Policy Memo
07/15/2021
Necessary nursing home and medical expenses that are recognized under state law are required deductions in calculating the post eligibility treatment of income if the below conditions are met.
- The expenses were incurred no earlier than the three months preceding the month of current application.
- The expense is a current and unpaid customer liability for a service that will not be paid for by Medicaid.
The post eligibility treatment of income (PETI) refers to the calculation that is made to determine how much an individual is able to contribute to the cost of their own care. This offsets the amount the Medicaid agency pays the facility.
Nursing Home Expenses
The deduction for nursing home expenses will not exceed the State Medicaid reimbursement rate for such services.
HFS Bureau of Long Term Care (BLTC) updates the State pay rates quarterly on their website. Workers should verify the rates set for the date of service of the nursing home expenses provided by the individual by visiting the appropriate link. The total rate column should be used as the State rate. Please refer to the following links when verifying State pay rates.
Verifying Allowable Nursing Home Expenses for PETI
A current bill from the facility showing the dates of service, total amount billed, amount owed and number of days being billed must be submitted by the customer or facility in order for this deduction to be allowed. In order to be considered current, a bill should have been issued by the facility no more than 30 days before the application was submitted.
When Nursing Home Costs are NOT Allowable Deductions
Medicaid providers are required by law to submit Transaction Audit Number (TAN) submissions timely. Providers cannot bill the customer if the State did not pay for services because the provider did not submit the TAN in time. In these instances, the nursing home expenses are the provider's liability, not the customers. If the unpaid nursing home expenses are a result of a late TAN submission, the deduction is not allowed. To determine whether the unpaid nursing home expense is allowable in this scenario send a 2150 to HFS Bureau of Medical Eligibility and Special Programs.
NOTE: Nursing home expenses the State will pay for shall not be used in the calculation.
Other Medical Expenses
Allow other previous medical expenses in the PETI calculation if below conditions are met;
- The expenses were incurred no earlier than the three months preceding the month of current application.
- The customer has provided a medical bill showing current and unpaid customer liability for a service that will not be paid for by Medicaid.
Continue to follow PM 15-08-05: Allowable Medical Expenses for application of ongoing allowable medical expenses on approved Medicaid cases.
NOTE: Nursing home and medical expenses cannot reduce resources.
[signed copy on file]
Grace B Hou
Secretary, Illinois Department of Human Services
Theresa Eagleson
Director, Illinois Healthcare and Family Services
