Family and Children's Medicaid MA-3315 MEDICAID DEDUCTIBLE
A. Apply the unpaid balance of a loan used to pay a medical expense incurred prior to the current c.p. on the first day of the c.p. if
1. The medical bill meets the requirements in III.A.1. except that instead of remaining unpaid, it has been paid by a loan, bank card, or other legally binding financial arrangement which is a liability to the a/b.
2. To verify the unpaid loan balance:
a. Financial Institutions
(1) Review a copy of the last loan statement from the lending bank, credit union, or other lending institution, bank card statement, or other similar document, prior to the first month of the current c.p.
REISSUED 1/01/13 – CHANGE NO. 01-13
(2) Subtract the amount of any finance charges shown on that statement to determine the current unpaid loan balance.
b. Personal Loans
For a personal loan from other than a financial institution (friend, relative, etc.) obtained to pay a medical expense, request a verbal or written statement from the lender regarding the original amount, purpose, repayment terms, and the amount of the unpaid balance.
3. Compare the cost of the medical service(s) paid by the loan to the unpaid loan balance on the first day of the c.p.
a. If the unpaid balance is less than the cost of the medical service, apply the unpaid balance to the deductible.
b. If the unpaid balance is equal to or greater than the cost of the medical service(s), apply the full cost of the medical service to the deductible.
c. If the unpaid balance is $0 in this or subsequent c.p.’s, there is nothing to apply to the deductible in that c.p.
4. If the amount of the loan applied to the deductible as determined in V.A.3. is equal to or greater than the amount of the deductible, any excess remaining after additional payments during the c.p. can be carried forward to subsequent c.p.’s as provided in III.A.1.b. If payments on the loan during the c.p. reduce the unpaid balance to $0, there is nothing to carry forward.
5. If the deductible increases because of an increase in income during the c.p., reverify the unpaid loan balance as of the first day of the month of the increased deductible and follow steps in V.A.3.
6. If payments are being made on the unpaid medical bill, count the unpaid balance on the first day of the c.p., not the payments.
REVISED 1/01/13 – CHANGE NO. 01-13
a. Recipient with a deductible took out a home equity loan for $5,000 at the bank to consolidate all of his bills, including an orthodontist’s charges of $2,250 that were incurred prior to the current certification period (c.p.). He has the provider’s bill for the services rendered and a statement showing that the bill was paid. He also has a copy of the promissory note for $5,000 to his bank dated a few days prior to his paying the medical bill and his current statement showing one payment for $100, finance charges of $49, and an unpaid balance of $4,949 ($5,000 - 100 + 49 = $4,949). The total amount of the medical bill can be applied to the applicant/beneficiary’s (a/b) deductible on the first day of the c.p. and carried forward to future c.p.’s as allowed, because the unpaid balance of $4,900, not counting finance charges, exceeds the amount of the medical bill.
b. The a/b always pays his bills, including medical bills, with his MasterCard, wherever it is accepted for payment. He has a copy of the physician’s statement showing the date of service and payment rendered by MasterCard for a medical service in the amount of $137 prior to the current c.p. He also presents his MasterCard statement showing an unpaid balance of $392. The finance charges on that statement are $5.88. Subtract the finance charges from the unpaid balance (392- 5.88 = 386.12). The full amount of the medical expense ($137) can be applied to his Medicaid deductible on the first day of the c.p., because the difference is greater than the amount of his medical charges.
c. The a/b presents his Visa card statement showing an unpaid balance in the amount of $75.96, including a finance charge of $11.25 for that month. He had previously paid a medical bill of $150 for a medical service incurred prior to the current c.p. with his Visa card. Only the amount of the unpaid balance, minus the finance charges on that statement (75.96 - 11.25 = 64.71), can be applied to the Medicaid deductible on the first day of the c.p., because the unpaid balance, minus the finance charges, is less than the medical expense and is all he still owes.
REISSUED 1/01/13 – CHANGE NO. 01-13