North Carolina Medicaid Agency’s Denial of Benefit Held Improper

The full amount of medical expenses incurred while a North Carolina man was eligible for, but not enrolled in, Medicare Part B must be used to calculate his Medicaid deductible, a state appeals court said.

Under federal law, a state Medicaid plan may not condition payment on a beneficiary’s enrollment in Medicare, the North Carolina Court of Appeals said. A plan also may not do so indirectly by excluding the amount that would have been covered by Medicare from the Medicaid deductible, it said.

John Hendrixson incurred outpatient hospital expenses totaling over $20,000 between March 6 and April 26, 2018. ...