Condition 1 - Medically Necessary
Medical expenses incurred by the client must be medically necessary and recognized under state law to allow it as a medical expense deduction on an LTC income calculation.
It is not your responsibility to determine if an expense is medically necessary. Only a medical professional can determine what the client’s medical needs are. The medical provider’s professional peer group must recognize the service as the prevailing standard or current practice and as consistent with the client’s diagnosis or condition. If the expense is for medical services received from a provider, assume that the expense is medically necessary. A provider includes:
- A medical professional.
- An ambulance service.
- A pharmacy.
- A medical facility.
For all other medical expenses not provided by a medical provider, such as over-the-counter medications or home care services, or while residing in a residential living arrangement or a housing with services establishment require a physician’s statement to verify the expense is medically necessary. The Proof of Medical Need (DHS-6112) form can assist in obtaining this verification. More information about this form is found in an upcoming section.
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The MA-LTC Medical Expense Deduction - Allowable Medical Expenses