Condition 4 - Incurred Within the Allowed Timeframe

The expense must have been incurred within the three months prior to the month the request form for MA-LTC is received or while the client is an MA-LTC enrollee. This is the fourth condition.

Example 1:

Todd County received a DHS-3531 in May for Sam who resides in an LTCF. He was admitted to the LTCF on May 5, of the same year. He does not have a community spouse.

Action:
Evaluate verified medical expenses incurred in February, March, and April prior to the month of receipt of the DHS-3531.

Example 2:

Carl has been eligible for MA-LTC since December of last year, the month in which his request for MA-LTC was received. He submits a renewal form (DHS-2128) in May of this year to determine ongoing eligibility for June. He is an SIS-EW enrollee. Carl verifies medical expenses incurred in February of this year that were not covered by MA.

Action:
Evaluate the February medical expense to determine if it can be allowed as a medical expense deduction. Any medical expenses incurred after September of last year meet the timeframe conditions.

Example 3:

Melody, an MA enrollee, requests MA-LTC on May 31, of this year. She reports a medical expense incurred in January of this year that was not covered by MA.

Action:
Do not allow the January medical expenses as a medical expense deduction because it was incurred prior to the three month timeframe of February, March and April.

Follow Spenddown Adjustment policy in the HCPM if you have questions on when to allow late-reported medical expenses at application.

Page 6

The MA-LTC Medical Expense Deduction - Allowable Medical Expenses

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