Spenddown allowable expenses chart
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Spenddown allowable expenses chart


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.

Modification Date: March 25, 2011