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6.1.2 RECOVERABLE SERVICES

6.1.2.1 QMB

 

Not all services provided by MA are recoverable.  Recoverability depends on what was provided and the client’s age and residence when s/he received the benefit.

 

Following are the services for which ERP may seek recovery:

 

  1. All Medicaid services received while living in a nursing home on or after October 1, 1991.
     

  2. All Medicaid services received while institutionalized in an inpatient hospital on or after July 1, 1995.
     

  3. Home health care services received by clients age 55 or older on or after July 1, 1995 consisting of:
     

    1. Skilled nursing services.

    2. Home health aide services.

    3. Home health therapy and speech pathology services.

    4. Private duty nursing services.

    5. Personal care services received by clients 55 or older on or after April 1, 2000.
       

  5. All home and community-based waiver services ( COP Community Options Program Waiver, CIP 1A, CIP 1B, CIP II, Brain Injury Waiver and Community Supported Living Arrangements) received by clients age 55 or older on or after July 1, 1995 and:
     

    1. Prescription/legend drugs received by waiver participants.

    2. Benefits paid associated with a waiver participant’s inpatient hospital stay.  These include inpatient  services that are billed separately by providers and Services that are non-covered hospital services.
       

  7. In pilot counties, Family Care services received by clients age 55 or older on or after February 1, 2000 and:
     

    1. Prescription/legend drugs received by waiver participants.

    2. Benefits paid associated with a waiver participant’s inpatient hospital stay.  This includes inpatient services that are billed separately by providers and that are non-covered hospital services.
       

  9. Costs that may be recovered through a lien are:

 

    1. Medicaid costs for services received on or after October 1, 1991 during a nursing home stay.
       

    2. Medicaid costs of all other recoverable services as listed in Items 1-5 that are received on or after April 1, 2000 by clients 55 or older as of the date of the service.

 

6.1.2.1 QMB

Payments for the Qualified Medicare Beneficiary ( QMB ) Medicare Part B premiums are not recoverable through ERP.

 

QMB co-payments and deductibles paid by Medicaid are recoverable through ERP.  They are only recoverable if the co-payment or deductible was used to pay for a Medicaid service that is recoverable.

 

This page last updated in Release Number : 01-01

Release Date: 01/01/01

Effective Date: 01/01/01