3614 Excess Medical Deduction | SNAP

Medical expenses incurred by an AU member who is elderly or disabled (as defined in the glossary) are considered when determining the excess medical deduction. If a household has more than one AU member that qualifies for the standard medical deduction or actual medical expenses, the first $35.00 of medical expenses is excluded only once per month per AU.

Determine the expenses that are for the AU member who is eligible to receive the deduction. The medical expenses of an individual, who was an AU member immediately prior to being hospitalized, institutionalized, or death would be allowed if the AU remains legally responsible for payment of the medical expenses.

If the following conditions are met, allow the medical expense(s):

If the medical expenses are billed through charge accounts (e.g., Master card, VISA, etc.), only the expense is considered as the deduction, not the interest. Count the expense as billed in the month the charge account statement including the charge was received.

Verify the current status of bills turned over to a collection agency and allow the expense if the AU incurs or is billed for the expense, provided the expense has not been previously allowed in a SNAP budget.

Do not shorten an AU’s certification period to allow an excess medical deduction.

The monthly cost share paid by an individual for services received through the Community Care Services Program (CCSP) may be considered an incurred medical expense. The cost share is the maximum amount an individual is required to pay for services in any given month. If the total cost of services received does not equal the established cost share, the individual is responsible only for the actual cost of services. The cost share paid must be for an allowable medical expense to be considered a SNAP medical deduction.

The medically needy spend down amount is not a medical expense on its own. The bills used in a medically needy budget may be used as medical expenses if they are allowable medical expenses in the SNAP.

Medical expenses are categorized into two types. They are:

Reimbursement of a medical expense is verified prior to allowing the expense. Verify the amount of reimbursement from a third-party source and subtract it from the total medical expense before allowing the expense as a deduction.

Do not allow a medical expense for nutritional supplements which can be purchased with SNAP benefits. Examples include: Ensure Nutritional Products, Complete Regular Formula, Enrich, Jevity, Osmolite.

Verify current, non-reimbursable expenses for all AU members who are 60 years of age or older or who are disabled. If the total expenses do not exceed $35 monthly, then verification is not required.

Verify medical expenses:

Suggested forms of verification are:

Document the case notes with the following information:

Medicare Part–D is a prescription drug insurance plan designed to assist Medicare and Medicaid recipients with the high costs of prescription drugs. Enrollment in Medicare Part-D began on 11/15/2005. The Medicare Discount Card Plans are valid until enrollment in Medicare Part-D or 5/15/06, whichever is earlier. The medical expenses of Medicare and Medicaid recipients enrolled in Medicare Part-D prescription drug plans are budgeted using the regular SNAP policy guidelines. For example, co-payments, plan premiums, and deductibles, if any, are allowable expenses for the medical deduction.

All SSI recipients and other low-income recipients receiving ABD classes of assistance will be automatically enrolled in a Medicare Part-D plan.

Those considered low income should pay no premium.

Georgia is approved to allow households with an elderly or disabled member with recurring medical expenses in excess of $35 per month to claim a standard medical deduction (SMD). Effective October 1, 2023, the approved SMD is $161 per month. Only one standard medical deduction can be given per AU.

There are two types of medical deductions that may be applied to elderly/disabled individuals: 1) Standard Medical Deduction and 2) a deduction for Actual Medical Expenses incurred.

SNAP households will remain eligible for the standard medical deduction at recertification (renewal) if they state that their medical expenses continue to exceed $35 per month. Verification of medical expenses is not required at recertification (renewal) unless the client’s statement is questionable.

Initial Application - To allow the deduction, qualifying expenses in excess of $35 per month must be verified. If requested verification is not provided, the expense will not be allowed. Households may report expenses in excess of the standard medical deduction, making actual medical expenses the better option. When a client opts for actual expenses, all medical expenses must be verified.

Recertification (Renewal) - Households will remain eligible for the standard medical deduction at renewal as long as the AU reports they still have allowable medical expenses in excess of $35 per month. Verification will not be required unless the client’s statement is questionable. If the standard medical deduction was previously allowed but the A/R failed to report medical expenses on the Alternate recertification form (i.e. did not respond to the medical expense section or checked NO expenses), a telephone contact to determine whether medical expenses will continue is required. If the client cannot be reached by telephone, the case manager will leave a message (when possible) and document the agency’s attempt to follow up. The case manager will send the Verification Checklist (VCL) allowing 10 days for the household to respond. If there is no response, the standard medical deduction will be removed, and the case will be completed without the deduction. When the client opts for actual expenses, all medical expenses must be verified.

Interim Change – There are no new reporting requirements for medical expenses. Verification will be required when the household reports new medical expenses that would qualify the AU for the standard or report expenses in excess of the standard. If requested verification is not provided, the expense will not be allowed as a deduction.

In Gateway, document in client level notes the qualifying expense(s) used when allowing the household, the Standard Medical Deduction. Document the reason why reported medical expenses were not given for potentially eligible AU members, such as current expenses, or non-reimbursed expenses not verified.

The following examples are to be used as a guide when applying the Standard Medical Deduction or a deduction for actual medical expenses to SNAP cases:

Example 1: A/R reports $998 per month RSDI + $104.90 recurring pharmacy prescription for elderly AU member. RSDI is verified by BENDEX. Recurring pharmacy prescription is verified by pharmacy printout and is in excess of $35 per month. Client is eligible for the standard medical deduction.

Example 2: At initial application, client reports he is disabled and has a one-time hospital bill that is more than $35 per month. The client provides a $250 hospital bill. Using the 12-month certification period to determine the monthly amount, $250/12 = $20.83. The verified monthly medical expense *is less# than $35 month. Please note: In order to determine if a one-time bill qualifies a customer for the Standard Medical Deduction, the total bill must be averaged over the certification period to determine the monthly amount. This must be documented in the client case notes. The client is not eligible for standard medical deduction but may receive a one-time deduction for the hospital bill.

Example 3: At recertification, a client recently approved for Social Security disability provides $100 one-time doctor bill. Using the 12-month certification period to determine the monthly amount, $100/12=8.33/month for this bill. Client also reports recurring prescription costs of $20 per month and recurring transportation costs of $10 per month. The total verified medical expenses = $38.33 (8.33+20+10 = $38.33). The medical expenses exceed $35/mo. Client is eligible for the standard medical deduction using combined prorated and recurring expenses.

Example 4: Elderly client owns a vehicle and reports he drives 65 miles each month to medical appointments and the pharmacy. 65 miles per month x .67 (current state mileage rate) = $43.55 per month for transportation costs. The medical expense exceeds $35 per month. Client’s statement is accepted when mileage is being reported as a medical expense. Client is eligible for the standard medical deduction.

Example 5: A disabled client pays a recurring Medicare premium in the amount of $204.90 per month which is verified via BENDEX. The client indicated during the interview that they have recurring prescriptions that total $55 per month. The total medical expenses = $259.90 (204.90+55 = $259.90).

Because the client’s medical expenses exceed $196 per month and are more than the standard deduction amount, the client may opt to claim and verify all medical expenses and receive a deduction for actual medical expenses incurred. Claiming actual expenses would be more advantageous to the client vs. allowing the standard medical deduction.

Client deduction claimed with standard medical deduction - $196-$35 = $161/mo.

Client deduction claimed with actual medical expenses - $259.90-$35 = $224.90/mo.

The household should receive $224.90/mo. as a medical deduction since it is more than what would be received under the standard medical deduction.

Use the following chart to identify allowable medical expenses used in determining financial eligibility:

Use the following chart to determine how to budget one-time only medical expense.

Use the following chart to determine how to budget recurring expenses.

Recurring expenses are allowed as a deduction by either averaging or using variable issuance (actual costs). The AU has an option to choose.