Allowable expenses chart

Revised date
Purpose statement

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

  • Away from home lodging costs related to medical treatment
  • Blood and its derivatives
  • Community case management in support of medical services or care
  • 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)
  • Food and other expenses for a medically necessary service animal
  • Hearing aids and related supplies
  • 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
  • Other services prescribed by an allowable medical practitioner
  • Out of State billings for medical services recognized under Washington State law
  • Oxygen
  • Medical/dental insurance deductibles and coinsurance charges incurred during the base period
  • Medically necessary improvements to the home to accommodate a disabled person
  • 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.
  • Medical transportation by other means (e.g. bus, taxicab/rideshare, etc.) at the actual fare or fee. May include parking fees
  • Medical transportation by personal vehicle at the current state reimbursement rate
  • Remedial care such as dialysis helpers

Nonallowable expenses

  • Commercial diet clinics and gyms
  • Dietetics
  • Food, health food and nutritional supplements, unless prescribed
  • Health camps or retreats
  • In-home cooking/cleaning services
  • Massage Therapy, unless prescribed (must be provided by licensed practitioner)
  • OTC drugs and medications not prescribed, including medical cannabis, even if it is prescribed
  • Out-of-state billings for medical services not recognized under Washington State law
  • Physical fitness aids unless prescribed for medical services
  • Property maintenance
  • Services obtained out of the US
  • Telephone charges
  • Trips or retreats
  • Unpaid LTC participation incurred while active on an institutional Medicaid program

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

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.

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