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Questions? | Policy Manual | Training Information

The second condition that an expense must meet in order to be allowed as a deduction in the LTC calculation is that it cannot be for an expense covered by MA.

The Minnesota Health Care Programs Benefit Summary (DHS-3860) provides a list of MA-covered services.

Do not deduct a medical expense if it is an MA-covered service that is incurred in a month for which MA eligibility is or will be approved.  Assume a medical expense incurred in a month for which MA eligibility is approved to be an MA-covered service unless the client provides documentation that it is not.

Long-Term Care Facility.

A client residing in an SNF or ICF/DD has a daily rate. When an MA client resides in an SNF or an ICF/DD, DHS pays the facility a daily rate (also referred to as a ”per diem rate”) to cover the client’s care. A medical expense cannot be an item or service that is included in the daily rate DHS has paid, or will pay, for the client’s cost of care within the facility.

Generally, the items and services included in the daily rate include nursing services, food, wheelchair, laundry and linen services, housekeeping services, routine over-the-counter medications and supplies, and personal care items (such as shampoo and soap). The items and services included in the daily rate vary based on an individual’s situation. Contact the facility to clarify if a reported expense is an item or service that is included in the daily rate.

Only medical expenses that are not included as part of the daily rate meet Condition 2. Contact the facility using the LTC - County Communication Form (DHS-3050) to determine if an expense is included in the client’s daily rate.

Residential Living Arrangements or Housing with Services Establishment.

A client residing in a residential living arrangement or housing with services establishment receives a variety of services that may be a medical expense, an LTC expense, or a room and board expense. Review each expense submitted to determine if the expense meets all of the conditions to be allowed as a deduction.