Medicaid: Cost-share deduction for health insurance premium

Cost-share deduction for health insurance premiums. The ALJ stated the issue as whether a nursing home resident is entitled to a deduction from her patient liability for Medicaid for Health insurance premiums paid by her spouse who resides in the community. DFCS disallowed IME coverage for health insurance premiums paid y the Community Spouse, taking the position that noly premiums paid for by the Institutionalized Spouse qualify for IME coverage. DFCS also disallowed a budgeting reduction of the patient cost-share based on voluntary tax withholdings. Citing Georgia Department of Community Health v. Gwinnett Hospital System, 262 Ga. App. 879 (2003); Bentley v. Chastain, 242 Ga. 348 (178) and Albany Surgical v. DCH, 257 Ga. App. 636 (2002), the court deferred to the agency and relied on a policy analyst memo indicating that health insurance premiums qualify for IME coverage only when they are paid by the applicant. The decision was affirmed.

OSAH-Houston-Woodard-6-2008.pdf (June 27, 2008).