Medicaid Policy
Medicaid Policy
When a Traditional Medicaid recipient is eligible to receive reimbursement for mileage or overnight costs, (see sections 651-3 and 651-4), payments should generally be made after the person has received the medical services and can provide evidence of the miles traveled and the actual lodging and food costs.
Sometimes a Traditional Medicaid recipient may need an advance payment. Evaluate such requests on a case-by-case basis. When making an advance payment, document the reason in the case record. The recipient must still provide verification of the mileage, and actual lodging and food costs, if applicable, after the recipient has received the medical services. Have the recipient complete a statement of miles traveled (odometer readings at start and end of trip may be needed). For lodging and food costs, request copies of the motel/hotel receipts and restaurant or grocery store receipts. Workers may estimate the mileage for certain trips based on past history or use an online site like Map Quest to find out the actual mileage.
A. Mileage Reimbursement
1. Rate Per Mile:
Eligibility workers shall reimburse mileage at the rate of 18 cents per mile, up to a maximum of $300 a month per household. The maximum may only be exceeded if the recipient's medical condition requires the individual to travel frequently for treatment. A reimbursement of more than $300 will need an eligibility supervisor to authorize it in the eligibility system. Document the reason and decision in the case record.
2. Mileage Reimbursements for Past Months of Eligibility
A Traditional Medicaid recipient may be reimbursed for prior months of mileage costs if:
a. The costs were incurred within one year before the date of request, and
b. The recipient was eligible or has become eligible for Traditional Medicaid benefits for the months the costs were incurred.
c. The 12-month limit does not apply when a person has just been granted eligibility that extends back more than 12 months (such as in some disability cases.) Inform the member to request mileage reimbursement for transportation costs to services received more than 12 months ago within 3 months of becoming eligible for Medicaid for those months.
d. The transportation was to receive medically necessary services that are Medicaid-covered and were provided by a Medicaid provider, with one exception:
· When Medicaid eligibility is approved for past months, the provider is not required to accept Medicaid, or the member may have seen non-Medicaid providers. However, if the services the member received are a type which could have been paid by the Medicaid plan for which the member qualifies, the recipient may be reimbursed for the mileage.
B. Overnight Lodging and Food Costs
Eligibility workers may reimburse overnight costs including lodging and food up to a maximum of $50 per night when Traditional Medicaid recipients must stay overnight to receive medical treatment. Reimbursement of food costs cannot exceed $25 of the total $50 per night rate. This includes travel to communities in other states that are near the Utah borders if members cannot receive services locally. (See section 651-4, item #2 for additional information.)
Reimbursement for overnight costs of up to $50 per night may also be paid for one companion or attendant that must accompany a Traditional Medicaid recipient who has a medical need for a companion, or for a parent that accompanies a dependent child as long as the Traditional Medicaid recipient stays with the companion, attendant, or parent, and not in a medical or treatment facility. (See section 651-4, item #2.E. for additional information.)
Traditional Medicaid recipients must provide verification of the lodging and food costs to receive reimbursement. Reimburse actual lodging costs or $50 per night, whichever is less. If the lodging cost is less than $50 per night, food costs up to $25 per night may be reimbursed. The total combined reimbursement for both lodging and food cannot exceed $50 per night for the Traditional Medicaid recipient and $50 per night for the attendant or parent.
At times a Traditional Medicaid recipient must travel out of the state for medical care because the services are NOT available in the state. In this case, the prior authorization unit must authorize the medical services AND the travel costs before the person receives the services. Do not reimburse the recipient for such trips unless you have received instructions from the Prior Authorization Unit at HCF to make the reimbursement.
C. Verification of every medical appointment is not required. For mileage reimbursement, the Traditional Medicaid recipient must complete a mileage log showing the miles traveled and the dates. For reimbursement of overnight costs, the recipient must provide receipts of the motel/hotel, restaurant and/or grocery costs. Eligibility workers may request verification of appointments when recipients make frequent trips or travel outside the local area for services.
D. Preferably, workers should arrange with the recipient to make reimbursements once a month, or even once every two or three months (for ongoing members) depending on how often the recipient travels to appointments. More frequent reimbursements can be made, however. Recipients who must travel frequently for medical treatment, particularly if they must travel long distances, may need to be reimbursed more often than once a month so that they can afford gasoline for their vehicle.
E. Workers can make advance payments for mileage and overnight costs when the medical appointment has been verified and it would be difficult for the Traditional Medicaid recipient to get to the appointment without an advance for mileage and/or lodging and food costs. Whenever an advance payment for overnight costs is made, the recipient must provide receipts and in some cases a mileage log within ten days after returning from the trip. (If the worker could approximate mileage fairly closely and had verification of the medical appointment, a mileage log is not needed.) If the recipient does not provide the needed verifications within ten days, see section 825 for policy on overpayments.
If you have questions about mileage or overnight costs reimbursements, please contact a Medicaid program specialist listed on Table IX.