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. See Section 5.9.5 Eligibility for an exception to the six-month deductible period for backdate periods after a formal disability determination has been made for a member certified under a presumptive disability.

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 after 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, July, or August.

However, the first month of a deductible period may not be a month in which the person is ineligible for excess assets or is non-financially ineligible. The applicant may choose a six-month deductible period that includes one or more months (except for the first month) in which they are ineligible for excess assets or for a non-financial reason. Excess income is still calculated and included in the deductible amount for any months that the applicant may be ineligible due to assets or a non-financial reason. If the applicant meets the deductible, they may only be certified for Medicaid during the months when they were non-financially and asset eligible.

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, but no longer had the $5,000 on June 30. Her deductible period will run from April through September. However, if she meets the deductible in April, she would only be eligible through the end of April and from June 1 to September 30. If she meets the deductible in May, she would only be eligible from June 1 to September 30. Due to excess assets in May, she may not be eligible for any day in that month.

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

Example 5

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

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 they 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 received a $10,000 gift. On May 29, he spent the $10,000 on a new roof. His assets were below the asset limit by the last day of the month, and he is otherwise eligible except for excess income for both backdated months, so his deductible period can begin in May.

A new deductible period can be established at any time before the current deductible has been met. The person must sign and submit a new application in order for the new deductible period to be established. A new application is required regardless of when the previous deductible period was established or if anyone in the household is eligible for another health care program such as a Medicare Savings Program.

Example 7

Jeff applies for Medicaid in January. His monthly excess income is $100. His Medicaid deductible is $600 and his deductible period is January 1 through June 30. In April, Jeff’s monthly excess income decreases to $10 a month. Jeff reports the decreased income in April and now has a choice between two different deductible recalculations. He can either have the agency recalculate the original $600 deductible which would then become a $330 deductible (three months of $100 excess income and three months of $10 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 through September with a $60 deductible obligation ($10 x 6 = $60). 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 Section 24.6.1 Income or Deduction Changes).

Members who have been certified for Medicaid after meeting a deductible will have to complete a renewal to establish a new deductible period. No renewal notice is sent regarding the new deductible period if the applicant did not meet the deductible for the current period.

This page last updated in Release Number: 22-03
Release Date: 12/05/2022
Effective Date: 12/05/2022