WAG 15-08-08-a.
A client can choose to use a bill to meet spenddown for the month of service. Bills used for the month of service are considered using the date of service, not the billing date, using the oldest bill first.
If a bill is used for the month of service, and the service is a Medicaid covered service, the bill may be a split bill. If the bill is a split bill, Medicaid pays the difference between the amount needed to meet spenddown and the
balance of the bill at Medicaid rates. See PM 15-08-11 for the use of split bills.
A bill that is used to meet spenddown for the month of service may not be carried over to a later month except in the following situations:
- When the bill exceeds spenddown but:
- is not a Medicaid covered service, or
- the provider chooses not to bill Medicaid, or
- the client does not want Medicaid to pay the balance of the bill.
In these situations, any excess over the amount needed to meet spenddown for the month of service may be carried over to a later month(s).
As long as a bill is verified as current, there is no limit to the number of months or enrollment periods that the excess can be carried over. The excess amount can be carried over and used month to month until the excess is used up. This does not
apply to DORS HSP expenses which cannot be carried over once spenddown is met.
- When a bill meets spenddown, but the amount of the spenddown is equal to or greater than the Medicaid rate for the service.
Because Medicaid will not pay any part of the bill, the excess over spenddown may be carried over to a later month(s) until the excess is used up.
The bills referred to in 1. and 2. above are not split bills. Medicaid makes no payment on them.
