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In order to be applied to spend-down, each medical expense must meet all of the following criteria:

 The expense must have been incurred by either a member of the assistance unit or by an individual who has been provisionally included in the assistance unit.  The expense must be for a medical service that is either customarily covered by MA or required by a physician for medical reasons. Additionally, customers may count any legitimate medical expense for a non-covered service including: o dental care for persons over 21 o chiropractic services, or o transportation to obtain a countable medical service, such as for a medical appointment, or to purchase medications.  The expense is not subject to payment by an MA program of any jurisdiction, a health insurance program, or any other liable third party (any portion of an expense that is subject to such payment is not countable).  The expense must not have been counted toward a previous spend-down deductible that resulted in earlier certification of eligibility in any jurisdiction.  The document verifying the expense must be legible and must include the date of service, the name of the person or organization that provided the service, the cost of service, the individual's liability (net of the amount owed by a third party such as an insurer), the type of service provided, and the current billing date for the balance due.

The expenses are allowable even if they are paid by a 'public program' (other than the Medicaid program) of the District of Columbia if the program is financed by the District of Columbia. A 'public program' must meet the following criteria:

 be under the administrative control of the District of Columbia, and  receive its funding, except for beneficiary deductibles and coinsurance amounts, directly from the District of Columbia (or funding transferred from another District of Columbia public program.)

Third Party Liability 7.4.1

In addition, the expense must not have been fully covered or paid by a third-party (Medicaid, Medicare, or other public or private insurance). If a third-party is liable for a portion of the medical expense, only the remaining liability of the applicant/recipient can be counted as an allowable medical expense. If third party liability cannot be ascertained, or third party payment has not been received, the Department cannot delay eligibility determination beyond the prescribed time period for reaching a decision on Medicaid eligibility, and the applicant/recipient's liability for the partially covered bills must be estimated.

Allowable medical expenses are deducted in the order most advantageous to the recipient. In general this will mean the expenses should be deducted in the following order:

 health insurance premiums (see Section 7.4.2: Health Insurance Premiums and 7.4.3: Medicare Part B premiums in this Chapter);  medical expenses not usually covered by Medicaid; Example Ms. Ogden has several medical bills from the past several months, some of which were covered by her former employer's health plan. If the health plan covered 80 percent of her $1,000 in doctor bills, then the only allowable medical expense deducted from Ms. Ogden's spend-down deductible is the remaining $200, her share of the expense.