Family and Children's Medicaid MA-3315 MEDICAID DEDUCTIBLE
II. HOW TO MEET A DEDUCTIBLE
A. When Deductible Is Met
1. The deductible is met on the day that the total of medical expenses applied to the deductible equals the amount of the deductible for the certification period. Refer to MA-2240, Transfer of Assets, in the Aged, Blind, And Disabled Medicaid Manual to determine when the CAP indicator is entered for CAP a/b subject to a deductible and a sanction period.
2. The inpatient hospital admission of a Medicaid a/b (who does not have Medicare Part A coverage) is assumed to meet the deductible on the date of admission, regardless of length of stay or the ultimate amount of charges. (See III. B.)
3. The inpatient admission of an individual under age 21 to a Psychiatric Residential Treatment Facility (PRTF) is assumed to meet the deductible, regardless of length of stay, the ultimate amount of charges, or Medicare coverage. PRTF admissions are not covered by Medicare.
B. Whose Bills to Apply to the Deductible
1. Apply medical bills of any budget unit member.
a. An individual, age 20, is certified for M-AF. He lives with his able-bodied parents. The budget unit will be three people. Medical expenses of the 20 year old and his parents are counted toward the deductible.
b. A child, age 15, lives with his mother. Both apply for M-AF. The budget unit is 2 and their countable income exceeds 200% of poverty. Medical expenses of both the child and the mother apply to the deductible.
REVISED 01/01/13 – CHANGE NO. 01-13
REVISED 01/01/08 – CHANGE NO. 01-08