A household is entitled to a deduction for excess medical expenses for an elderly or disabled member if the expenses exceed the amount in Chapter 560 Appendix A.
NOTE: This does not include expenses for special diets.
The following persons may be entitled to a deduction for medical expenses:
An elderly person age 60 or older
A disabled person (See Chapter 510 to determine if a person is considered disabled.)
A person receiving emergency Supplemental Security Income (SSI) benefits based on presumptive eligibility
A person who did not meet the disabled-person criteria at application, but was later found eligible for SSI. This person is entitled to retroactive deductions for excess medical expenses.
Important: The CAO must restore benefits back to the SNAP application date or to the initial SSI eligibility date, whichever is later.
A household member who is not elderly or is not disabled but receives disability benefits as the dependent of a disabled or elderly person is not entitled to this deduction.
The CAO must not allow a medical deduction unless the household includes an elderly person or a disabled member as per the disability requirements in Chapter 510.
The CAO must use only the elderly person’s or disabled person's medical expenses as a deduction for excess medical expenses.
The following are allowable medical expenses when incurred by an elderly or disabled household member:
Medical and dental care, including psychotherapy and rehabilitation services provided by a licensed practitioner authorized by state law or by a qualified health professional
Hospitalization, outpatient treatments, or nursing care, including payments the household made for a household member immediately before he or she entered a state-recognized hospital or nursing home
Prescription drugs or over-the-counter medications, (including insulin), when prescribed or approved by a licensed practitioner or qualified health professional
Rental or purchase of prescribed medical supplies, sick room equipment, or other prescribed equipment
Health and hospitalization insurance policy premiums except:
Policies payable in a lump sum for death or dismemberment
Policies payable to the policy owner in a set daily or weekly amount for illness or injury
Policies that continue payments on mortgages or loans
Medicare premiums
Copayments for medical assistance recipients, including the waiver a client must pay for intermediate care facility/mentally retarded (ICF/MR) service
Dentures, hearing aids, and prostheses
Purchase and maintenance of a seeing-eye dog or hearing dog, including costs for dog food and veterinarian expenses
Eyeglasses prescribed by an optometrist or a physician skilled in eye diseases
Reasonable transportation and lodging to get medical treatment or services
Maintenance of a non-household member attendant, such as a homemaker, home health aide, childcare service, or housekeeper. The service must be necessary due to age, infirmity, or illness of the elderly or disabled household member
NOTE: If the household provides the majority of an attendant’s meals, the household is eligible for a deduction equal to the SNAP benefit for one person. The CAO must update the benefit amount when the standard benefit changes.
Examples:
A household consists of a mother and her 19 year-old son, who suffers from mental disabilities and requires constant care. The son attends an adult day care center so the mother can go to work. The cost of the adult day care services qualifies as a medical expense, as the son is a disabled person and the care services are necessary for the parent to maintain employment.
A household consists of a disabled mother and her infant child. The mother requires regular kidney dialysis and pays a non-household member for child care during treatment. The cost of child care is an allowable medical expense, as it is needed for the disabled mother to receive necessary medical care.
An employed mother has a temporary disability and has a babysitting expense for her child during her hours of employment. This expense is not an allowable medical deduction as the expense is not related to a medical need.
Households containing an elderly or a disabled member may have fluctuating medical expenses averaged to get a monthly figure by using the steps below:
An expense billed less often than monthly, such as every three months, may be averaged forward over the period until the next bill is expected.
An expense which is incurred on an irregular basis may be averaged over the time it is expected to cover.
A one-time-only medical expense may be averaged over the remaining months of the certification period in which it is billed. Averaging begins in the month the change becomes effective.
For households with a 24-month certification period averaging any one-time-only medical expense that the household has to pay in the first 12 months, the CAO must give the household the option of:
Deducting the expense for one month;
Averaging the expense over the remainder of the first 12 months of the certification period; or
Averaging the expense over the remaining 24 months in the certification period.
For averaging any one-time-only medical expense after the first 12 months of the certification period, the CAO must give the household the option of:
Deducting the expense for one month; or
Averaging the expense over the remaining months in the certification period.
For SAR, weekly or biweekly expenses are converted to a monthly amount by multiplying the weekly amount by 4.0.
The case narrative must clearly discuss the basis used for averaging medical expenses.
A reimbursable medical expense is not deductible. Any portion of the medical expense that is not reimbursed will be counted at the time when the reimbursement is received or can otherwise be verified. Any portion of the expense which is not covered by the reimbursement is allowed as a medical deduction.
The annual VA disability pension adjustment, which considers the past year’s medical expenses for the veteran and the veteran’s spouse, is not a medical reimbursement.
The household must report and verify all medical expenses at initial certification.
The household must report and verify all medical expenses at renewal, and provide verification only if the expense is new, or if the change was greater than $25 and would result in an increase in benefits. If the medical expenses remain unchanged or would result in a decrease in benefits, the household does not need to provide verification. The CAO should not request verification for known medical expenses unless they have changed by $25 or more, or the information is incomplete, inaccurate, inconsistent, or outdated.
Example: Mrs. Smith reported and verified $70/mo in prescription costs at application. At renewal, she reports that her prescription costs are $80/mo. The CAO should not request verification for this since the change is less than $25.
The household's monthly medical deduction for the certification period is based on:
Information reported and verified by the household; and
Any anticipated changes in medical expenses that can be reasonably expected to occur during the certification period, based on available information about the persons’ medical condition, public or private insurance coverage, and current verified medical expenses.
If the household reports but cannot verify an allowable medical expense at certification, and the CAO cannot figure out the amount of the expense using available information, the CAO must allow the nonreimbursable portion of the expense when the amount is reported and verified.
NOTE: The household is not required to file medical expense reports during the certification period.
If the household voluntarily reports a change in its medical expenses during the certification period, the CAO must verify a change that increases the household’s SNAP benefit. If the reported change decreases the benefit, the CAO must act on the change without requiring verification.
If the CAO learns of a change in medical expenses from a source other than the household, the CAO must act on the change unless it requires more information or verification from the household. If the report of a change in medical expenses requires contact with the household, the CAO must not contact the household and must not take any action on the household’s medical expense deduction.
Examples of acceptable verification are:
Bills from providers of health insurance, services and products,
Statements from providers: or
Health insurance policies.
If the CAO questions whether a medical service was performed, prescribed, or approved by a licensed practitioner, qualified health professional, or recognized facility, the worker may request verification. Examples of acceptable proof include, but are not limited to:
copies of prescriptions; or
statements or bills from physicians, pharmacists, or certified providers.
If the household does not contain an elderly or disabled person, medical deductions are not included in the SNAP calculation of the benefit amount.
The CAO must not use the expenses of a spouse or dependent of an SSA or SSI recipient unless the spouse or dependent is also elderly or disabled.
If a person chooses to report medical expenses monthly or during the certification period on the SAR reporting form, the expenses must be verified.
Reissued September 29, 2022, replacing March 1, 2012