DHS-6059B - Page 2

The tracking charts on page 2 of the DHS-6059B are completed when actually applying the medical expenses as a deduction in the LTC income calculation.

In the Month 1 column, enter the first month in which the LTC income calculation is used. The months entered in the columns may not correspond directly with the certification period.

To Do: Click on the links below to learn what information to enter on each line of the chart. The eDocs version of DHS-6059B will value some fields automatically for you and keep track of allowable expenses that may carry forward.

Line A. Enter the total amount of allowable medical expenses incurred prior to the initial LTC income calculation budget month. This amount is pulled from the total of the medical expenses listed in Section 1 of page 1 of the form.

Line B. Enter the amount of medical expenses incurred in the budget month that are allowed as a deduction. This amount is identified from medical expenses that were entered in Section 2 of page 1 of this form. Enter the monthly total for each budget month separately based on allowable medical expenses incurred.

Line C. Enter the total of lines A and B in line C. This is the total amount of medical expenses allowed as a deduction for the budget month.

Line D. Enter the amount of income remaining in the LTC income calculation after all other deductions but prior to the medical expense deduction.

Line E. The amount entered on this line is the amount that is carried forward to Line A of the next month that uses an LTC income calculation. This amount is determined by comparing the total expenses listed on line C and the remaining income available for payment of medical expenses listed on line D.

If Line D (remaining income) ≥ Line C (total expenses), enter $0. No expenses will be carried to the next month.

If Line D < Line C, enter the difference between Line D and Line C. This amount is then entered in Line A of the next LTC income calculation budget month.

Line F. The amount entered on this line is the amount of the medical expense deduction allowed for the budget month.

Enter the amount from Line C if Line D is ≥ Line C.
Enter the amount from Line D if Line D is < Line C.

FYI:
If a combination LTC/medical spenddown month exists, track the amount of allowable medical expenses used to meet the medical spenddown portion and subtract this amount from the carried forward amount (Line A on DHS-6059B). Redetermine the remainder of the certification period after subtracting the amount of expenses used to meet a medical spenddown. This will reduce the carried forward amount for any months beyond the combination LTC/medical spenddown month.