PM 15-08-08: Use of Medical Expenses

WAG 15-08-08.

For community, LTC, and SLF cases, monthly spenddown is met by subtracting from the monthly spenddown amount, the following medical expenses of all the persons included in the Standard. The medical expenses must be subtracted in the following order:

  1. DHS-DRS Home Services Program (HSP), DHS-DMH/DDD Community Based Services(for AABD only) and New TextDoA services. See PM 06-11-02 for DHS-DMH/DDD Community Based Services. Consider these expenses incurred as of the first day of the month, regardless of the day the services are actually provided.

    If spenddown is not met for the month that the charge is incurred, the cost can be used to meet spenddown for a later month(s). There is no time limit on the use of these expenses.

    Once spenddown is met, any remaining DHS-DRS HSP, DHS-DMH/DDD Community Based Services and New TextDoA charges cannot be carried over to a later month. 

  2. Receipts, including carryover amounts from receipts used in prior months, subject to the 6 month limit on the use of receipts. Use the oldest receipt first.

    NOTE: For an LTC or SLF client, a receipt for payment of LTC or SLF charges can only be applied to a client's credit or spenddown in the month the payment is made

  3. Medical Bills, including carryover amounts from bills used in prior months. Consider bills in service date order, using the oldest first.

A medical expense can only be used once to meet spenddown. When a bill for a medical expense has been used to meet spenddown, a receipt for the same expense cannot also be used unless the full amount of the bill was not used.

In order to use a medical bill or receipt to meet spenddown, the bill or receipt must be dated within 6 calendar months of the month that the client wants to use the bill. When the client has a receipt and a bill for the same service always use the receipt to meet spenddown, unless the bill is from an earlier month and the client wants to use it for that month.

Except for Revised textDHS-DRS HSP charges or DHS-DMH/DDD Community Based Services, it is the client's responsibility to decide for which month the bill or receipt is to be applied. See PM 06-11-02 for DHS-DMH/DDD Community Based Services.

Consider all other bills for the day and month that the service was provided, unless the client chooses to use it to meet spenddown for a later month. If the client does not choose to use the bill or receipt for a later month and it does not meet spenddown for the month it was incurred or paid, consider it for the first day of the following month(s), until spenddown is met.

Cost-sharing amount(s) for DoA services are considered incurred on the first day of the month, or the actual date of service if the services began after the first day of the month. See PM 15-08-08-b for the use of hospital care costs.