorced from the AG member.