Actual Medical Expense Versus Standard Medical Expense Deduction 430-05-55-20-07

(Revised 05/01/13 ML3365)

View Archives

 

Households with elderly or disabled individuals who are billed and responsible for more than $35 in allowable monthly medical expenses can choose the Standard Medical Expense Deduction of $200 per month rather than actual medical expenses. Only one Standard Medical Expense Deduction can be allowed per household. The expense must be coded by an elderly or disabled individual with a participation code other than DI using the ME ST code on the EXSA screen in TECS.

The only medical expense that will be allowed in addition to the standard medical expense deduction is when a household is legally responsible for payment of expenses for an individual who was an elderly or disabled household member immediately prior to dying or entering a hospital or nursing home (ME LR).

TECS will automatically deduct $35 from the total of all medical expenses for all individuals entered on the EXSA screen.

Initial Application

At initial application, verification of medical expenses is required. If verification of medical expenses is not provided, no expense is allowed. If verification of medical expenses is provided and the total of all allowable monthly medical expenses for all elderly and disabled household members exceeds the $200 Standard Medical Expense Deduction, actual verified expenses are allowed. Actual allowable monthly medical expenses must be coded by the elderly or disabled member(s) that incurs the expense.

Exception:

If the household has medical expenses that are greater than $200 but chooses the Standard Medical Expense Deduction rather than actuals, this must be documented in the case file.

If verification of medical expenses is provided and the total of all allowable monthly medical expenses for all elderly and disabled household members is greater than $35 but less than $200, the Standard Medical Expense Deduction is allowed for the household. The Standard Medical Expense Deduction must be coded by only one elderly or disabled individual with a participation code other than DI.

If a household also reports a one-time medical expense at application, the household can choose to have the one-time expense averaged over the review period or used as a one-time expense. If the household chooses to:

If the total is greater than $200, the household can choose to use actuals. The actuals must be allowed for the next month. The one-time expense must then be removed for the following month. Once removed, if monthly expenses are less than $200, the household can choose the Standard Medical Expense Deduction again for the following month.

Review

At review, households will remain eligible for the Standard Medical Expense Deduction if they report the total of all elderly and disabled members’ allowable medical expenses are greater than $35. Client statement of medical expenses is acceptable and must be documented in the case file. If the household reports medical expenses that are greater than $200, verification is required. If verification of medical expenses is not provided, the Standard Medical Expense Deduction will continue to be allowed for the new review period.

Ongoing Cases

Households entitled to the Standard Medical Expense Deduction are allowed to change to actual medical expenses during the review period. If a household reports new medical expenses that would entitle them to the Standard Medical Expense Deduction or expenses which exceed the standard, since these changes will result in an increase in benefits, the changes must be verified. Notice F419 – “Request for Verification” must be sent allowing the household 10 days from the mail date of the notice to verify the reported change.

If the household provides verification within the 10-day period, the worker must act on the reported change within 10 days and send the household the appropriate notice. If the verification entitles the household to the Standard Medical Expense Deduction, the expense must be coded by only one elderly or disabled individual in the case. If the verification entitles the household to actual medical expenses, the actual allowable expenses must be coded by the elderly or disabled member(s) that incur the expense.

If the household fails to provide verification within the 10-day period, the previously verified amount is used and the benefit stays the same. If there is no previously verified amount (i.e. household reports now incurring medical expenses and previously had not), no change is made and the benefit stays the same.

If the household fails to provide verification within the 10-day period and provides verification at a later date, benefits are increased the month after receipt of the verification.

If a household reports a one-time medical expense in an ongoing case, the household can choose to have the one-time expense averaged over the remainder of the review period or used as a one-time expense. If the household chooses to:

If the total is greater than $200, the household can choose to use actuals. The actuals must be allowed for the next month. The one-time expense must then be removed for the following month. Once removed, if monthly expenses are less than $200, the household can choose the Standard Medical Expense Deduction again for the following month.

Example:

At initial application in February, a household verifies monthly medical expenses of $140 and chooses to use the Standard Medical Expense Deduction. The household is approved and certified through July. On May 5, the household timely reports a one-time medical expense of $300 for glasses. When calculating the benefits for the month of June, the household has the option of using the $300 deduction as follows: