Reported Medical Expenses Notice of Action (DHS-6059C)

Clients must be notified of how reported medical expenses were used in the eligibility determination process. Specific information must be communicated to the enrollee either by the MAXIS notice or by use of the DHS-6059C.

The Reported Medical Expenses Notice of Action (DHS-6059C) (PDF) can be sent to a client when required information regarding the medical expense deduction cannot be added to a MAXIS system notice. It should be used both when the Medical Expense Deduction is initially applied and ongoing as changes occur. You may find this form helpful in explaining complex medical expense situations.

To Do: To learn more about the DHS-6059C, take out your copy of the form (or view it in eDocs) and click on the links below that correspond to the tables on the form.

Medical expenses that were not used (first table).

Complete this table when reported medical expenses are not allowed. Be sure to provide a reason, such as which condition was not met.

Medical expenses that were used (second table).

Complete this table when reported medical expenses are allowed. Enter the amount of the expense that was used as a deduction.

Amounts Allowed Monthly (third set of tables).

Complete a line on each table for each month that a medical expense deduction was allowed and the amount of the deduction allowed in that month. How a deduction is applied is discussed in the next section. The information provided in the text above these tables instructs the client to use the income that remains after paying their obligation to pay these medical expenses.

Remaining Medical Expenses.

Enter the amount of any remaining medical expenses that may be deducted from future LTC income calculations in the field found at the bottom of page 1.

Insurance or other payment proof needed (page 2).

Complete the table found on page 2 when an estimated amount was allowed as a deduction because a third party payment had not yet been made to the provider. The text below the table instructs the client to submit proof of the actual third party payment amount.

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The MA-LTC Medical Expense Deduction - Forms

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