Allowable expenses chart
This section gives a listing of allowable medical or remedial services and expenses that are allowed to reduce participation or used in MN spenddown. This is not a complete list, but an aid to use when determining whether a claimed medical expense is allowed to reduce participation or used to meet spenddown.
Allowable expenses | |
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Medical supplies (e.g. syringes, adult diapers, etc.) and drugs, including OTC drugs prescribed by an M.D., D.O. or A.R.N.P. | Cost of, or payments if rental or purchase contract for durable medical equipment, including aids to mobility, rehabilitative aids, prosthetic/orthotic devices, and Electronic Emergency Response Systems (EERS) |
Hospital services, emergency room, clinic (including mental health clinics) and nursing facility expenses | In-home nursing care if need is documented with a physician's statement |
Insulin and its necessary administration devices | Blood and its derivatives |
Hearing aids and related supplies | Oxygen |
Medical/dental insurance deductibles & coinsurance charges incurred during the base period | Out of State billings for medical services recognized under WA State law |
Remedial care such as dialysis helpers | Community case management in support of medical services or care |
Medical transportation by personal vehicle at the current state reimbursement rate | Medical transportation by other means (e.g. bus, taxicab/rideshare, etc.) at the actual fare or fee. May include parking fees |
Medically necessary improvements to the home to accommodate a disabled person | Other services prescribed by an allowable medical practitioner |
Away from home lodging costs related to medical treatment | Food and other expenses for a medically necessary service animal |
Nonallowable expenses | |
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OTC drugs and medications not prescribed, including medical cannabis, even if it is prescribed | Out-of-state billings for medical services not recognized under WA State law |
Services obtained out of the US | Food, health food and nutritional supplements, unless prescribed |
In-home cooking/cleaning services | Property maintenance |
Trips or retreats | Health camps or retreats |
Dietetics | Unpaid LTC participation incurred while active on an institutional Medicaid program |
Commercial diet clinics and gyms | Telephone charges |
Physical fitness aids unless prescribed for medical services | Massage Therapy, unless prescribed (must be provided by licensed practitioner) |
Note: When an individual lives in an alternate living facility (ALF) and pays privately to the facility for their care, these charges are not considered a medical expense and cannot be allowed towards meeting spenddown. See WAC 182-513-1205 for rules on how to determine Medicaid eligibility for an individual who is living in a licensed, state contracted alternate living facility.
Long-term care medical expense chart
The Allowable medical expenses is a chart that describes the allowable medical and remedial services allowed to reduce participation in post eligibility for long term care.