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

Eligibility for individuals in an alternate living facility

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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