625.05 Allowable Medical Expenses (MAM)

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Offset the monthly or six-month spenddown by incurred costs of medical care and services recognized as legitimate under state law. Incurred costs for medical care and services that the medical assistance program does not cover are also considered valid expenses. Allow the medical expenses of the assistance group and any individual the recipient is liable for.

Incurred cost means the amount of the medical expense which the individual is responsible for after third-party payments have been made.

Exception: Allow medical expenses paid by local, county, state, or federal public funds, including medical expense payments using local, county, state, or federal public funds, provided by agencies that have a contract with the State to provide these payments (such as a Community Mental Health Center or Area Agency) as if the individual were responsible for them.

The following are examples of allowable incurred medical expenses:

. current medical expenses;

. health insurance premiums such as Blue Cross-Blue Shield, Medicare Part B, and any other enrollment fees or premiums;

. over-the-counter medication that is part of a treatment plan supervised by a physician;

. medical transportation (see Chapter 900 of the Medical Assistance Manual);

. adult medical day care; and

. currently obligated unpaid prior medical bills, including debts of individuals for whom the recipient is liable.