How to Discuss Medical Expenses with Clients

Tips for Talking with the Elderly or Persons with Disabilities About Medical Expenses

Talk to clients about possible disability accommodations and work with your office’s CAC to ensure clients are appropriately and fully accommodated. Clients whose total medical expenses are above $190 per month may need help verifying medical expenses as an accommodation.

Before asking about medical expenses, start by explaining that DTA asks about health insurance and medical expenses for anyone in the household that is age 60 or older or is certified as disabled. It should be further explained that health insurance premiums and medical expenses they are responsible to pay may help increase their SNAP benefit amount, if they are not already receiving the maximum SNAP allotment.

Some clients may be reluctant to disclose information about their health problems and medical expenses with a government agency. Understand privacy concerns and clearly communicate the scope of information DTA does and does not need (for example, we do not need information about the name of a medication or dosage - just the cost).

Remember: If an elderly and/or disabled client declares that they incur medical expenses less than or equal to $190 per month, they can verify these expenses by telephonic or written self-declaration.

If an elderly and/or disabled client indicates that they incur medical expenses above $190 per month, they must submit documentary evidence to receive credit above the standard medical deduction (SMD) of $155. A self-declaration is not acceptable for a credited deduction above the SMD of $155. (However, you must take a telephonic or written self-declaration of medical expenses in the SMD range to credit the household with the SMD pending the return of documentary evidence for all their medical expenses.)

For more information, see Standard Medical Deduction Waiver.

Tailor the questions that you ask about medical expenses based on the household’s situation and in a hierarchy to assess if the medical expenses will exceed $190 per month. For example:

Do you pay an insurance premium for health, dental or drug insurance?
- If this question results in a medical expense greater than $190 per month, then you must explain that you will be sending a verification checklist for them to review and submit all the documentation they have for their out-of-pocket expenses. It is best practice to provide examples of other medical expenses they can report, including mileage. If the client confirms they use their own vehicle for medical purposes, they can receive credit for mileage by providing a telephonic self-declaration of their starting location(s), destination(s), and number of trips. Depending on the mileage costs, this may allow you to credit the client with the SMD, pending additional documentation. However, if there are no additonal costs (aside from the health insurance premium) greater than $190 per month, you will want to accept a telephonic self-declaration of having more than $35 per month of medical expenses to credit the household with the SMD, pending documentary evidence. For more information on how to enter this in BEACON, see SMD Verified Option for Special Scenarios.
Clients on MassHealth typically pay for less out-of-pocket expenses than someone who has private health insurance or Medicare. For MassHealth clients, it may be more effective to start by discussing transportation expenses, dental costs or over the counter medical items.
If there is a child with a disability in the household, travel costs are likely to be incurred for getting to and from medical appointments or the pharmacy.

Solely talking about medical expenses may miss claimable costs - clients often think about this topic as a bill incurred at the doctor’s office. Explain the variety of allowable expenses. Be sure to ask clients whether they have travel costs for getting to/from medical appointments and/or the pharmacy.

Let clients know that medical expenses may be reported at any time during their certification period; and that if they have new medical expenses to report, they may send in documentation, go to DTA Connect and update their health insurance premiums or medical expenses, or call the Assistance Line.

Sample Language to Use When Talking to Clients About Medical Expenses

Listed below are examples of suggested language based upon the situation

“Many people pay for different types of medical expenses. Sometimes, telling DTA about these expenses can help increase your SNAP benefit. I’d like to talk about this with you to see if you might have eligible expenses that would increase your SNAP.”

MassHealth Cases (Especially Standard/Full Coverage)

“Many people with MassHealth still have to pay for some medical expenses. Often these are things like transportation costs to go to the doctor, over-the-counter items and dental expenses.

How do you get to your medical appointments and the pharmacy?
(If driving), do you pay for parking?
Do you buy medical items at the drugstore (list a few that may be relevant such as painkillers, supplements, etc.)?
Do you have to pay for dental care?
Do you have any large, one-time bills you have not paid off yet?
Do you have a service or Emotional Support animal? (If yes) do you pay for pet food or veterinary bills for that animal?
Is there anything else your doctor suggested you do to improve your health that costs you money?”

For Seniors on Medicare Who are Paying Medicare Part B (Verified through BENDEX)

“Medicare counts as a medical expense, so because of your Medicare Part B premium you are already/will already get the Standard Medical Deduction. If you have additional monthly medical expenses, then your SNAP may increase further. We can see if it makes sense for you to tell us about other medical expenses.

Do you pay a premium on another type of insurance?
What are you paying in copays each month on your prescriptions?
What are you paying in copays each month for your medical appointments?
How do you get to those appointments?
(If driving), do you pay for parking?
Do you buy medical items at the drugstore (list a few that may be relevant such as painkillers, supplements, etc.)?
Do you have to pay for dental care?
Do you have large, one-time bills you have not paid off yet?
Do you have a service animal? (If yes,) do you pay for pet food or veterinary bills for that animal?
Do you pay for housekeeping, home healthcare, or adult daycare services?
Is there anything else your doctor suggested you do to improve your health that costs you money?”

Clients in Subsidized Housing

Clients in subsidized housing may not have received or know about the rent calculation worksheets containing the annual medical expense amount. You may need to explain that housing authorities keep this information in their records and that clients have the right to ask for documentation of their amount of annual medical expenses if they provided this to the housing authority. Here is sample verbiage to use with clients in subsidized housing whose total medical expenses are above $190 per month:

“If you live in subsidized housing and claimed medical expenses as part of your rent calculation, you could use a document from your housing authority as proof of your medical expenses for SNAP, since your total medical expenses are more than $190 per month. You can ask them for a copy of your Rent Calculation Worksheet, and send it to us. Most housing authorities don’t count over-the-counter expenses. If you buy over-the-counter medical items at the drugstore and your total medical expenses are more than $190 per month, you can also give us receipts from the store showing the product price.”

For more information on medical expenses claimed by clients in subsidized housing, see Medical Expenses Claimed by Housing Tenants.

Note: If the client requests additional resources about medical expenses, provide them with a copy of the Medical Expense Flyer.