SNAP Directors’ Conference
September 23, 2013
Medical Expense Deduction:
A View from the Field
By: Leslie Fried
Director, National Center for Benefits Outreach &
Enrollment
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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National Council on Aging (NCOA)
NCOA is a nonprofit service and advocacy organization.
Our mission is to improve the lives of millions of older
adults, especially those who are vulnerable and
disadvantaged.
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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What is the National Council on Aging? (NCOA)
 NCOA is a national voice for older
Americans—especially those who are
vulnerable and disadvantaged—and the
community organizations that serve
them.
 NCOA brings together nonprofit
organizations, businesses, and
government to develop creative
solutions that improve the lives of all
older adults.
 NCOA works with thousands of
organizations across the country to help
seniors find jobs and benefits, improve
their health, live independently, and
remain active in their communities.
A nonprofit service and advocacy organization
Over 2 million
people visit
NCOA
websites
every year
© 2013 National Council on Aging
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What is BenefitsCheckUp®?

BenefitsCheckUp®
is a free, easy-to-use,
confidential online service that
screens individuals for
thousands of public and private
benefits and helps them take the
steps to enroll.

A BenefitsCheckUp® screening
can help identify hundreds or
even thousands of dollars in
potential benefits for older
adults in need and often leads to
a senior receiving a hot meal,
saving on their medicine, or
being able to pay rent.
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Senior hunger and SNAP participation
 About 5 million seniors will experience
hunger this year
 Food banks are seeing more seniors
become repeat clients
 Only 1 in 3 eligible older adults
participates in SNAP, i.e., 65% are
missing out on a benefit for which
they are eligible
 Aging network has the knowledge and
experience to help close the gap
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Overcoming barriers to participation
 Key barriers:
• The $16 Myth: Many believe they are only eligible for the minimum
benefit of $16/month, although the national average is $122/month
• Application process considered “not worth it”
• Others are more in need
 The medical expense deduction helps overcome these
barriers
• Increases benefit amount, often dramatically
• Although deductions may require paperwork, the increased benefit
amount is “worth it”
 Policy options simplify the deduction process
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Seniors are missing out on medical deductions
 About 14% of seniors take the medical deduction, but 55% of
SNAP-eligible seniors would qualify
 Deductions increase SNAP benefit amount by reducing net
income
 Even seniors with the Part D Low Income Subsidy (LIS) and
Medicare Savings Programs have unreimbursed out-of-pocket
costs in excess of $35 that would be eligible, including:
Medical and dental care, prescription drugs, health policy premiums
Costs of dentures, hearing aids, prosthetics
Vet bills, food, and other costs associated with owning a service dog
Eye glasses prescribed by an optometrist or specialist
Transportation and lodging costs incurred to obtain medical
treatment, including mileage (calculated at federal rate = 55.5¢/mile
in FY ’12)
• Attendant, home health aide, homemaker, or child care services
•
•
•
•
•
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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“Fighting a Forest Fire with a Squirt Gun”
 Quote is from a local DSS worker trying to do more
with less
 With increasing caseloads, reduced staff and state
fiscal woes, case workers are extremely busy
• Not as much time for robust interviews
• Often take what clients present and move on to
process application
• May not have the time to provide as much assistance
to maximize the medical deduction
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Concern about Lack of Education or Training of
Local “Boots on the Ground”
 Many clients and case workers do not
know or understand processes
• Example: If you are over 60, you
can deduct medical expenses
 Workers may not ask about medical
expenses, or do not know what is
included in the deduction
 Some workers will only accept
premiums for medical deductions.
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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It’s All a Bit “Fuzzy” as to what is a deduction
 In states where SNAP is county-administered, every
county handles the medical deductions differently
 Guidelines can be a bit “fuzzy” and open to
interpretation
 Each county interprets requirements somewhat
differently
 Case workers make their own judgment call too
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Barriers and Hurdles Too High To Leap
 Face to Face Interviews – pros and cons
 Seniors & people with disabilities do not have
access to basic technology (computers, internet,
email, fax)
 Documentation requirements
• Difficult to provide especially with lack of copier and no
assistance
 Lack of transportation
• Clients lack access to public transportation, especially in
rural areas, or in large suburban communities
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Medicaid & SNAP Medical Expense Deduction
 Many medical bills can also be used
for adult Medically Needy (MN)
Medicaid also known as Spend Down
Medicaid.
 In some states….
• Once a bill is used for spend down, it
cannot be used as an Excess Medical
Expense Deduction.
• However, the reverse is not true. Use a bill
towards the food stamps budget and then
help the client apply for medically needy.
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Online Application System
 Revamped online application systems
 Some questions have been removed and no longer
includes questions on medical expenses
 Removed because most applicants are under 60
 Caseworkers are supposed to ask questions about
medical expenses in interviews but do not
 Net result: Minimum $16 award or denied SNAP
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Tools and Checklists: How NCOA can Help
 Many seniors do not know what can be considered
as Excess Medical Expenses.
 Numerous programs have created worksheets to
help advocates and seniors identify the type of
expenses that should be considered.
 On some forms, there is a place to ask the
administering agency for help in verifying the
medical expenses
 Clients/advocates are encouraged to question a low
benefit amount
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Online Resources to Connect Seniors to Benefits
 BenefitsCheckUp.org - Free,
online comprehensive benefits
screening
 SNAP Maps and Application
Form Center
 Online LIS/Extra Help
application
 Medicaid Office Locator
 Senior Housing Locator
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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Other NCOA’s Resources Online
 Economic Security Group : www.ncoa.org/enhance-economic-security
• National network of aging services providers
• Benefits Access, Economic Security Initiative, Mature Workers, Reverse
Mortgage Counseling
 www.CenterForBenefits.org
• Resource Library – webinars, issue briefs, promising practices
• Fact sheets: Medicare, Medicaid, Prescriptions, Food and Nutrition, Energy
 National Institute of Senior Centers (NISC): www.ncoa.org/NISC
• Over 2,000 member centers across the country
• Economic Security Work Group focusing on benefits access
 NCOA’s Center for Healthy Aging: www.ncoa.org/improve-health
• Chronic disease self management (CDSMP), falls prevention, community
education, behavioral health
A nonprofit service and advocacy organization
© 2013 National Council on Aging
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