Condition 3 - Not Eligible for Payment by a Third Party

<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%> Condition 3 - Not Eligible for Payment by a Third Party

Income and MA-LTC

The third condition is that the expense cannot be eligible for payment by a third party. Do not allow the portion of the expense as a deduction for which the third party is responsible to pay. Responsible third parties include other health care coverage, such as Medicare or private health insurance.

Do not delay processing eligibility beyond the processing period when you are uncertain of the amount the third party is responsible to pay. Follow these steps when you are uncertain of the amount:

Step 1.

Estimate the amount or use the actual amount that the client will be responsible to pay using the best information available. Use the coverage information to make that estimate.

Step 2.

Request the client to report and verify the actual third party payment when he or she is notified of that payment.

Follow-up with the client at the next scheduled renewal if the verification of the payment is not received. If the client has not provided an explanation of medical benefits (EOMB), obtain a release of information from the client and contact the third party directly to verify the amount paid.

Step 3.

Adjust the LTC income calculation in the month the expense was deducted based on the actual amount for which the client is responsible when verification is returned.

People requesting MA-LTC who are residing in an LTCF.

People requesting MA-LTC through the EW who have a community spouse and whose income is greater than the SIS.

Page 5

The MA-LTC Medical Expense Deduction - Allowable Medical Expenses

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