Paying for Dental Care: A How-To Guide (Incurred Medical Expenses)
Overview of Incurred Medical Expense
The Incurred Medical Expense regulations1 can help most nursing facility residents who are enrolled in Medicaid pay for dental care.2 Medicaid residents with Social Security or other retirement income3 may be able to pay for medically necessary dental care that is not covered by Medicaid.4
The following illustrates how the Incurred Medical Expense regulations may operate in practice for:
You can also download a PDF of all the Incurred Medical Expense guidelines (PDF).
1. To view the regulations, read Subpart H — Post-Eligibility Financial Requirements for the Categorically Needy of the linked PDF.
While this document does not use the term "Incurred Medical Expense," it provides the information the ADA's Incurred Medical Expense documents are based on.
2. If the resident has applicable income and pays for medically necessary dental care that is not covered by Medicaid or another third party payer, the state Medicaid agency may be permitted to increase its pay- ment to the institution in the amount that the resident incurred for the care.
3. Medicaid beneficiaries with certain forms of income must generally apply that income, less certain deduc- tions, to the cost of institutional care. The state Medicaid agency reduces its payment to the facility in
the amount of such income less the deductions.
4. One required deduction is for expenses that the patient incurred for certain non-covered dental care. The agency may establish reasonable limits on the amounts of these expenses.