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West Virginia Income Maintenance Manual Chapter 4

West Virginia Income Maintenance Manual Page 238 Chapter 4 Income

Example 2: A mother applies for Medicaid for herself and her two children. Also, in the home are her husband and his two children, who are also applying for Medicaid. The medical bills of the husband and his children are used to meet the spenddowns of his wife and stepchildren as well as his own and his children's spenddown. Example 3: Same situation as above, except the husband and his children are not applying for Medicaid. The medical bills of the husband and his children are used to meet the spenddown of the mother and her children. Example 4: A man and woman live together but are not married. They each have two children from previous marriages, and all are applying for Medicaid. The medical bills of the woman and her two children are used to meet their own spenddowns, but not those of the man and his two children. The medical bills of the man and his two children are used to meet their own spenddowns, but not those of the woman and her two children. 4.16.4.J.3 Allowable Spenddown Expenses The following medical expenses, which are not subject to payment by a third party, and for which the client will not be reimbursed, are used to reduce or eliminate the spenddown. • A current payment on or the unpaid balance of an old bill, incurred outside the current POC, is used as long as that portion of the bill was not used in a previous POC during which the client became eligible. No payment or part of a bill that is used to make a client eligible may be used again. Old unpaid bills, which are being collected by an agency other than the medical provider, may be used when the expense is still owed to the provider. If the expense has been written off by the provider, it is no longer considered the client's obligation, and is, therefore, not an allowable spenddown expense. Medical bills that were previously submitted, but were not sufficient to meet the spenddown, are used again in a new POC. When only a portion of the old bill, incurred outside the current POC, is used to meet spenddown, any remaining portion of the bill for which the client is still liable may be used to meet spenddown in a new POC. In addition, when the client submits an old bill and then withdraws his application, the old bill may be used again if he reapplies. • Health insurance premiums, including Medicare or the enrollment fee for a Medicare- approved drug discount card. • Medicare co-insurance, deductibles, and enrollment fees. • Necessary medical or remedial care expenses. This includes, but is not limited to: