Overview of Medical Expense Deduction
This is an optional verification.
Overview
Claiming medical expenses can substantially boost SNAP benefits for certain households not already receiving the maximum SNAP benefit for their household size. Individuals aged 60+ (i.e., elderly) and/or individuals with a verified disability are eligible for a medical deduction if their average out-of-pocket medical costs exceed $35. per month.
- Individuals aged 60+ will automatically be credited with a medical deduction if verified medical expenses exceed this threshold.
- Individuals with a verified disability will be credited as long as they meet the disability criteria outlined in SNAP Disability Requirements and Verifications. You may need to confirm that the appropriate disability verification is indicated in BEACON for the medical expense deduction to be applied.
- For clients under 60 years of age who receive EAEDC cash assistance, check the Disability page in BEACON.
Note: EDSAP households are subject to the same rules for medical expenses as non-EDSAP households.
You must always explore the possibility of out-of-pocket medical expenses when interviewing a household with an elderly member and/or individual with a verified disability. Do not assume that clients with state paid Medicare Part B or MassHealth do not have countable medical costs (see How to Discuss Medical Expenses with Clients).
Medical Deduction Amounts
Medical expenses are calculated by adding each individual medical expense including both dollars and cents. After the medical expenses are totaled standard rounding logic is applied based on SNAP regulations. This means if the total medical expense ends in .49 or less, the total will round down to the nearest dollar amount; and if the total medical expense ends in .50 or more, the total will round up to the nearest dollar amount.
- Example: Elena (she/her) has monthly medical expenses of $12.50 for prescriptions and $22.89 for copays. Because Elena’s total monthly medical expenses are $35.39, BEACON will round down to $35. Elena will not be credited with a medical expense deduction. However, if Elena was to call back and report her copay cost increased to $30, her total medical expenses would be $12.50 + $30 = $42.50. BEACON would then round her total monthly medical expense cost to $43 and she would be credited with the SMD of $155.
It is important to remember that if a client contacts DTA regarding their medical expenses because the are not receiving a deduction you must explain how medical expenses are calculated and review the allowable medical expenses to see if they have any additional medical expenses that were not previously considered. If they do and their medical expenses remain less than or equal to $190 per month you must accept a written/telephonic self-declaration and update their case record.
Below is a chart to represent how totaled medical expenses are credited to a household’s SNAP calculation based on rounding rules and the application of the SMD or Actual medical expenses:
| Total Medical Expense Amount after Rounding Rules are Applied | Amount of Medical Expense Deduction |
|---|---|
| $35 a month or under | $0 |
| $36 to $190 per month | $155 (SMD) |
| $191 a month or more | Excess over $35 (Actual) |
Countable Expenses
A broad range of unreimbursed medical costs can be claimed by a person aged 60+ or an individual with a verified disability. This cost can still be claimed even if the client is not able to make payments or a bill is outstanding.
A medical expense is not countable if the:
- expense was or will be paid by someone else (e.g., a third-party reimbursement);
- cost is claimed for a household member who is not aged 60+ or does not meet the SNAP disability criteria; or
- expense is non-recurring and already fully credited to the client for the allowable number of proration months.
Verifying Medical Expenses Above $190 per Month
If an elderly and/or disabled client declares that they incur less than or equal to $190 per month in medical expenses, they can self-declare these expenses on DTA Connect, telephonically, or a written statement. For more information on the procedures for self-declaring medical expenses, see Standard Medical Deduction Waiver.
Note: A self-declaration is also sufficient for crediting dependent care costs that a client chooses to claim as a medical expense. For more information, see Dependent Care Expense Deduction.
If an elderly and/or disabled client indicates that they incur medical expenses above $190 per month, they must submit verification of all medical expenses to receive credit for expenses above $190 per month. A self-declaration is only acceptable for medical expenses less than or equal to $190 per month to be credited with the SMD.
- Example: Cory (they/them) has a monthly medical expense of $40 for prescriptions and provided a self-declaration through DTA Connect. Cory receives the SMD in the households SNAP calculation. Cory later reports having to now pay a health insurance premium of $200 per month. To receive an Actual medical expense deduction of $205 ($40 + $200 - $35 = $205) they must provide documentary evidence of both the prescriptions and health insurance premium.
Households with total medical expenses above $190 can verify the costs through a variety of sources, including but not limited to invoices, receipts, cancelled checks, pharmacy print outs, documentation from Housing Authorities (when all household members are elderly and/or have a disability), or insurance printouts indicating patient responsibility. The verification does not need to specify the medical procedure, names of medications, or other private information regarding the nature of the health care treatment received.
Remember: You must attempt a cold call in all instances where a verification is received, but the document is unclear or unusable, so the client is informed of what is happening with their case.
Medical Expenses Above $190 per Month: Frequency of Verification Needed
When it comes to medical expenses above $190, we cannot restrict the type of verification provided by the client, e.g., a receipt versus a printout from the pharmacy. The frequency of medical expenses may be difficult to verify as all verifications do not include standardized information. While we cannot limit the type of verification, we can determine the frequency of the medical expense from what the client tells us on the Application, Interim Report, or Recertification. If the information is not clear from the documentation provided, you must cold call the client to get verbal confirmation of the frequency.
If a client states in writing or verbally confirms that they purchase specific over-the-counter medications at a specific frequency (e.g., monthly, quarterly, etc.), you may use this as verification of frequency if the information is not questionable. If a client states that they are purchasing certain medical items every month such as a hearing aid or a monthly supply of medication, you must require actual verification since the frequency of this information is questionable.
- Example: Jane (she/her), whose total medical expenses are above $190, submits a statement of her prescription co-payments for the month of July and a receipt for allergy medicine. She does not indicate if this is one time or ongoing. You must contact Jane to find out if these are recurring amounts. If Jane submits two months of documentation of her pharmacy bills, you do not need to call her and may presume these are recurring monthly expenses.
This self-declaration of frequency of medical expense is acceptable when provided verbally, telephonically, on DTA Connect, or in a written/typed statement from the client, or on any DTA form. You must use discretion when allowing the self-declaration of frequency and must narrate the reasons why the self-declaration of frequency was or was not acceptable.
If an expense covers a period exceeding one month, be sure to designate the correct frequency in the Medical Expenses page. For example, if a client purchases a three-month supply of medicine in one month, the total amount of the purchase must be entered, and the frequency coded as quarterly. This will ensure that the correct monthly amount is used in the SNAP calculation.
If you have questions about the frequency of a medical expense, but you are unable to reach the client for clarification, you must send an optional VC-1 for the frequency. To ensure that the client knows specifically what you are requesting on the VC-1, select Additional Verification for Element and type the following for Document(s) of evidence:
“You reported that you have medical expenses, but we need more information about how often you pay for these costs. Please call us or send us a signed letter to tell us how often you pay for the medical expenses that you have just reported.”
If the client does not follow up, you cannot credit the medical expense.
Assisting Clients with Obtaining Medical Expense Verification
In many cases, clients will be able to verify their medical expenses via DTA Connect, telephonically, or as a written self-declaration due to the total amount falling within the SMD range. However, for clients who are required to verify medical expenses due to the monthly total exceeding $190, getting proof of medical expenses can be a challenge. You are required to assist clients who need help obtaining verifications.
- Assistance can include, but is not limited to:
- Re-explaining different types of acceptable verifications;
- discussing disability accommodations;
- conducting a collateral contact to seek verification directly from the source, if the client is in the office with you or you have a properly signed release of information; or
- explaining transportation related costs
Households at Maximum SNAP Benefits
Sometimes, it will be clear that the household will receive the maximum SNAP allotment for their household size even if they are not credited with medical expenses. For example, a household with no income will receive the maximum benefit allotment, regardless of expenses on record.
In this situation, you do not have to delay processing of the case and/or request verification of medical expenses, even if the household reports medical expenses above $190. Advise the household that they will not benefit from verifying medical expenses at this time, but they can submit the verification if they want the information on record to potentially offset future changes that will otherwise decrease their benefit level.
For more information, see Standard Medical Deduction Waiver and Medical Deduction During Review Periods.