Spenddown allowable expenses chart

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DSHS Home Acronyms Revisions WAC Number Index Site Map WCCC

Revised March 25, 2011

Allowable expenses

- Medical supplies (eg 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 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

Non-allowable expenses

- OTC drugs & medications not prescribed - Medical marijuana	- Out of State billings for medical services not recognized under WA State law.
- Services obtained out of theUS	- Food, health food & nutritional supplements, unless prescribed
- In home cooking/cleaning services	- Property maintenance
- Trips or retreats	- Health camps or retreats
- Sex change operations	- Dietetics
- Commercial diet clinics & gyms	- Telephone charges
- Physical fitness aids unless prescribed for medical services	- Unpaid LTC participation incurred while active on an institutional medicaid program

NOTE:

When a client 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 therefore cannot be allowed towards meeting spenddown. See WAC 388-513-1305 for rules on how to determine Medicaid eligibility for a client who is living in a licensed, state contracted alternate living facility.

Long-term care medical expense chart

The long-term care allowable medical services and expense section is a chart that describes the allowable medical and remedial services allowed to reduce participation in post eligibility.