What is Medicaid Recipient Liability?

Recipient liability is your gross monthly income minus allowable income levels, deductions and disregards.

Your remaining monthly net income is considered to be available for payment of medical services provided to you or your family.

Recipient liability is the total amount of medical expense that you must be billed for in each month before the Medicaid program will pay. The amount of your recipient liability does not have to be paid for you to receive Medicaid. It is like meeting your deductible with private health insurance.

What Are Medicaid Monthly Income Levels?

Medicaid monthly income level is the amount of income you are allowed to have to meet your monthly living needs or the needs of your family.

There are three general monthly income levels based on the type of Medicaid coverage you are receiving: categorically needy income levels; medically needy income levels; and, poverty income levels. You need to ask what kind of Medicaid coverage you are under.

As an example the medically needy income levels are:

For each person in the household above ten, add fifty-seven dollars to the monthly amount.

What Expenses May Be Deducted?

1) Premiums for health insurance.

2) Medical expenses incurred by you or your family.

3) Transportation expenses necessary to obtain medical care.

4) Reasonable child care expenses.

5) Others

What Income Is Disregarded?

1) Temporary Assistance for Needy Families.

2) Low Income Home Energy Assistance Program Benefits.

3) County General Assistance.

4) Lump Sum SSI benefits in the month received.

5) Occasional small gifts.

6) A loan from any source that is subject to a written agreement requiring repayment by you.

7) Income Tax Refunds and Earned Income Credits.

8) Educational loans, scholarships, grants, awards, Workman's Compensation vocational rehabilitation payments, and work study received by a student.

How is the Amount Determined?

To determine the amount of your recipient liability, total all your income. Then subtract allowed income level, deductions, and disregards. The result is your recipient liability.

What Are Your Responsibilities?

You are responsible for paying the medical bills that are identified as your recipient liability. Once your medical bills for the month total your recipient liability, then medicaid starts paying.

Medicaid only pays for expenses that are over your recipient liability. Medicaid will pay even if you do not pay your recipient liability.

If you receive Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF), you should not have a recipient liability.

Disclaimer: This information is not legal advice. If you have a legal problem, you should talk to a lawyer and ask for advice about your options.

Reviewed July 2007

NDCC §75-02-02.1-39,40,41.6
Published by Legal Services of North Dakota