This page is displayed because you indicated this medical bill was either changed, ended or added. This page will repeat for each type of expense selected on the Medical Bills Type Selection page. If this was indicated by mistake, remove the record once you reach the Other Bills Summary page at the completion of this section of the Redetermination/Change Report/Simplified Report.
Some items have an asterisk (*) next to them, indicating they are mandatory. You must fill in these items before you can continue to the next page.
Hospital Bills Details
Depending on if you selected that an expense was added, changed, or ended, enter the date into the “When did this bill start,” “When did this bill change,” or “When did this bill end” fields.
Payment Details
When entering the amount the household member pays, only enter two decimal places. Special characters, such as commas, are not allowed.
Help with Paying
When entering How much do they pay? Only enter two decimal places. Special characters, such as commas, are not allowed.
Add Another?
To add another medical-related expense, select Yes to the question in this section.
Click the Print button to print this page for your reference.
Click the Next button to save and continue with the online Redetermination/Change Report/Simplified Report.
Click the Previous button to view the previous page.
Click the Save & Exit button to exit the online Redetermination/Change Report/Simplified Report and save your progress on your Redetermination/Change Report/Simplified Report. The Redetermination/Change Report/Simplified Report is saved as Incomplete.