|
Client Circumstance
|
Allow Standard Deductions
|
Allow out-of-pocket expenses
|
Verify
|
Spenddown
|
|
Medicare PRX Card:
Standards chosen
|
$23 for certification period; and
$50 for 24 months; or
$50 for prorated months in 2005
|
Under “normal” procedures; and
In addition to standards.
|
“Medicare-approved” card
Any current out-of-pocket expenses the client actually pays; and
Not covered by subsidy or discount.
|
Standards:
Regardless of spenddown status:
Allow $23 standard throughout certification; and
Allow $50 for prescribed length of time.
Out-of-pocket portion:
Adjust if budgeting when due; or
Do not adjust if averaged over certification period.
|
|
Medicare PRX Card:
Pre-card expenses chosen: Actual
|
None
|
Amount prior to using card; and
That the client paid regularly; and
Consistently budget throughout certification period
|
The amount paid prior to using the discount card and/or subsidy.
|
Allow expenses regardless of spenddown status as they are considered to be averaged over the certification period.
|
| Medicare PRX Card:
Pre-card expenses chosen: CMS average
|
None |
Allow $48.17 for each pre-card expense for which the specific amount paid prior to the client having the card is not known. |
The number of regular pre-card prescriptions the client paid. |
Allow expenses regardless of spenddown status as they are considered to be averaged over the certification period. |
|
No card or Medicare Part D enrolled
|
None
|
Out-of-pocket allowable expenses as described in WAC,
Either:
When due; or
Averaged over certification period for consistency
|
The expenses when due; or
|
If recurring expenses are budgeted when due, adjust expenses for Medicaid approval;
|
|
The expenses as anticipated.
|
If paid expenses are averaged over certification, do not adjust for spenddown status.
|
