Recipient liability

Recipient liability is the amount of monthly net income remaining after all appropriate deductions, disregards, and Medicaid income levels have been allowed. All such income must be considered to be available for the payment of medical services provided to the eligible individual or family. The following deductions apply to all individuals: 1. Up to fifteen dollars per month of expenses for necessary medical or remedial care, incurred by a member of the Medicaid unit or spouse or child for whom that member is legally responsible, in a month prior to the month for which eligibility is being determined, may be subtracted from recipient liability other than recipient liability created as a result of medical care payments, to determine remaining recipient liability, provided that: a. The expense was incurred in any month during which the individual who received the medical or remedial care was not a Medicaid recipient or the expense was incurred in a month the individual was a Medicaid recipient, but for a medical or remedial service not covered by Medicaid; b. The expense was not previously applied in determining eligibility for, or the amount of, Medicaid benefits for any Medicaid recipient; c. The medical or remedial care was provided by a medical practitioner licensed to furnish the care; d. The expense is not subject to payment by any third party, including Medicaid and Medicare; e. The expense was not incurred for swing-bed services provided in a hospital, nursing facility services, or home and community-based services during a period of ineligibility determined under section 75-02-02.1-33.1; f. Each expense claimed for subtraction is documented by the applicant or recipient in a manner which describes the service, the date of the service, the amount of the cost incurred, the amount of the cost remaining unpaid, the amount of the cost previously applied in determining Medicaid benefits for any Medicaid recipient, and the name of the service provider; and g. The Medicaid unit is still obligated to pay the provider of the medical or remedial service. 2. The Medicaid unit must apply the remaining recipient liability to expenses of necessary medical care incurred by a member of the Medicaid unit in the month for which eligibility is being determined. The Medicaid unit is eligible for Medicaid benefits to the extent the expenses of necessary medical care incurred in the month for which eligibility is being determined exceed remaining recipient liability in that month.