Medical Expense Deduction During Review Periods
Medical Expenses at Interim Report
Clients are not required to report changes in medical expenses at Interim Report (IR). However, a client at IR may voluntarily report changes in medical expenses by writing the change in the Additional Notes section (or elsewhere on the form); verbally reporting the change during a call or in-person interaction; and/or submitting medical documentation with the form.
You must not ask clients who submit an Interim Report to submit documentary evidence of medical expenses, unless they voluntarily report one of the following changes:
- A change in medical expenses resulting in the household’s total medical expenses going from less than $190 per month to Actuals (i.e., more than $190 per month).
- A change in medical expenses resulting the household’s total medical expenses remaining in the Actuals range.
Important: If a client does not report any medical information on the IR form and they have existing medical expenses, you must not call or send a letter to ask the client about their medical expenses. You must leave the medical expense record as is.
Procedures for Verifying Changes in Medical Expenses at IR
Client Reports Change in Medical Expenses that Results in Standard Medical Deduction (SMD)
If a client at IR clearly indicated their medical information (including a breakdown of each type and cost) on the IR form, and the change results in the household’s total medical expenses being less than or equal to $190 per month, you must accept the information on the IR form as a written self-declaration.
At IR, clients who report a change in medical expenses resulting in the SMD must provide at least a telephonic self-declaration of medical expenses if they:
- wrote on the IR form that their medical expenses changed, but omitted necessary details (such as the amounts) to complete the written self-declaration; or
- did not report a change in medical expenses in writing, but reported during a call or in-person interaction that their medical expenses changed.
If the client at IR voluntarily indicates a change in medical expenses, but you are unsure whether they are still in the SMD range (>$35/month, <$190/month), you must follow the optional verification procedures detailed in Simplified Reporting Interim Report.
Reminder: Staff must act on verified-upon-receipt information. This means that if a client voluntarily supplies verification of their medical expenses, you must act upon them. The medical expense amount must be updated in BEACON, even if the client was not actually required to provide documentary evidence.
SMD into Actuals
At IR, if a client is already receiving the SMD and they voluntarily indicate a change in medical expenses (verbally or in writing) that brings their monthly total into Actuals, you must send them an optional VC-1 for verification of all medical expenses.
This means that if the household is already receiving the SMD solely based on their self-declaration of medical expenses in the SMD range, they must also submit documentary evidence of the items that they previously self-declared.
Example
A client is currently receiving credit for $150 per month in prescriptions. DTA credited this expense based on the client’s self-declaration because $150 is in the SMD range (>$35/month, <$190/month). At IR, the client reports $50 per month in health insurance. Because the additional $50 brings the household’s total medical expenses into Actuals (>$190/month), staff must send a VC-1 for both the prescriptions and the health insurance.
Note: In some cases, a client getting the SMD will have already submitted documentary evidence of medical expenses, even though they were only required to provide a self-declaration. In such cases, if the client at IR reports a change that brings their medical expenses into Actuals, they do not need to reverify the item for which they already provided documentary evidence.
Remaining in Actuals
At IR, if a client is already credited with medical expenses above $190 per month and they voluntarily indicate a change in medical expenses that keeps their monthly total in Actuals, you must send them an optional VC-1 for only the medical expenses that changed. (Since the total medical expenses were already in the Actuals range, the ECF already includes documentary evidence of the items that did not change.)
Example
A client is currently receiving credit for $200 per month in prescriptions. DTA credited this expense based on a print-out from a pharmacy (rather than the client’s self-declaration) because $200 per month is in the Actuals range. At IR, the client reports $50 per month in health insurance. Because the additional $50 will keep the household’s total medical expenses above $190 per month, staff must send a VC-1 for only the health insurance. The client does not have to reverify prescriptions because they did not change and documentary evidence is already in the ECF.
$0 into Actuals
At IR, if a client voluntarily indicates a change in medical expenses (verbally or in writing) that brings their monthly total from being less than $35 per month into Actuals, you must:
- Use the medical items and amounts that the client wrote on the form as a self-declaration that their medical expenses are at least less than or equal to $190 per month. If the information on the form is incomplete or no form was submitted, follow the Telephonic Signature procedures to have the client self-declare a portion those medical expenses that are less than or equal to $190 per month.
- Enter all the medical expenses into BEACON. You must select the appropriate Expense Type in the Health Insurance and/or Medical Expense pages and enter the self-declared amounts.
- Send an optional VC-1 for all the medical expenses (including those that client already self-declared). Please note that in order for the household to receive an Actual medical expense deduction, all medical expenses except mileage must be verified through documentary evidence.
- Mark the self-declared items of the medical expenses as verified. Do NOT mark as verified the portion of medical expenses that need documentary evidence and cannot be verified via telephonic or written self-declaration. Write a detailed narrative.
- If there are otherwise no missing mandatory verifications, process the case without crediting the medical expenses that are marked as unverified. Only credit the SMD.
- If not crediting medical expenses above $190 per month results in the case getting denied or approved at $0, the case must not be processed at this time. Rather, you must:
- remove the authorization to process the case.
- create an Action to process the case on or before the BEACON Release Date for the IR.
- If the medical expense verification is received on or before the BEACON Release Date, enter all the medical expenses into BEACON and approve the case. Credit the household with the medical expenses above $190 per month.
- If the medical expense verification is not received by the BEACON Release Date, process the case without entering the portion of the medical expenses that brings the total medical expenses above $190 per month. Only credit the household with the standard medical deduction.
Medical Expenses at Recertification
Medical expenses must be reviewed again when it's time to recertify. Clients can report that they are continuing to incur the same medical costs, new medical costs or changed medical costs by:
- writing them on the form,
- telling a worker during an in-person visit or interview, or
- sending proof.
If the client does not provide new proof or new self-declaration of recurring medical expenses on record, you must remove them.
BEACON will remove one-time expenses on or before the reevaluation end date.
Reminder: You must continue following the procedures for handling optional verifications at recertification. See Verifications and When to Process a Recertification with Optional Verifications Outstanding.
Procedures for Verifying Medical Expenses at Recertification
Clients with $190 or less in monthly medical costs can self-declare them in writing or by telephonic self-declaration.
At recertification, you do not have to send a VC-1 for medical costs if:
- the total monthly medical costs are $190 or less
AND
- the client clearly lists each medical type and amount on the form (or a separate paper), or
- the client is able to verbally break down each type and amount, and telephonically self-declare.
You must send a VC-1 for medical costs in one or more of the following situations:
- The total monthly medical costs are above $190: You may be able to figure out the total from what the client wrote on the form and/or what they reported verbally. The total includes both regular and one-time medical costs. Any costs that are not monthly must be changed into a monthly amount. (You do not have to send a VC-1 if the client sent all the proof with the recertification.)
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Reminder: You must continue following the procedure for crediting the household with SMD if they are unable to verify medical costs above $190. See Standard Medical Deduction Waiver.
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- The client does not know their monthly total or cannot break down each medical type and cost: To count a medical cost for SNAP, the client must be able to break down each type of cost and how much it is. If they do not, you must send a VC-1. This rule still applies even if their total is under $190 a month. Example: A client says they pay $180 a month but does not remember the separate costs.
- The client does not self-declare less than $190 in monthly medical costs: If for any reason the client does not provide a written or telephonic self-declaration of their monthly medical costs < $190, you must send a VC-1.
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Reminder: If the client does not provide a telephonic self-declaration (due to refusing or the call getting disconnected), you must attempt to call the client back. If the call is unsuccessful, you must send a VC-1 to give the client an opportunity to verify the item another way. For more information, see Telephonic Self-Declaration.
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Examples
Telephonic Self-Declaration Accepted
Cory (he/him) is federally disabled and was credited with $100 in monthly medical expenses when he initially applied for SNAP. At recertification, Cory writes on his recertification form that his total medical expenses increased from $100 to $140 per month. Because Cory’s medical expense total remains less than or equal to $190 per month, Cory must provide a self-declaration of the change. Moreover, since Cory did not break down each medical expense type, amount, and frequency on the form that he submitted, he must provide a telephonic self-declaration to confirm these missing details. If BEACON will not allow the record to be updated because they are pre-existing medical expenses with an older Medical Expense Type and/or no Subtype (i.e., Subtype indicated as “Not Applicable”), in those instances you would delete or end the pre-existing medical expense record and create a new record using the updated Types, Subtypes and frequency.
Verification Needed
Elizabeth (she/her) is federally disabled and in the process of recertifying her SNAP case. Elizabeth is reporting an increase in her total medical expenses from $180 to $210 per month. Since the total monthly amount is over $190, verification is required. Staff must use the medical information that Elizabeth wrote on her recertification form as a self-declaration that her medical expenses are (at least) less than or equal to $190 per month. Staff must then send Elizabeth an optional VC-1 for all the medical expenses and, pending the return of the full medical verification, process the case with credit given for the SMD.
No Self-Declaration or Verification Needed
Kevin (he/him) is elderly and was credited with $100 in monthly medical expenses when he initially applied for SNAP. At IR, Kevin does not provide any written information about his medical expenses but calls DTA to verbally report that his total medical expenses have not changed. Because Kevin reported no change, staff do not need to send a VC-1 or ask Kevin to provide a self-declaration. The previously verified amount of $100 in medical expenses must continue to be used in Kevin’s SNAP benefit calculation.
Medical Expense Records with Obsolete Selections
When you visit the Medical Expense page during the IR or recertification workflow, a pop-up may appear if there are pre-existing medical expenses on record with an older Medical Expense Type and/or no Subtype (i.e., Subtype indicated as “Not Applicable”). These are selections that were in BEACON before these items were obsoleted when the Medical Expense pages were updated (as the updates detailed in 2024-17).
You do not necessarily have to delete or end the existing record.
You must determine if the record must be updated based on the procedures detailed in this Online Guide page.