Effect of Paying for Medication Outside of Medicaid

by AJ


If medicaid or medicare will not pay for specific medication for my mother can I pay for it without penalty?


Chapter 15 of Gabriel Heiser's terrific book Medicaid Secrets addresses this question. He says that necessary medical expenses (as recognized by state Medicaid rules) that aren't covered by Medicaid or Medicare can be purchased by a medicaid recipient and that would be a deductible expense that would reduce the income a nursing home resident would be required to pay the nursing home. The nursing home resident can submit a request to the state to have the expense covered out of the resident's own income.

Assuming the request is approved, in the end, effectively Medicaid would be paying that necessary medical expense (possibly the medication you are asking about) by allowing the resident to shift income from the nursing home to the provider of the medication.

So, the bottom line is you should submit the request to your state medicaid office and see what they say. It would be best to have your mom pay for it; if she can't it doesn't seem it would affect her negatively if you do. But, ask the state medicaid office to be sure.

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Jun 25, 2010
Additional Comments on Paying for Medication On Own
by: Mo Johnson

Theoretically, if a child buys medicine for the parent, that's a gift, and the value would be income to the parent in the month received. However, as a practical matter, these kinds of purchases are often not reported to the Medicaid agency and so the issue never really comes up.

Also, often there are generic medications that are allowed. Also, sometimes some providers allow them and others don't (so changing providers might solve the problem).

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