Section 144-332-10-5 - APPLICABLE MEDICAL COSTSMedical costs are applied in the following order:
I. Verified medical insurance premiums, including Medicare. Note: Indemnity insurance premiums are not allowed. These are policies that pay for length of stay or a condition (such as cancer) but not for a specific service.
II. Verified actual costs incurred during the eligibility period for medical or remedial care costs not covered under Medicaid such as eyeglasses, dental services and hearing aides for individuals over age 21.III. Medical costs incurred during the eligibility period by individuals who are part of the assistance unit but not eligible for coverage (such as an ineligible spouse or deeming parent in an SSI - Related unit or the parents of an individual whose eligibility is based on being under age 21).IV. The unpaid balance on a loan taken out to pay for an old medical bill which was incurred prior to the eligibility period provided: A. The proceeds of the loan were used to pay the medical bill. Only the amount of the loan actually used to pay the old medical bill may be deducted. Any portion used for another purpose may not be deducted.B. Neither the medical bill nor the unpaid balance of the loan was previously applied against another deductible.C. Only the principal part of the unpaid balance may be used in the deductible - not the interest. This provision allows the individual to use the liability to the lender in place of the liability to the provider.
V. Medical costs incurred prior to the eligibility period and not applied toward another deductible, and which are unpaid on the first day of the eligibility period, which resulted in eligibility. Example
Individual has a medical bill of $5000. He has a deductible for January through June of $4500. He meets the deductible and in July incurs another $4500 deductible. The $500 remaining from the $5000 medical bill can be used towards the new deductible if it was not paid.
VI. Additional services or items necessary for medical treatment such as transportation, long distance telephone calls to medical providers, cost of lodging to receive treatment away from home and nonprescription items or drugs incurred during the eligibility period.VII. Medicaid coverable costs, paid or unpaid, incurred during the eligibility period in order of service date, including the following medical costs: A. Medical costs incurred during the eligibility period as long as they have not been written off by the provider during the eligibility period.B. Medical costs paid with all state or local funds such as General Assistance, DEL and some payments by Vocational Rehabilitation (VR). Once the deductible has been met, the eligible individuals in the assistance unit will be eligible for Medicaid for the remainder of the eligibility period or until information is provided which would change the eligibility.
10- 144 C.M.R. ch. 332, § 10-5