Using the DHS-6059B Example
James, who has a community spouse, is requesting MA-LTC on March 10 and is not requesting retroactive coverage. He permanently entered an LTCF on March 1. He receives $803 each month in RSDI. James is eligible for QMB, and he has no other health care coverage. He meets all MA and MA-LTC eligibility requirements. He is not eligible for a community spouse income allocation.
James provides the following verified medical expense amounts after Medicare has paid its portion:
- An unpaid clinic bill of $50 incurred on January 8.
- An unpaid ambulance bill of $100 incurred on February 18.
- An unpaid hospital bill of $1,316 incurred on February 26.
Action:
Allow each of the medical expenses to be used as a deduction as each meets all of the conditions. Complete the DHS-6059B (PDF) to track the expenses. The amount allowed on the form for income available (Line D) is based on allowing the personal needs allowance as a deduction from his gross income ($803) before the medical expense deduction.
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The MA-LTC Medical Expense Deduction - Forms