Policy 340:50-7-31

A person must be 60 years or older and/or declared permanently disabled to qualify for medical expenses. Refer to article SNAP: Household Composition: Elderly/Disabled

To receive the medical deduction a person must provide proof of recurring itemized receipts or billing statements for the last 60 days. If customers claim prescription drug costs, it may be advantageous for the customer to provide up to 90 days of their pharmacy costs to ensure that we are able to give credit for medications that may only be filled every 90 days.

Allowable expenses include but are not limited to: Medical and dental costs, prescription drugs, doctor approved over the counter medications and supplies, Medicare and dental premiums, dentures, hearing aids, prosthetics, eye glasses, maintaining a home health aide, and reasonable cost of transportation and lodging to obtain medical treatment or services.

A person must be able to verify that they are paying and not just owing.

Special Circumstances:

• The following are NOT allowable medical expenses – cost for special diets, health and accident insurance policies such as those payable as lump sum settlements for death or dismemberment, income maintenance policies such as those that continue mortgage or loan payments while the beneficiary is disabled.
• Marijuana, even when prescribed for medical use, is against federal law and cannot be used as a medical expense for SNAP.
• Expenses that also qualify as dependent care expenses are considered a medical expense rather than a dependent care expense. For instance, payment for maintaining an attendant or home health aide due to age, infirmity, or illness; count it as a medical expense even though it seems to fall under the dependent care expense.
• If your client is approved to receive QMB, SLMB, or QI-1, the Medicare premium expense should be removed the next effective date.
  • If it is a non-report month when the premium payment is approved by the agency, the premium will remain as an included expense and the change will show on the “CX” side as displayed on the IMS EC screen. The change will be effective in the mid-certification renewal month or at the certification renewal.
  • If the SNAP is processed along with the QMB, SLMB, or QI-1 benefits, the worker will need to determine whether or not the premium will be approved by the agency when the SNAP is certified.
• For example: Your client submits a SNAP and medical application on September 25th. The client is interviewed for both programs on October 7th and provides all necessary verification at the interview. Your client is eligible for QMB benefits effective 11/01 because the application was processed in October. When certifying the programs, include the premium as a medical expense for the SNAP benefits for September and October using a 2 month unfinished issuance transaction and remove the premium amount effective 11/01.
  • If it is unknown whether the premium will be approved by the agency because the medical application is still pending verification, add the Medicare premium as a medical expense for the SNAP benefits. **Document in case notes that the Medicare premium expense is allowed because we cannot make a determination for medical benefits at the time of SNAP certification due to pending verification on the medical application.
• If your client reports transportation costs and uses his/or own vehicle, the state’s current mileage rate is used to determine costs.
  The link to website U.S. General Services Administration (Privately Owned Vehicle (POV) Mileage Reimbursement Rates Apply the rate for use of a privately owned vehicle. If your client uses public transportation or pays a non-household member for transportation, the actual amount paid is allowed and will need to be verified to allow that expense as a deduction.
• If your client has a medically necessary service animal per a licensed practitioner or other qualified health professional authorized by state law, items such as pet toys would not be allowed, but specialized grooming, veterinarian bills, pet food costs, and/or specialized equipment would be considered care/maintenance of the pet and those expenses would be allowed.

Examples:

1. Mr. Smith spends some days each month at an adult daycare center. He pays $100 per week for the care provided at the daycare center. He has provided his weekly receipts as verification.

You would allow $100 x 4.3 = $430 / month as a medical expense.

2. Ms. Willis is driven by her daughter once per month from Tulsa to Oklahoma City to see a specialized doctor. In addition, Ms. Willis drives herself once per week to her primary care physician’s office. She pays her daughter $80 per month to drive her to her doctor in Oklahoma City. You have verified this with her daughter. She states she drives 10 miles to her primary care physician’s office from her home (20 miles round trip).

You would allow the $80 / month paid to her daughter as a medical expense. You would also allow 20 x $0.67(current rate / mile) = 13.40 x 4.3 (weekly expense) = $57.62 or $58. Total allowed monthly transportation medical expense is $138.

3. Ms. Lange has a service animal and you have verified that the animal has been deemed medically necessary by her physician. Ms. Lange has brought in several receipts for proof of medical expenses. The Pet Store receipt shows she has purchased dog food, dog vitamins, and a squeaky toy bone. The dog food and vitamins are purchased monthly. Ms. Lange has also provided the pet’s annual shot receipt from her veterinarian.

The dog food and dog vitamins would be considered as monthly expenses. The veterinarian bill can be allowed and either divided by 12 and shown as a monthly expense or allowed only in the month paid, whichever is most beneficial to the client.

Ensure case notes are updated clearly with medical expense explanation, verification, and calculation.