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Incurred Medical Expenses: Suggested Steps for Residents and their Representatives

Paying the Nursing Facility's Bill

Upon admission to a nursing facility, a Medicaid Caseworker determines how much income you as a resident receive each month and applies that income to pay your Nursing Facility's bill, except for an amount for personal needs and certain other required deductions. Generally, residents on Medicaid don't have enough income to pay the total amount of the Nursing Facility's Bill, so the Caseworker directs Medicaid to pay the remaining balance each month.

Paying the Dental Bill

When a resident receives a Dental Bill for services that are not covered by Medicaid or another third party payer, the bill may qualify as an Incurred Medical Expense. The resident's Medicaid Caseworker plays
an important role in this process by reviewing the Dental Bill, approving it as an Incurred Medical Expense, and then notifying the resident or the resident's financial representative to pay the Dental Bill instead of that portion of the Nursing Facility's bill. At the same time the Caseworker approves payment of the Dental Bill, he or she must notify the state requesting it to increase the amount that Medicaid pays towards the Nursing Facility's Bill to make sure that the facility continues to be paid in full. If the total amount of the Dental Bill is less than the resident's total monthly income, then the Dental Bill can be paid in full with just one payment. If the total amount of the Dental Bill is greater than the monthly income, then several monthly payments will need to be approved so that the entire Dental Bill gets paid. During each of those months, the Nursing Facility's payment from Medicaid would be increased by the amount of the Dental Bill payment.

Each state will have variations in the procedures for Incurred Medical Expenses which will be addressed by the resident's Medicaid caseworker and dentist.

Working with the Medicaid Caseworker to pay for dental services

  1. The dentist will provide a Dental Bill for the resident and may also provide a second copy for your Caseworker.
  2. After your Caseworker has reviewed the Dental Bill and approved payment, you will receive detailed instructions regarding paying the bill. Depending on the total amount of the Dental Bill, it may be necessary to make monthly payments until the bill is paid in full.