Practitioners

ARNP advanced registered nurse practitioners

CRN certified registered nurses

DC chiropractors

DDS dentists, denturist, orthodontist, periodontitis

Dental hygienists

DO osteopath

DPM podiatrists

Electrotherapist

Hydro therapist

Inhalation/respiratory therapists

MD physicians

Midwives

OD optometrist

Opticians

PA physicians assistants

Pharmacists

Physical Therapists

Psychologists/psychiatrists

Speech therapists

X-ray technicians

Acupuncturist

Dietitians

Licensed massage therapist

Naturopaths

Herbalists

Holistic healers

Homeopaths

Hypnotists

Masseurs or manipulators

Medical cannabis distributor

Practitioners not licensed under Washington State law

Psychic or faith healers

Sanipractors

Veterinarians (unless the expense is for a medically necessary service animal)

Services obtained out of the US

Interest and fees incurred on an unpaid medical bill

Durable medical equipment or modification approved under the HCBS Waiver program for individuals receiving Waiver services is not an allowable participation deduction

Insurance premiums for policies that pay a cash benefit to the insured and the benefit is not intended to reimburse a provider. These premiums are not health insurance but pay directly to the insurance holder under certain conditions. (usually a daily rate when the client is unable to work, in the hospital or has a certain type of medical condition). Contact the carrier to find out if it is a health insurance or one of these policies that pay a cash benefit to the client and not a provider because of a health condition. This does not include LTC insurance. LTC insurance premiums are an allowable deduction. LTC insurance policies waive the premiums when the client starts receiving benefits from the LTC insurance. Once the client is accessing LTC insurance, remove the premium as a deduction.

In home cooking/cleaning services/yard work/property maintenance

Telephone charges including long-distance charges

Commercial diet clinics, gyms and pools that are not monitored by a licensed physical therapist

Toiletries such as toothpaste, shampoo, personal grooming products

Private alternate living facility (ALF) charges are not considered a medical expense. See WAC 182-513-1205 for possible eligibility of Medicaid using rules for individuals living in state contracted ALFs.

Drugs not approved by the Federal Drug Administration (FDA)

Out of state billings for medical services not recognized under Washington State law.

Items covered under Medicare, Medicaid, or an Apple Health managed care plan is not an allowable deduction from long-term care participation. If a client chooses to go to a non-Medicaid/Medicare contracted provider or outside the healthy options managed care network, the cost is their responsibility.

Food/special diets is not a medical expense

Nutritional supplements unless prescribed as medically necessary . Examples are enteral liquid and powdered supplements.

For active Medicaid clients, liquid supplements that are medically necessary are covered by Health Care Authority (HCA). Liquid supplements (enteral supplements) not approved by HCA are not considered a medically necessary expense to be used to reduce participation.

Food items are covered under the basic food program, consider eligibility for basic food for individuals not in a facility claiming food items as a medical expense. AFH, Assisted living facilities, NF and RHCs are required to provide meals taking into account an individuals special dietary needs. Meals are included in the daily rate.

Over the counter drugs and medications not prescribed or considered not medically necessary . Many over the counter drugs , medications and vitamins are covered by Medicaid.

Health camps, trips or retreats

Medical cannabis. Cannabis is not an approved prescription drug under the Federal Food, Drug and Cosmetic Act and has not been approved by the FDA for treatment.

Unpaid participation incurred while active on a Medicaid program

Dietetics

Spouse's unpaid medical expenses are not allowed to reduce participation.

Where to indicate medical expenses

LTC medical expenses are indicated on the LTCX screen. The MEDX screen is used for recipients on other programs such as food assistance. Non-Medicare health insurance premiums are indicated on the MEDX screen for noninstitutional spenddown cases. Make sure the medical expense is indicated on the LTCX and MEDX screen when a LTC recipient is on food assistance.