Medical expenses specific to long-term care

WAC 182-513-1350 (6) (b) gives the criteria for allowable medical expenses used to reduce excess resources. DDA waivers , HCS CN waivers , hospice, and participation rules point to this WAC for allowable out-of-pocket medical expenses.

Premiums, deductibles, and coinsurance/copayment charges for health insurance and Medicare premiums

Necessary medical care recognized under state law, but not covered under the state's Medicaid plan;

Necessary medical care covered under the state's Medicaid plan incurred prior to Medicaid eligibility.

Expenses for nursing facility care are reduced at the state rate for the facility that the client owes the expense to

As long as the incurred medical expenses: Were not incurred more than three months before the month of the Medicaid application. Are not subject to third-party payment or reimbursement. Have not been used to satisfy a previous spend down liability. Have not previously been used to reduce excess resources . Have not been used to reduce client responsibility toward cost of care. Were not incurred during a transfer of asset penalty described in WAC 182-513-1363 . Are amounts for which the client remains liable.

Expenses not allowed to reduce excess resources or participation in personal care are: Unpaid expense(s) prior to HCBS Waiver eligibility to an adult family home (AFH) or boarding home is not a medical expense. Personal care cost in excess of approved hours determined by the CARE assessment described in 106 WAC is not a medical expense