Revised (8/03)
MEDICAL EXPENSES/DEDUCTIONS
Medical Deductions-General
All households are required to report medical expenses at application,
reapplication, 12-month review and recertification. To be considered timely, the
change must be reported within the certification period in which the medical
expense was incurred.
Allowable medical deductions should be handled as follows: if paid, the expense
and, if applicable, the reimbursement MUST have been reported timely.
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Determine if the reported medical expense is currently being billed and the
reimbursement status of the expense. (Only the currently existing balance of
a currently billed expense can be considered. If the expense is no longer
being billed, the expense cannot be allowed).
Do not consider any medical expense which is reported timely which will be
reimbursed or which reimbursement is undetermined until such time as the
reimbursement is verified or denied and the non-reimbursable amount is
determined. If unable to determine the reimbursement status, the case record
needs to be documented accordingly.
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Determine if the member eligible for a medical deduction has medical
insurance or if that member is included in a Medical Assistance (MA) case.
(Medical insurance or an MA case indicates the possibility of reimbursement
and this MUST be resolved prior to the expense being considered).
If an SSI individual has expenses for prescription medicine which are not covered
by the medical card, the individual needs to be advised to contact the prescribing
physician and inquire about pre-authorization for the Medicaid program.
One-Time Only Expenses
Once a one-time only expense has been considered during a certification period,
the same expense CANNOT be considered in succeeding periods.
EXCEPTION: If the household elected to receive a deduction for each
month that an installment payment is due, the deduction may cover
more than one certification period.
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Determine if any currently reported ONE-TIME only medical expenses were
considered during any prior certification period. (Some examples of one-time
expenses include, but are not limited to: hospital bills, ambulance bills,
laboratory fees, non-continuing doctor visits and/or prescription costs such as
treatment for flu, etc.)
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For one-time only, non-reimbursable expenses, the household has the option
of receiving the entire deduction at one time, having it averaged over the
certification period, or receiving a deduction for each month an installment
payment is due. The method that the household chooses must be
documented.
For one-time only, non-reimbursable expenses that are reported during the
last month of the certification period, the household has the option of:
(1) electing to have the entire deduction considered in the first month of
the succeeding certification period or
(2) having the deduction averaged over the succeeding certification period
and receiving a deduction for each month an installment payment is
due.
The method the household chooses must be documented.
A SNAP household that is receiving a medical deduction for a one-time only
expense continues to receive a deduction even if the eligible member dies.
Households certified for more than 12 months that incur one-time medical
expenses in the first 12 months of the certification may elect to do the folloiwng:
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Have the expense averaged over the remainder of the first 12 months of the
certification period.
Budget the expense in one month.
Average the expense over the remainder of the certification period.
Recurring Medical Expenses
For recurring medical expenses, such as a regular bill for prescriptions or
attendant care, the non-reimbursable expense is considered ONLY in the month
the expense is billed. Recurring medical expenses that are past due or brought
forward from prior billing periods are NOT allowed.
Fluctuating Medical Expenses
For fluctuating medical expenses, such as a prescription that fluctuates in cost or
frequency of use, verification of all non-reimbursable expenses for the last 2
months, which are expected to continue, needs to be obtained. The average
monthly amount is considered. Fluctuating expenses DO NOT include one-time
bills that are NOT expected to continue. (If the last 2 months of fluctuating
medical expenses do not adequately represent the client’s anticipated expenses
for the certification period, less than 2 months of fluctuating expenses can be
considered.)
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Other
 For medical expenses paid by a credit card, allow only the expense and NOT
the interest.
 Consider the expense to have occurred when the bill is received. Payments
that are made on a loan when the loan is used to pay a one-time medical
expense ARE allowed. Do NOT allow the interest as part of the expense.
 For allowable medical insurance charges, only the amount billed for the actual
premium is considered. Any surcharge or billing/handling fee in excess of the
premium cannot be considered as part of the deduction. (Example: A
household is billed annually for their medical insurance premiums but the
household chooses to make monthly payments. The company charges an
additional fee for the monthly billing statements. Only the annual amount
billed, divided by twelve, can be considered as the monthly amount for
deduction purposes).
 Medical expenses MUST be reported at application, reapplication and
recertification according to reporting requirements. If the expense is not
reported timely, NO deduction is allowed.
Allowable Medical Deductions
The following are ALLOWABLE medical expenses:
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Medical and dental care including psychotherapy and rehabilitation services
provided by a licensed practitioner and authorized by State law or other
qualified health professional.
Hospitalization or out-patient treatment, nursing care and nursing home care
including payments by the household for an individual who was a household
member prior to entering a hospital or nursing home.
Prescription drugs prescribed by a licensed practitioner and other over-thecounter medication, including insulin, approved by a licensed practitioner or
other qualified health professional along with the 25 cents revenue tax that
pharmacies are allowed to charge per prescription.
Medical supplies, sick-room equipment including rental or other prescribed
equipment and the cost of repairs necessary to keep the equipment in
working condition.
Health and hospitalization insurance policy premiums (without surcharges),
for the eligible person only. (Medicare premiums paid by the eligible
household related to coverage under Title XVIII of the Social Security Act,
SMI premiums paid by the Medicaid Program, including those for QMB,
QDWI, or SLMB eligible individuals, are not an allowable deduction).
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Any cost-sharing or spend down expenses incurred by Medicaid recipients.
Dentures, hearing aids and prosthetics.
Eye glasses and contact lenses prescribed by a physician skilled in eye
disease or by an optometrist.
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The cost of securing and maintaining “service animals,” such as seeing-eye
dogs, hearing guide dogs, and housekeeper monkeys trained to assist
quadriplegics, including the cost of food and veterinary bills.
Telephone charges for telephone aids, such as amplifiers and warning signals
for disabled persons and costs of teletypewriter equipment for the deaf.
Reasonable cost of transportation and lodging to obtain medical treatment for
services. This includes trips to a doctor, dentist, etc. as well as trips to fill
prescriptions for medicine, dentures, hearing aid, eyeglasses, sickroom
equipment, etc. Reasonable transportation cost is the current state mileage
rate when a personal vehicle is used or the actual verified costs. Lodging
costs are the ACTUAL verified costs.
Maintaining an attendant, homemaker, home health aide, child-care services
or housekeeper necessary due to age, infirmity or illness. State and federal
withholding taxes paid by the disabled individual for attendant care payment,
even if paid with other monies received by the disabled individual, are
allowable.
Disallowable Medical Deductions
The following medical expenses are disallowed:
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The cost of health and accident policies such as those payable in lump sum
settlements for death or dismemberment or income maintenance policies
such as those that continue mortgage or loan payments while the beneficiary
is disabled.
Any surcharge or billing fee added to the monthly insurance premium.
Expenses of spouses or other persons receiving benefits as a dependent of
the SSI or disability recipient.
Expenses for which the household will be reimbursed or which for which an
insurance company or government program will directly pay. The nonreimbursable portion is considered at the time the amount of reimbursement
is verified or when it is denied. If the reimbursement status cannot be
determined, the expense is NOT considered and the case record should be
documented accordingly.
Expenses incurred jointly with other household members are not allowed in
their entirety. Only the eligible person’s expense is deducted. If the eligible
person’s share cannot be identified, the expense is prorated evenly among
the members the expense covers.
Medical expenses billed to a SNAP household but which are for a nonhousehold member.
Manual References
Vol., II, Sections 5420, 5430, 5440
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