Page 708

West Virginia Income Maintenance Manual Chapter 4

West Virginia Income Maintenance Manual Page 236 Chapter 4 Income

o The provider of the service o The total amount of the bill o The third-party liability amount • Medical Processing in the Bureau for Medical Services (BMS) accesses the eligibility system to determine the date on which 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). 4.16.4.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 the client’s spenddown. 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: An AG that meets a spenddown remains eligible until the end of the POC in the following situations, regardless of whether or not the individuals is an AG member. • A member(s) of the IG experiences an increase in income; or • An individual(s) with income is added to the IG; or • An individual(s) is removed from the NG.