Obligation Payment Options
MA-LTC clients are responsible for the obligation amount, whether the obligation is a medical spenddown, LTC spenddown, waiver obligation, or medical spenddownusing LTC costs.
How the client pays that obligation and to whom, varies based on the type of obligation.
- Clients residing in a facility must pay the LTC spenddown amount directly to the facility.
- Clients receiving services through SIS-EW pay their waiver obligation amount directly to one waiver services provider or pay multiple waiver services providers based on an Explanation of Medical Benefits (EOMB).
- Clients receiving services through EW pay the LTC spenddown or medical spenddown to any medical or waiver services provider based on the EOMB.
This module first reviews two payment options available to MA-LTC clients, in addition to “potluck” processing.
It also discusses all payment options available based on the type of obligation the client has. The Obligation Payment Options (PDF) handout provides a summary of the information provided in this section.
Definition: The process of applying health care claims to the recipient amount as DHS receives them. DHS does not pay health care claims for any amount equal to or less than the recipient amount shown in MMIS. MMIS issues a monthly Explanation of Medical Benefits (EOMB) that lists the client’s incurred health care expenses for the month. The client uses the EOMB to determine which bills DHS paid and which bills the client is responsible to pay.
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Obligation Payment Options