(Revised 07/01/18 ML3528)
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That portion of medical expenses in excess of $35 per month, excluding special diets, of an elderly (beginning in the month an individual turns age 60) or disabled household member are allowable after third party payments. These expenses must be reported and verified within 30 days of the billing date. If the household has made arrangements with the provider to make payments within 30 days after the initial billing or within 30 days after third party payment, verification must be provided at the time the expense is reported.
Medical expenses include all allowable medical expenses made by a household for an individual who was an elderly or disabled 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. The expense must be coded by the individual responsible for the medical expense on EXSA using the ME LR code.
Examples:
- An elderly mother and daughter are living together and are one household. The mother goes into the hospital and the daughter who is not legally responsible for her mother’s medical costs is paying on those expenses as she can. The daughter is not allowed to claim a medical deduction for her mother’s costs because she is not legally responsible for them.
- An individual (not elderly or disabled) applies for SNAP. At the time of application, the individual reports that her disabled husband passed away and also reports medical expenses that were incurred by her husband that she is legally responsible to pay. These expenses are an allowable deduction for this individual. This expense must be coded as ME LR on EXSA.
Households may but are not required to report any changes in medical expenses during the review period. If the household reports a change, the worker must determine if the change will result in an increase or decrease in benefit. If the change results in an increase in benefits, the change must be acted on. If the change results in a decrease in benefits, the change must not be acted on until review.
Exception:
If the change meets the criteria to decrease benefits, the change must be acted on within 10 days from the date the change was reported and a 10 day advance notice must be sent. If the change is reported in writing and signed by the household, a 10 day advance notice is not required. Adequate notice is required.
If the household reports a medical expense but is unable to provide verification of the expense, a deduction is not allowed.
The $35 applies to the total expenses incurred by all elderly or disabled household members, it does not apply to each person's expenses if more than one person in the household is elderly or disabled. TECS automatically deducts $35 from the amount entered on the EXSA screen.
Individuals who are not aged (over 60) or disabled receiving Social Security benefits as a dependent or survivor are not eligible to receive the medical deduction.
Individuals receiving emergency SSI benefits based on presumptive eligibility are eligible to receive the medical deduction.
At initial application and review medical expenses should be averaged from a prior three month period, if that is indicative of what the household anticipates to have as ongoing medical expenses in the new review period.
The medical expenses from the three prior months may not be indicative of combination SNAP/Medicaid cases when the full client share is not being met. The worker must thoroughly discuss this with the household to establish what the household anticipates as ongoing medical expenses.
In a combination SNAP/Medicaid case, when making a change for both programs, if the client share for Medicaid changes and the client share is being allowed as a medical expense for SNAP purposes, change the amount allowed as an expense for SNAP on the EXSA screen as follows:
- If the household is incurring
the entire client share,
change the amount allowed as an expense for SNAP on the EXSA screen to
the new amount, if the change results in an increase in benefits. If
the change results in a decrease in benefits, the change is not acted
on until review.
If the household is incurring only a portion of the client share and the amount has been averaged, and the income or expenses for this case causes the client share to change, continue to use the previously averaged amount as a medical expense for SNAP. At review, reaverage using the new client share.
The SFN 187 - Medical Expense Worksheet should be used for all households entitled to a medical deduction.
If the SFN 187 is used, the household must be asked to complete the bottom portion of the form and the top half is completed by the worker. This worksheet also serves as documentation of verified medical expenses, the calculation and the amount allowed as a deduction.
