Medicaid will not pay medical bills that you incur before you are eligible. However, Medicaid may begin your 6 month Period of Consideration (POC) for eligibility as much as 3 months before you apply to determine your eligibility. So, if you apply for Medicaid shortly after you incur the bills, you may be able to get Medicaid to pay for them.
If your income is above the Medically Needy Income Limit (MNIL), you can use old unpaid medical bills toward your spend down. Medicaid will not pay the old bills, but you may not have to pay for additional medical expenses that you incur. You can also use your spouse’s or dependents’ medical bills to meet the spend down if they live in your home.
For example, say you have $5,000 worth of medical bills and you decide to apply for Medicaid. Let’s further say that you have a spend down limit of $1,000. You can use $1,000 worth of the old medical bills toward your spend down amount. By doing this, you will not have to pay anything for your medical expenses during the six-month period, starting with the date of your application for Medicaid; Medicaid pays it all. However, you are still responsible for paying the old medical bills.
Medicaid reassesses your eligibility every six months. Each time, Medicaid will set your spend down amount. You can keep using the old bills toward your spend down amount, as long as you do not use the same portion twice. That means that if your spend down amount was $1,000, and you had a single old unpaid medical bill for $5,000, you could use $1,000 of the $5,000 bill five times as your spend down amount. After that, you would pay the spend down amount yourself for bills you incur, or those for which you must pay, as needed.
In terms of getting Medicaid coverage with your upcoming medical expenses, old unpaid medical bills can help you. However, Medicaid will not actually pay any of these bills.
Also, Medicaid will not pay for any medical expense that is eligible for coverage by any other insurance such as Medicare or a private insurer. Likewise, Medicaid will not use any medical expense that is covered or eligible for coverage by Medicare or other insurance to meet the spend down.
For more information, see: West Virginia Department of Health and Human Resources, Income Maintenance Manual, §§ 1.22(M), 10.22(D)(11), http://www.wvdhhr.org/bcf/family_assistance/policy.asp (last visited May 26, 2015).