Medicaid Policy
Medicaid Policy
1. When excess resources cause ineligibility
When the agency discovers a member was over assets in a past month, the overpayment review period includes that first month of exceeding resource up to the date of discovery.
a. Determine which months during that period the member's assets exceeded the limit.
b. For each overpayment review period during which resources exceeded the applicable resource limit in one or more months, the amount of the overpayment is the lesser of:
i. The amount the medical assistance program paid for the medical services the member received during the months in that period when resources exceeded the limit, or
ii. The difference between the highest amount of the member’s countable resources in a month during that period and the applicable resource standard for the program for which the member was approved.
iii. If the member could have qualified for another Medicaid program during the period under review, no overpayment occurred.
2. When factors other than excess resources cause ineligibility
The amount of the overpayment is the amount the medical assistance program paid for the medical services the member received during the month less any spend down, contribution to cost of care or premium that the member paid during the month.
3. When an understated liability is the medical assistance payment error
The amount of the overpayment is the lesser of:
a. The amount the medical assistance program paid for the medical services the member received during the month, and
b. The difference between the correct liability amount and the amount the member paid for the month.