24.3 Deductible Period

The Medicaid deductible period is a period of six consecutive months. It is the length of time the group has for meeting the Medicaid deductible. It begins in the month which the applicant chooses, and it ends six months later. See 5.9.5 Eligibility for an exception to the 6 month deductible period for backdate periods after a formal disability determination has been made for a member certified under a PD.

The applicant can choose to begin the Medicaid deductible period as early as three months prior to the month of application, and as late as the month of application.

Example 1: John applies for Medicaid in July. He can choose to begin his six month Medicaid deductible period in April, May, June, or July.

The applicant cannot choose a Medicaid deductible period which includes a month in which, if he or she had applied, he or she would have been ineligible due to excess assets.

Example 2: Doyle applies for Medicaid in July. He has excess income in July. He wants a Medicaid deductible period that goes from April through September. In addition to having excess income in April, Doyle had $5,000 in his savings account on April 30. He cannot include April in his Medicaid deductible period. He no longer had the $5,000 on May 31, so he can begin his Medicaid deductible period in May.

Example 3: Clarice applies for Medicaid in July. She has excess income in July. She wants a Medicaid deductible period that goes from April through September.

In addition to having excess income in April and May, Clarice had an inheritance of $5,000 in May. She still retained it on May 31. Therefore, she cannot include May or any months prior to May in her Medicaid deductible period. She no longer had the $5,000 on June 30, so she can begin her Medicaid deductible period in June.

The applicant can choose a Medicaid deductible period which includes a month in which, if he or she had applied, he or she would have been ineligible for a non-financial reason. Although excess income is still calculated over a six month period, the individual can only be certified for Medicaid during the dates when he or she was non-financially eligible.

Example 4: Marion applies for Medicaid in July. She has excess income in July. She wants a Medicaid deductible period that goes from April through September.

Marion was incarcerated from April 30th through May 18th. She meets the deductible with a countable expense from April 10th, so she should be certified from April 10th through April 29th, and May 19th through September 30th.

Example 5: Janet applies for Medicaid in July and requests a Medicaid deductible period from April through September. She gave birth on June 30th. Janet paid the full deductible amount, so is certified from April 1st through June 30th.

For backdate months, when a person had excess assets in any of the three months prior to the month of application, his or her eligibility in the backdate month is determined by whether or not he or she had excess assets on the last day of the month.

Example 6: Jack applies for Medicaid in July. He wants a Medicaid deductible period that goes back two months to include May and June. In May, he would have been eligible except for excess income. In June he had received a $10,000 gift. On June 29 he went to the track and lost the $10,000. Had he applied on June 30 he would have been eligible. Jack can include both May and June in his Medicaid deductible period.

Example 7: Mansour applies for Medicaid in July. He is found to be eligible. He had medical bills in April and May. He also had excess income in April and May. He wants a Medicaid deductible period that includes April and May. Unfortunately, he was the recipient of a $5,000 cash gift on June 29. It was several days before he was able to spend it on groceries and other legitimate purchases. Mansour will not be able to include April or May in the deductible period because on June 30, had he applied, he would have been determined ineligible.

An individual can establish a new deductible period at any time if they file an application for Medicaid. This includes situations where someone has already established a deductible period, hasn’t yet met the deductible, and wishes to establish a new deductible period.

Example 8: Jeff applies for Medicaid on 1/1/14 and his monthly excess income is $100.00. His Medicaid deductible is $600.00 and his deductible period is January 01, 2004 through June 30, 2014. In April 2014, Jeff’s monthly excess income decreases to $10.00 a month. Jeff reports the decreased income in April and now has a choice between two different deductible recalculations. He can either have his worker recalculate the original $600.00 deductible which would then become a $330.00 deductible (three months of $100.00 excess income and three months of $10.00 excess income) or since he hasn’t yet met that deductible, he can file a new application in April and establish a new deductible period of April 2014 through September 30, 2014 with a $60.00 deductible obligation ($10.00 x 6 = $60.00). If Jeff hasn’t already incurred any substantial medical expenses, he may want to file a new application, set a new deductible period, and be in a better position to meet a much smaller deductible. (See 24.6.1 Changes During the Deductible Period> Income Changes.)

Individuals who have been certified for Medicaid after meeting a deductible, will have to complete a review to establish a new deductible period. CARES does not send a review notice to the member regarding the new deductible period if he or she did not meet the deductible for the current period.

This page last updated in Release Number: 15-01

Release Date: 06/10/2015

Effective Date: 06/10/2015