(Revised 10/1/18 ML #3533)
Medical expenses incurred by any current member of the household may be considered when calculating medical deductions. A medical expense may be deducted only if it has been paid, OR there is an agreement with the medical vendor for a specific payment plan.
If an incurred expense may be reimbursed by an insurance policy, it cannot be deducted as a medical expense until the insurance company has paid their portion and the household has a specific payment plan with the medical vendor or has paid the bill. This would include reimbursement from the Veteran's Administration or private insurance for pharmaceutical expenses.
Allowable Medical Expenses
The following is a list of allowable medical expenses:
- Medical and dental care provided by a licensed practitioner, including but not limited to:
- psychotherapy
- rehabilitation
- surgery
- orthodontics
- Hospitalization or outpatient treatment, nursing care, and nursing home care. This includes payments by the household for an individual who was a household member immediately prior to dying or entering a hospital or nursing home, if the remaining household members are legally responsible for payment of the expenses.
- Prescription drugs and other over-the-counter medication (including insulin) prescribed by a qualified health professional. Additionally, costs of medical supplies, sickroom equipment (including rental) or other prescribed equipment are deductible.
- Health and hospitalization insurance premiums (includes nursing home insurance) used to cover medical expenses are allowable. This includes Workers with Disability (WWD) and Children with Disability (CWD) premiums and enrollment fees.
EXCEPTION:
Disability or accident policies that are primarily for income maintenance are NOT allowable.
When health insurance premiums are an automatic deduction from a checking or savings account, the service fee charged by the bank is not an allowable deduction.
- The incurred client share from Health Care Coverage Programs (Medicaid).
Medical expenses from the three prior months may not be indicative of combination Medicaid cases when the full recipient liability is not being met. The worker must thoroughly discuss this with the household to establish what the household anticipates as ongoing medical expenses. - Medicare premiums and co-pays.
Part A and B Medicare premiums for an individual who is QMB/SLMB, QI-1 or Buy-In eligible are not allowable medical expenses.
The actual out-of-pocket Part D Medicare premium is an allowable medical expense. - Medical needs including but not limited to:
- Dentures
- Hearing aids
- Prosthetics
- Prescription eyewear
- Securing and maintaining a service animal, including the cost of food and veterinarian bills.
- Reasonable cost of transportation and lodging to obtain medical treatment or services including trips to a pharmacy, dental office, optometrist, etc. The current Medicaid rates are used to determine the cost of transportation and lodging.
EXCEPTION:
Meals are not an allowable expense for households who must travel to obtain medical care. - Maintaining an attendant, homemaker, home health aide, child care services or housekeeper necessary due to age, disability or illness.
- Child care expenses for a child receiving SSI which are necessary and identifiable.
Example:
Mom is not working and stays home to care for her disabled child receiving SSI. Mom takes the child to a child care facility while she runs errands, medical appointments, etc. The child care expense incurred is an allowable medical expense deduction. - Monthly phone fees for the medic alert system. The basic fee for the phone is allowed as a medical expense.
Calculating Medical Expenses
Allowable medical expenses are annualized as follows:
- Recurring medical expenses are averaged from a prior three-month period if that is indicative of what the household anticipates to have as ongoing medical expenses. Multiply the average monthly amount by 12 to arrive at an annual expense.
If a recurring medical expense does not have a three-month history (ex: new prescription) but the worker can establish what the household anticipates as a monthly ongoing expense, the expense can be annualized (x12). - For non-recurring medical expenses only the actual amounts paid between the previous June 1 and the following May 31 are allowed as an expense.
