Medicaid Policy
Medicaid Policy
1. An overpayment is a payment for medical services for a member who was not eligible in the month the member received the service.
2. An overpayment is also a payment for medical services for a member who was eligible but not for the medical service the member received (Comparison of Adult Medicaid Programs).
3. An understated liability occurs when the member pays less than the correct liability amount while receiving medical assistance. Liability includes:
A. The spenddown amount (461)
B. The contribution to cost of care for Home and Community based services (381, 382, 383, 384, 385, 386, 387, 388 and 389).
C. The contribution to cost of care for services provided by nursing homes (463). However, members in nursing homes who pay a contribution to cost of care that is less than the correct amounts do not have an understated liability error because they owe the contribution to cost of care to the nursing home (463-1).
D. The MWI premium (462).