Standard Medical Deduction Waiver

Overview

The Standard Medical Deduction (SMD) is a $155 deduction that is credited to elderly and/or disabled SNAP clients who incur medical expenses greater than $35 and less than (or equal to) $190 per month. Elderly and/or disabled SNAP clients who incur medical expenses above $190 are credited with the actual cost of the medical expenses minus $35. These deductions usually result in a higher SNAP benefit level.

DTA has an approved waiver from USDA that allows elderly and/or disabled clients to self-declare medical expenses that are less than or equal to $190 per month. This flexibility not only allows clients access to the SMD deduction without the burden of collecting multiple receipts and documents, but also helps to maximize their SNAP benefits. Additionally, this reduces the administrative burden of reviewing and entering documents.

Acceptable Verification of Medical Expenses 

Verifying Medical Expenses Less Than or Equal to $190 per Month

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

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.

Verifying Medical Expenses Above $190 per Month

If an elderly and/or disabled client indicates that they incur medical expenses above $190 per month, they must submit documentary evidence of all medical expenses to receive a deduction above $190 for all the medical expenses that they are reporting.

In this case, a self-declaration is no longer acceptable. Examples of acceptable verifications include receipts, bills, invoices, etc.

Important: To receive credit for medical expenses above $190 per month, the client must submit verification of all their medical expenses—not just the portion that brings them above $190.

Pending the return of verification for medical expenses above $190, you must credit the client with the SMD of $155 per month if the client self-declares to having more than $35 per month in medical expenses. For more information, see the procedures detailed in the Procedures for Taking Medical Information section of this page.

Reporting New Expenses While Receiving SMD or Actuals

If the client is already credited with the SMD and they report a new medical expense that brings them above $190 per month, they must submit verification of all the medical expenses, including the ones they self-declared to receive the SMD. If they do not submit verification that puts them above $190, the client must continue receiving the SMD.

Example

Alfred (he/his) is currently receiving credit for the SMD because his monthly medical expenses total $180. During case maintenance, Alfred reports that he now must pay an additional $20 per month for health insurance.  To receive credit for the $20 insurance premium and get into the Actuals range with $200 per month, Alfred must submit verification of all the expenses he previously self-declared plus the new $20 expense. If Alfred does not submit verification, DTA cannot give him any additional credit and must continue crediting the SMD of $155 per month.

If the client is already credited with medical expenses above $190 per month (Actuals) and they report an additional medical expense during case maintenance, they must submit verification of only the new medical expense; they do not have to reverify the medical expenses for which they already submitted documentary evidence. If the client does not submit verification of new medical expense, they will not receive credit.

Example

April (she/her) is currently receiving credit for Actuals because her monthly medical expenses total $215. During case maintenance, April reports that she must pay an additional $30 per month for a new prescription. To receive credit for the prescription and bring her total medical expenses to $245 per month (for which DTA would credit $210), April must submit verification of the prescription. Otherwise, DTA must continue crediting April with the monthly medical deduction of $180 (i.e., $215 – $35) that she previously verified. April does not have to reverify all the medical expenses that she previously verified to first get credit for Actuals.

If the client is already credited with medical expenses above $190 per month and they report an additional medical expense during Interim Report or recertification, you must follow the procedures outlined in Medical Expense Deduction During Review Periods.

Procedures for Taking Medical Information 

A client may report medical expenses at application, recertification/IR, or case maintenance. Clients may report these expenses verbally, in writing, or just by submitting the verification. Regardless of where they are in their certification period and how they choose to report the expenses, you must do the following:

  1. Determine whether the client has any medical expenses that they pay on a regular (recurring) basis.
  2. If yes, determine the type, amount, and frequency of the recurring medical costs. Key the recurring medical expense information into the Medical Expense and/or Health Insurance pages in BEACON.
  3. Determine whether the client has any one-time (non-recurring) medical expenses from the last 36 months that they paid off or have yet to pay off.
  4. If yes, determine the type and amount of the non-recurring medical expense. Key the non-recurring medical expense information into the Medical Expense and/or Health Insurance pages in BEACON.
  5. Determine the number of months by which to divide the one-time medical expenses following the procedures in Non-recurring Medical Expenses. Enter the appropriate number of months in the “Number of months” field available to input for non-recurring medical expenses. (Note that the Start and End Dates for the non-recurring medical expenses will be automatically determined upon the number of months entered.)
  6. If there is another elderly/disabled member in the household, follow the previous steps to record their medical information.
  7. If the household’s total medical expenses are less than (or equal to) $190 per month, follow the Telephonic Signature procedures to have the client self-declare these medical expenses. (If the client already provided verification or an adequate written self-declaration of the medical expenses, then they do not have to provide a telephonic self-declaration.)
    1. Example: If the client has a hospital bill for $55, copay for $38, prescriptions for $42, and over-the-counter medication for $37, you must have the client self-declare all of them because their sum total is less than or equal to $190 per month.

    2. Important: Before transferring the client to the IVR line to telephonically self-declare their medical expenses, you must verbally run through each item and amount that the client declared to ensure that the information is correct.

  8. Enter the medical expense information into BEACON and mark each item as verified. If you are using the Optimal Proration Tool to record the information, convert the tool from a spreadsheet to a PDF file and attach the PDF to the narrative.

    1. Remember: The Optimal Proration Tool is not mandatory for recurring medical expenses; however, it may be helpful in determining the if the expenses are in the SMD or Actual range. The tool however is mandatory when calculating nonrecurring medical expenses.

  9. If the household’s total medical expenses are above $190 per month, the next steps are based on where the client is in their certification:

Medical Expenses > $190 at Application 

If a client reports more than $190 per month in medical expenses at application, you must do the following during the application interview:

  1. Follow the Telephonic Signature procedures to have the client self-declare the total value of those medical expenses that are less than or equal to $190 per month. (If the client already provided verification or an adequate written self-declaration of this medical expense portion, then they do not have to provide a telephonic self-declaration.)
    1. Example: If the client has a hospital bill for $250, copay for $60, prescriptions for $50 and over-the-counter medication for $45, you must have the client self-declare the copay, prescriptions and over-the-counter medications. The client must submit verifications of all expenses claimed to receive credit for actual medical expenses above $190.
    2. Example: If the client has a hospital bill for $75, copay for $50, prescriptions for $50, over-the-counter for $30, you must have the client self-declare any three out of the four items to get into the SMD range. However, the client must submit verification of all four items to receive the actual medical expense deduction.
  2. 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.
  3. Send an optional VC-1 for all medical expenses (including those that client already self-declared telephonically or in writing, as this will allow for clients to verify and get credit for actual medical expenses).
  4. 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. If you are using the Optimal Proration Tool to record the information, convert the Optimal Proration Tool to a PDF file and attach to the narrative.
    1. It is crucial that you properly record the medical expenses that were self-declared. “Properly record” means that each medical expense is entered under the appropriate dropdown selection, and marked as verified or unverified depending on what verification or self-declaration was already obtained. Staff must also adhere to the standards for BEACON narratives, per Completing BEACON Narratives.
    2. You must not process the case until the verifications are received or Day 30, whichever occurs first. If the verification is subsequently received, update the medical information in BEACON based on the amounts displayed on the documentary evidence and mark the outstanding items as verified.

Medical Expenses > $190 at Recertification or IR 

If a client reports more than $190 per month in medical expenses at recertification or IR, follow the procedures detailed in Medical Expense Deduction During Review Periods.

Medical Expenses > $190 at Case Maintenance

If a client calls to report more than $190 per month in medical expenses during case maintenance, follow these steps:

  1. Check whether the household is already receiving the maximum SNAP allotment for their household size.
  2. If the household is already receiving the maximum SNAP allotment for their household size, explain to the client that:
    1. they must submit medical expense verification to be fully credited for what they reported on DTA Connect;
    2. they will not benefit from verifying medical expenses at this time due to already receiving max benefits; and
    3. they can still submit the verification if they want the information on record to potentially offset future changes that would otherwise decrease their benefit level.
      1. Write a narrative and do not send a VC-1.
      2. If the household is not already receiving the maximum SNAP allotment for their household size, proceed to the next step.
  3. Check if the household is already receiving a medical deduction (i.e., SMD or Actuals).
  4. If the household is already receiving the SMD, send an optional VC-1 for medical expenses. Write a narrative confirming that the client is already receiving the medical deduction and will be credited with additional medical expenses if they submit the optional verification.
    1. If the household is not already receiving the SMD, proceed to the next step.
  5. Follow the Telephonic Signature procedures to have the client self-declare the total value of those medical expenses that are less than or equal to $190 per month. (If the client already provided verification or an adequate written self-declaration of the SMD portion, then they do not have to provide a telephonic self-declaration.)
  6. Enter all the medical expenses into BEACON. You must select the appropriate Expense Type and Subtype in the Health Insurance and/or Medical Expense pages and enter the self-declared amounts.
  7. Send an optional VC-1 for all medical expenses (including those that client already self-declared telephonically or in writing, as this will allow for clients to verify and get credit for actual medical expenses).
  8. 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. If you are using the Optimal Proration Tool to record the information, convert the Optimal Proration Tool to a PDF file and attach to the narrative.
  9. Wrap up the case and recalculate the benefits to credit the household with the SMD.

If the client subsequently follows up with the verification, the FAW who receives the Action to review the documents must add them to the BEACON record (based on the medical information displayed on the verification), mark the outstanding items as verified, and recalculate the benefits.

Remember: You must always make sure that the reported medical expense is not a duplicate of an item that is already on record. If it is, then you must disregard it and document it in the narrative. You must also cold call the client to remind them that we already know about the item they are reporting.

Example of Procedures

Jane (she/her) is telephonically applying for SNAP benefits with her husband John (he/his). Both Jane and John are elderly. John receives an employment related pension of $3,939 per month, and Jane receives $821 per month in RSDI. They are responsible to pay a mortgage of $1,239 per month and their SUA is for heating. Jane pays $50 per month for prescription medications. John pays $2,666 per month for a home health aide.

Since Jane’s prescription costs are less than or equal to $190 per month, the case manager asks Jane to provide a telephonic self-declaration of these expenses. However, since the cost of John’s home health aide places the total medical expenses above $190, the case manager must request verification of both Jane’s prescriptions and John’s home health aide to potentially credit them with Actuals should the documentary evidence be provided.

After Jane provides the telephonic self-declaration of their prescriptions, the case manager enters Jane’s medical expenses into the Medical Expense page in BEACON and then sends the optional VC-1 for both the prescriptions and John’s home health aide. After the VC-1 is generated, the case manager only marks Jane’s medical expenses as verified. The case manager will not mark John’s home health aide cost as verified until documentation is received. The case manager must then wrap the case so the SMD will be applied pending medical expense documentation.

Action: DTA Connect – Medical Expenses greater than $190 

During case maintenance, if the client uses the DTA Connect to report medical expenses and the reported amount brings the household’s total medical expenses above $190 per month, BEACON will create the Action: DTA Connect – Medical Expenses greater than $190.

Note: BEACON will not create this Action if the household’s total medical expenses are already above $190, and the client removes a medical item on DTA Connect. In this scenario, BEACON will automatically wrap the case, even if the household’s total medical costs remain above $190 after the removal of the item on DTA Connect.

If you receive the DTA Connect – Medical Expenses greater than $190 action, you must follow these steps:

  1. View the DTA Connect Datasheet available on the Client Communications page in BEACON.
  2. Check if the household is already receiving the maximum allotment for their household size.
  3. If the household is already receiving the maximum SNAP allotment for their household size, make two cold call attempts to reach the client. If one of the calls is successful, explain to the client that:
    1. they must submit medical expense verification to be fully credited for what they reported on DTA Connect;
    2. they will not benefit from verifying medical expenses at this time due to already receiving max benefits; and
    3. they still can submit the verification if they want the information on record to potentially offset future changes that will otherwise decrease their benefit level.
      1. Write a narrative and disposition the DTA Connect – Medical Expenses greater than $190 action using the normal Business Process procedures. Do not send a VC-1.
      2. If both cold calls are unsuccessful, write a narrative and disposition the action. Do not send a VC-1.
      3. If the client is not already receiving the maximum SNAP allotment for their household size, proceed to the next step.
  4. Check if the household is already receiving a medical deduction (i.e., SMD or Actuals).
  5. If the household is already receiving the SMD, send an optional VC-1 for medical expenses. Write a narrative and disposition the action.
    1. If the client is not already receiving a medical deduction, proceed to the next step.
  6. If the household is not already receiving a medical deduction, you must credit the household with the self-declared medical expense(s) in the SMD range (those that are less than or equal to $190 per month). To do this, go to the BEACON Verifications tab and mark medical expense(s) less than or equal to $190 as self-declared. Do NOT mark any medical expense(s) as verified that would bring the total over $190 per month.
  7. Send an optional VC-1 for medical expenses with additional language. Add a User-Entered Verification, select Additional Verification for Element, select Optional for FS under Program(s), and add the following text in the Document(s) of evidence:
    1. “You are getting this letter because you reported new medical expenses. We have credited some of them.  To get full credit give us the verifications we are asking for. You may get a separate letter confirming the expenses we have already credited. Your SNAP may go up based on the expenses we credited, but they may go up more if you give the verifications.”
  8. Wrap the case to credit the household with the SMD of $155.  Write a detailed narrative.

If the client subsequently follows up with the verification, the FAW who receives the Action to review the documents must add them to the BEACON record and recalculate the benefits to get into Actuals. (If the medical expense is non-recurring, staff must remember to utilize the proration procedures detailed in Non-recurring Medical Expenses). If necessary, the FAW must issue a related benefit.

If the client does not follow up with verification, no further action is required, as there are no follow-up Actions for outstanding medical verification during case maintenance.

Remember: If a client is adding new medical expenses at case maintenance, you must not remove any existing recurring medical expenses on record unless the client tells you that they no longer have to pay for those items.

SMD Verified Option for Special Scenarios

The Medical Expense and Health Insurance pages in BEACON include SMD Verified as a dropdown option for Type and Insurer, respectively. The SMD Verified dropdown option is necessary for situations where a client is newly reporting a singular medical expense greater than $190 per month and they do not already have medical expenses in the SMD range.  In these particular situations, the client can self-declare having medical expenses greater than $35 per month and be credited with the SMD until they provide verification of the medical expense greater than $190.

SMD Verified: Recurring

You may use the SMD Verified option for a singular recurring medical expense that is greater than $190 per month when the client self-declares they have a medical expense greater than $35 per month.  When you are using the SMD Verified option to record a recurring medical expense, you must enter $36 for the monthly amount.

Example

Rory (he/his) self-declares on DTA Connect that he pays $220 per month for private health insurance. Staff receive the DTA Connect – Medical Expense greater than $190 Action. Staff confirm that Rory is not receiving the maximum SNAP allotment for his household size, and he is not currently receiving a medical deduction. Staff review the DTA Connect data sheet and confirm that the Rory provided a self-attestation of medical expenses greater than $35 per month. On the Health Insurance page in BEACON, staff enter an Insurer of SMD Verified for $36 per month. Staff then send a VC-1 to Rory (using the Additional Verification denoted language in the Action: DTA Connect – Medical Expenses greater than $190 section of this page) and process the case maintenance change. This allows Rory to receive the SMD.

If the client subsequently provides the verification the recurring expense BEACON must be updated to reflect the information and amount that the client submitted. You must delete SMD Verified ($36 per month) from the Medical Expense/Health Insurance page and reenter the item using the applicable dropdown selection and the amount reflected on the verification.

Example

Rory from the previous example submits a health insurance bill from Tufts showing that Rory pays a $220 monthly premium. Staff end the existing SMD Verified expense of $36 per month and add a new Insurer of Tufts and enters the $220 per month amount. The case is wrapped and processed.

SMD Verified: Non-Recurring

When a client reports a singular non-recurring medical expense that when averaged over the remaining certification period results in more than $190 per month, the client can self-declare having medical expenses greater than $35 per month and be credited with the SMD. To calculate the amount for the SMD Verified Type you must follow the steps below to use the SMD Verified option:

  1. Multiply $36 (the amount used to credit the SMD to the case) by the number of months remaining in the household’s certification period.
  2. Enter the result of Step 1 for the monthly amount and mark “one-time” for Frequency.
  3. Enter the number of the months remaining in the certification period. You can determine the number of months remaining in the certification period by using the table at the bottom of the Optimal Proration Tool. See the sample screenshot below: View/HideView/Hide

    Optimal Proration Tool Table

In the Optimal Proration Tool, you must key in the Effective Date of the non-recurring expense and the current (or upon approval of application/recertification/IR, what will be the) reevaluation end date of the case. Once you do this, the spreadsheet will automatically populate the months remaining the certification period. For more information on crediting nonrecurring medical expenses, see Non-Recurring Medical Expenses.

Example

On December 15, 2023, Etta (she/her) reports that her only medical expense is a non-recurring surgery bill for $6,000. When prorated over the remaining course of her certification period, Etta would receive a medical deduction in the Actuals range (greater than $190 per month).  Staff received a telephonic signature from Etta that she has more than $35 per month in medical expenses. Staff sends an optional VC-1 for medical expenses.  Staff uses the Optimal Proration Tool to determine the number of months remaining in the certification period. Etta’s SSN ends in “0”, the effective date of the non-recurring expense is 1/01/2024 and the reevaluation end date is 8/31/2025.  According to the tool Etta has 20 months remaining in her certification period.  Staff multiples $36 (the SMD credit) x 20 (months) = $720 as the SMD nonrecurring medical expense amount. Staff then selects SMD Verified as the medical expense Type and enters $720 for Amount. Staff also entered 20 in the Number of Months field. The case is wrapped and Etta receives the SMD deduction in her SNAP calculation.

If the client subsequently provides the missing medical information and/or verification after staff applied the SMD Verified option for the non-recurring expense, you must delete SMD Verified from the Medical Expense/Health Insurance page and reenter the item using the following steps:

  1. Check the number of months for which SMD Verified has been credited so far.
    1. You can determine this by reviewing the Entered date at the bottom of the Medical Expenses page and reviewing the Results tab to count the months from which it became effective: View/HideView/Hide

      Expense  Results

  2. Multiply the result of Step 1 by $36.
  3. Subtract the result of Step 2 from the out-of-pocket amount listed on the verification that the client submitted.
  4. Credit the client with the result of Step 3 (i.e., the credit that the client has not already received for the expense until this point) using the proration procedures detailed in Non-recurring Medical Expenses.

Example

On 07/15/2024, Etta from the previous example provides verification of the surgery. The worker previously recorded the surgery under “SMD Verified” as a one-time expense of $720, i.e., $36 per month applied for 20 months. Now that Etta has submitted verification of the expense, staff must work backwards to determine how much of the expense has been credited so far and to update the Medical Expense accordingly. Specifically, staff must:

Check the number of months for which SMD Verified has been credited so far.

Etta has received credit from January through July: 7 months.

Multiply the result of Step 1 by $36.

$36 x 7 months = $252

Subtract the result of Step 2 from the total amount of the surgery bill ($6,000).

$6,000 - $252 = $5,748

Credit Etta with the non-recurring expense of $5,748 using the proration procedures detailed in Non-recurring Medical Expenses. You must determine the optimal number of months for prorating the $5,748 over the remainder of the certification period using the Optimal Proration Tool.

Best Practices

Screen, Explain, and Advise

If you are processing a case with an elderly and/or disabled client, it is important to screen for medical expenses. You must explain to the client that reporting medical expenses may result in more SNAP benefits. During this conversation, you must determine what medical expenses the client has (if any), and whether they are eligible for the SMD or an actual medical expense deduction. You should also explain how the medical deduction works and advise the client to retain hard copies of their medical documentation (e.g., receipts, invoices) in the event their case is selected for review by DTA’s Quality Control division.

How to Discuss Medical Expenses with Clients

When asking clients about medical expenses, you must ask questions in general terms. For example, instead of asking “What prescription medications do you pay for?”, ask “Do you pay for any prescription medications?” Similarly, instead of asking “What did you go to the hospital for?”, ask “Do you have any hospital bills?” For more information, refer to the How to Discuss Medical Expenses with Clients page.

Using External Data Sources

Although DTA is allowed to accept a self-declaration of medical expenses that are less than or equal to $190 per month, you must continue using SVES and BENDEX to verify medical expenses if the information is available through these data sources. For example, if the client at application provides a self-declaration that includes the monthly cost of Medicare Part B, SVES is still to be used to validate the Part B information (in accordance with the guidance in SSA Data).

When calculating total medical expenses to determine whether they are less than or equal to $190 per month, medical expenses available through data sources must be factored into the total medical expense amount (this includes health insurance such as Medicare Part B).

Example

An elderly client at application self-declares that their monthly medical expenses include Medicare Part B ($164.90) and prescriptions ($30). Because the total amount is above $190 ($164.90 + $30 = $194.90), staff must send a VC-1 for medical expenses. Even though staff will no longer need the client to verify Part B once it is verified through BENDEX, the VC-1 must be sent because the initial calculation of total medical expenses is above $190.

What to do if Verification Differs from Self-Declaration

In cases where a VC-1 is sent for medical expenses above $190: If the client subsequently provides all the verification, you must review the verification against what was already self-declared. If the verification shows a different amount than what was self-declared, you must enter the amount reflected in the documentary evidence. For example, if a client initially self-declares $30 per month in prescription costs but then provides a pharmacy printout showing $25 per month, you must change the amount in BEACON to $25 per month.

Retention of Prior Medical Records at Case Maintenance

If a client is adding new medical expenses at case maintenance, you must not remove any existing recurring medical expenses on record unless the client tells you that they no longer have to pay for those items.

When a Client Reports Medical Expenses but is Missing Information

If an elderly or disabled client communicates to you that they have medical expenses but are unable to provide essential information such as the type, cost, frequency, etc., you must advise them on how they may follow up with the information once they have it. You must tell them that they can report the information DTA Connect, submit a written and signed letter, or call back to provide a telephonic self-declaration.

The Out-of-Pocket Medical Expenses Form

You must also provide them with the Out-of-Pocket Medical Expenses Form. The Out-of-Pocket Medical Expenses Form is a fillable PDF file that clients can print and complete by hand, or by telephonic signature. The form includes a checklist of common medical expenses with fields for indicating each one’s cost and/or frequency.

You can download the form by clicking here. You must mail them a copy of the Out-of-Pocket Medical Expenses Form or advise them that the form is available for download at https://www.mass.gov/resource/dta-documents-forms. You can mail this form by utilizing the Letter Request feature in BEACON.

Clients can submit the Out-of-Pocket Medical Expenses Form by mail, fax, scanning at a local office, or uploading it online through DTA Connect. If you complete the form for the client and they sign it telephonically, you must manually save the document into the ECF by attaching it to the narrative or scanning it to the DPC.

Last Update:  March 8, 2024