Allowable Medical Expenses 430-05-55-20-20

(Revised 10/01/06 ML3044)

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The following is a partial listing of allowable medical costs:

1. Medical care provided by a licensed practitioner.
2. Dental care, including dentures and orthodontics.
3. Hospitalization, outpatient treatment and nursing care, including Home and Community Based Services (HCBS).
4. Nursing home care including payments by a legally responsible household member for an individual who was a household member immediately prior to entering a nursing home.
5. Prescription drugs when prescribed by a licensed practitioner and over-the-counter medication (including insulin) when approved by a licensed practitioner.  This includes postage and handling costs associated with mail order prescription drugs.
6. The co-pays that Medicaid allows as a deduction in determining the monthly Recipient Liability.
7. The costs of prescribed medical supplies are allowed as a deduction. The following is a partial list: 

• Sick-room equipment (including rental). 
• Equipment added to a vehicle or home for a handicapped person.
• The cost of building a ramp for a wheelchair.
• Amplifiers and warning signals for handicapped individuals (medic-alert).
• Typewriter equipment connected to a telephone for deaf individuals.

Exception:

Computer purchased by a handicapped individual for learning purposes is not an allowable medical expense.

8. Health and hospitalization insurance premiums.

Only the portion of a medical insurance premium assigned to the elderly or disabled household member is allowed when computing the deductible amount. If the policy does not define how much of the premium is for each insured household member, the worker must prorate the premium amount among all members insured on the policy. Only the prorated amount for the eligible elderly or disabled household member is allowed as a deduction. 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 cost of health, accident, cancer, nursing home and ambulance policies which state that the monies will be used to cover medical expenses are allowable medical expenses.

Exception:   

The costs of accident, cancer, or nursing home policies that do not state that the monies are intended for use to cover medical expenses.

 

Health or income maintenance policies payable in lump sum settlements for death or dismemberment or that continue mortgage or loan payments while the beneficiary is disabled are not allowed as a deduction.

9. Medicare premiums, co-insurance, and deductibles.

Exceptions:

A Medicare premium for an individual who is QMB/SLMB or Buy-In for Medicaid is not an allowable medical expense for food stamp purposes as the household will be reimbursed for these premiums once it is no longer deducted from the Social Security check.  The Medicare premium is no longer allowed when the QMB/SLMB application is approved.

 

Qualifying Individual 1 (QI-1) are entitled to payment of their Medicare Part B premium. The Medicare part B premium is not an allowable medical deduction.

10. Hearing aids and prosthetics.
11. Securing and maintaining a seeing eye or hearing dog including the cost of dog food and veterinarian bills.
12. Eyeglasses and contact lenses prescribed by a licensed practitioner.
13. Reasonable cost of transportation and lodging to obtain medical treatment or services, including trips to a pharmacy, dental office, optometrist, etc. can be counted as a medical deduction up to the following amounts: 

• $0.45 per mile for mileage. 
• $55 plus tax for in-state lodging. 
• $80 plus tax for out-of-state lodging.

These costs must be verified.

Exception:

Meals are not an allowable expense for households who must travel to obtain medical care.

14. Maintaining an attendant, homemaker, home health aide, child care services or housekeeper necessary due to age, infirmity, or illness. In addition, an amount equal to the Thrifty Food Plan for one-person is deducted if the household furnishes the majority of the attendant's meals.

The Thrifty Food Plan for this meal related deduction must be the benefit in effect at the time of initial certification. The worker is required to update the benefit amount at the next scheduled recertification. The worker has the option to do so earlier if the benefit changes before the next scheduled recertification.

 

If a household incurs attendant care costs that could qualify under both the medical deduction and dependent care deduction, the worker must treat the cost as a medical expense.

15. Child care expenses for a child receiving SSI that 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.

16. Payments on loans for one-time medical expenses or medical expenses billed on a credit card are deductible, but the interest must not be allowed as part of the deduction.
17. Monthly Phone Fees for Medic Alert systems.  The basic fee for the telephone which the system uses is handled as a utility expense.

Example:

Individual is charged $20.00 per month by the phone company for a Medic Alert system and $15.00 per month for basic phone service.  The $20.00 is allowed as a medical expense.  The $15.00 for basic telephone services is allowed as a utility expense.

18. Enrollment fees and monthly premiums paid by the household for the Medicaid Workers with Disabilities coverage.
19. Premiums, co-payments, co-insurance and deductibles paid by the household for Medicare Part D.