7 CFR § 273.9(d)(3)


Allow a medical expense deduction for: 

  • Elderly or disabled EDG members; 
  • EDG members receiving emergency SSI benefits based on presumptive eligibility; or
  • A non-EDG member meeting the following requirements:
    • The elderly/disabled definition; 
    • The individual was in the EDG immediately prior to being placed in an institution (hospital, nursing home, etc.) or death of the member;
    • The individual cannot establish SNAP eligibility on his/her own; and
    • The EDG is paying the medical expenses of the individual.


Ongoing and one-time expenses are allowed but have different budgeting procedures. See Determining Income, Expenses and Deductions.


Medical expenses start the month the individual:

  • turns age 60, or
  • is determined disabled.


Explore medical expenses during the interview process for EDGs with at least one elderly or disabled member.  

Allowable Medical Expenses

7 CFR § 273.9(d)(3)(i)-(x)


Allow the following medical expenses:

  • Ambulance services;
  • Attendant, homemaker, home health aide, child care, or housekeeper necessary due to age, infirmity or illness; 

Note:  Attendant care costs can qualify as either a dependent care expense or a medical expense, but not both. Add, to other claimed expenses, the one-individual SNAP benefit amount if the EDG furnishes the majority of the attendant's meals. Use the benefit amount in effect at the time of approval. 

  • Cost sharing or spend down expenses incurred by Medicaid members;
  • Credit card or loan principal payments if the medical expense was paid with the card/loan;

Note: Do not allow interest payments as a medical expense. 

  • Dental care, including denture costs;
  • Eye glasses and contact lenses prescribed by an ophthalmologist or optometrist;
  • Hearing aid costs;
  • Hospitalization or outpatient treatment;
  • Insurance premiums for health and hospitalization costs; 

Note:  Only allow the premium of the elderly or disabled EDG member. Allow a prorated amount if there is not specific information on separation of the premium amount.

  • Lifeline/MedicAlert costs;
  • Medical care, including psychotherapy and rehabilitation services provided by a qualified health professional;
  • Medical equipment, supplies, other prescribed equipment, including rental equipment; 
  • Medicare/Medigap premiums; 
  • Nursing care;
  • Nursing home costs;
  • Over-the-counter medication, including insulin and vitamins, when recommended by a qualified health professional;
  • Prescription drugs when prescribed by a qualified health professional, including the cost of postage for mail-order prescription drugs;
  • Prosthetic costs;
  • Service animal costs, including, but not limited to: 
    • Food
    • Maintenance 
    • Purchase
    • Veterinary care       

Note:  The animal must be trained to perform some function that the disabled/elderly member cannot readily perform, or to help compensate for a physical condition. The trainer does not need to have any special credentials and can be the individual claiming the expense, as long as the animal is trained to do a specific function the owner cannot do for themselves.

  • Transportation and lodging to obtain medical care, prescription drugs, over the counter medication, etc. Allow the actual cost if paid to a non-EDG member. Allow the Federal mileage rate-Medical Rate  if an EDG member drives.  

Expense Not Allowed

7 CFR § 273.9(d)(3) and (iii)(B)-(iv) & 7 CFR § 273.10(d)(1)(i)-(ii) & 7 CFR § 273.11(c)(1)-(3)


Do not allow the following medical expenses:  

  • Expenses paid or that will be paid by another source (insurance, Medicare, Medicaid, etc.).
  • Insurance premiums for 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.
  • Schedule One controlled substances, including medical marijuana.
  • Special diets regardless if the diet is related to a medical condition.

Examples:  

    • Ensure 
    • Juices
    • Nutritional supplements, etc.

Medical Expense Deduction 

7 CFR § 273.9(d)(3)


Allow a monthly medical expense deduction if the EDG’s allowed medical expenses are more than $35.00.


The medical expense deduction is the total cost of the allowed medical expenses minus $35.  

Example:  The EDG has total allowable medical expenses of $173.  The medical expense deduction is $138.  ($173 - $35).

Verification 

7 CFR § 273.2(f)(1)(iv)


Verify medical expenses, including the amount of reimbursements, before allowing a deduction.  


Verify any questionable factors, such as the eligibility of the elderly or disabled individual, or if services provided are allowable.


Provide the EDG with form W-1348, Proofs We Need, for any required verification. Allow the EDG 10 days to provide the verification. Treat verification not provided in time to meet the action timeliness standard, but submitted later, as a verified change. 


Take the following actions if verification is requested. 

Application 

7 CFR § 273.2(f)(3)(ii) and (i)(3) and (4)(B)


Process the application without the deduction if required verification is not submitted prior to the end of the 30-day processing period.


Postpone verification for expedited service month(s), unless verification is provided in time to meet the 7-day standard of promptness.

Periodic Report

7 CFR § 273.12(a)(5)(iii)(D)-(E)


Increased benefits – Verify: 

  • new expenses, or 
  • changes of more than $25 in medical expenses reported by the EDG.  

Do not allow new or changed expenses if required verification is not provided. Continue with the previously verified expenses.


Decreased benefits - Process the change and get verification of changes more than $25 at renewal.  

Interim Change

7 CFR § 273.12(c)(1)-(4)


Act only on those changes in medical expenses reported by a source other than the household when those changes are verified upon receipt and do not require contact with the household.


Example: Act on a Medicare Part B premium change reported through BENDEX which is verified upon receipt.


Do not act on changes in medical expenses reported by a source other than the household which require contact with the household for verification or information in order to take action.


Example: A caregiver reports that the disabled member no longer needs oxygen. Since the EDG would have to be contacted to verify this, no action is taken.

Renewal

7 CFR § 273.2(f)(8)(i)-(iv) & 7 CFR § 273.14(b)(4)


Verify:

  • previously unreported medical expenses, and
  • changes in medical expenses of more than $25.  


Process the renewal without the deduction if required verification is not submitted prior to the end of the processing time period.