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size is based on the number of family members only – that is, the LTSS beneficiary is not counted. c. Family maintenance of needs allowance. The difference between the family maintenance of need standard and total gross income of the family members is the family maintenance of need allowance. The family maintenance of needs allowance counts toward the maximum monthly maintenance of need standard. 8.7 Health Expenses A. Health care and insurance. Additional amounts of the income of a Medicaid LTSS beneficiary may be protected to cover certain medical/health costs incurred by the beneficiary or financially responsible relatives, such as spouse, sibling, or adult child. 1. Health Coverage Costs – Health care premiums, co-payments and deductibles incurred by the Medicaid LTSS beneficiary that are not subject to payment by Medicaid or a third (3rd) party may be deducted from income. This includes the beneficiary’s costs for Medicare, including Medicare Advantage and Part D plans, supplemental health insurance for dental and/or vision and long-term care insurance policy premiums. Only the portion of these costs that is for the Medicaid beneficiary are allowed. 2. Allowable Medical Expenses – Unpaid past expenses for medically necessary services may be deducted from available income in certain circumstances. For such expenses to reduce available income for beneficiary liability determination purposes, they must meet all the criteria to be considered allowable and exclude any costs of care already used to meet the beneficiary’s spenddown. A medical expense must be allowable under this section to be deducted in the LTSS income calculation. An allowable expense must meet the following conditions: a. Medically necessary. The expense must be medically necessary. A necessary medical expense is an expense rendered – for any of these situations: (1) In response to a life-threatening condition or pain; (2) Treat an injury, illness or infection; (3) Achieve a level of physical or mental function consistent with prevailing community standards for the diagnosis or condition; (4) Provide care for a mother and child through the maternity period;