If your household includes a person age 60 or older or person with disabilities, you are allowed to claim a wide range of unreimbursed medical or health care expenses as a deduction. The more medical expenses you can claim, the lower your "countable" will be. The lower your countable income, the higher the SNAP/food stamp benefits you will receive. Remember— Under the SNAP/food stamp rules, you are "elderly" once you reach age 60. You are considered disabled only if you receive a disability-based benefit. 106 C.M.R. § 361.210. See 19. Are there special rules for elders and persons with disabilities?

There are two ways DTA allows un-reimbursed medical expenses under 106 C.M.R. § 364.400(C):

• The "standard" $90 medical deduction: If you have medical expenses over $35 a month, you will receive a standard $90 monthly deduction off your countable income. You need only show that you have over $35/month in expenses to get this $90 deduction.
• The regular medical deduction: If you incur more than $125 per month in medical expenses (that's the $35 threshold plus $90 value standard deduction), you can claim the actual expenses (minus the $35 threshold) to get a higher income deduction. You will need to give DTA proof of your actual medical/health expenses above $125 to claim a higher deduction.

Example

Sally Winsor is 78 years old. She has MassHealth coverage, but the combination of small co-pays plus her over-the-counter pain relief and skin treatments add up to $36 per month. In calculating Mrs. Winsor's SNAP/food stamp benefits, DTA will allow the $90 standard medical deduction off her income. If Mrs. Winsor was billed substantially higher out-of-pocket expenses— more than $125/month— she could claim the actual expenses that could be verified above $35/month.

If you have a large, one-time medical expense during your certification period, you have the option of claiming the expense as a one-time deduction or having it averaged over the remaining months in your certification period. 106 C.M.R. § 364.440(C). The most advantageous option depends on the circumstances.

Example

Sally Winsor reports a one-time unpaid hospital bill of $960 and she just applied for SNAP/food stamp benefits. Because she is elderly, she will be certified for 24 months. The amount of the bill averaged over 24 months would be $40. Mrs. Winsor also reports she now has only $15/month in other health care expenses each month. The $15/month alone would not get her a standard deduction, but if she uses the unpaid hospital bill, her medical expenses easily exceed $35 and she gets the $90 standard medical expense deduction.

Suppose Mrs. Winsor had enough other regular expenses (above $35) to claim the standard medical deduction. She should then have the choice of claiming the $960 bill as a one-time deduction for one month. Or, if she was in the midst of her certification period (say six months left in her 24-month cert period), she could average the $960 over the six months and claim a medical deduction of $160/month of medical expenses in addition to her regular monthly expenses. This could help her get higher SNAP/food stamp benefits for the remainder of her certification period.

Scope of allowable health care expenses

• your co-pays or premiums for Medicare, Medicare Part D, Medex or other health insurance, and your deductible for Medicare Part D;
• any medical services for from doctors, clinics, hospitals laboratories or other facilities not reimbursed by a third party;
• any custodial or attendant care services you need (even if that person is a relative), as well as housekeeping services you pay for;
• dental care, dentures, dental adhesives;
• health treatments by a licensed practitioner, including chiropractic, acupuncture, physical or other therapy;
• prescription drugs, including postage costs and any transportation costs to pick them up;
• over-the-counter drugs prescribed by any licensed health care provider (for example, aspirin, laxatives, insulin, herbal and homeopathic remedies);
• eyeglasses, contact lenses, hearing aids, batteries, communication equipment for the hearing or visually impaired;
• health-related supplies prescribed by a health care provider including incontinent supplies, creams and ointments, commodes and walkers;
• private transportation costs at the current federal mileage rate (as of July 2011 it is 55.5 cents/mile), or the monthly cost of taxis, vans, or public transportation needed to get to medical appointments;
• veterinary bills, dog food, and other needs for trained service animals; and
• any other un-reimbursed medical expenses prescribed or recommended by your health care providers.

106 C.M.R. § 364.400(C).

Proof of medical/health care expenses

You are only required to provide proof of the amount of your medical expenses. You are not required to proof that your health care provider is licensed, or that your medical supplies or treatments were prescribed or recommended by your provider. 106 C.M.R. § 364.450(A). The following are examples of proofs you can submit for medical expenses, but you can also submit other items:

• Billing statements, canceled checks or other proof of your insurance premium, and any health care bills you paid or owe.
• A Medicare or insurance "Claim Summary" that shows what services you received, how much your insurance paid, and how much you are responsible to pay. The Claim Summary is also useful in showing the dates of visits to your doctor and laboratory visits that you can use to claim transportation costs.
• Print-out from your pharmacy showing your co-pays and out-of-pocket payments for drugs (and it is also useful in showing all your visits to the pharmacy for claiming transportation). You need not show DTA exactly which drugs you take— you can white-out the names of the medications from the pharmacy print-out.
• Copies of receipts for things you bought at a pharmacy or health supply store, like incontinence supplies, aspirins, vitamins, skin ointments, hearing aid batteries. You do not need a statement from your health care provider about these items as DTA should assume you only bought them because you needed them and they were recommended.
• A written statement (self-declaration) from you of how many times you traveled in your car to your health care provider (doctor, physical therapy, pharmacy, etc.). DTA can help you figure out the mileage using MapQuest. If you have a T-pass that you use for medical expenses, show DTA the T-pass.
• A written statement (self-declaration) from you that the medications, health supplies or other treatments are recommended by your treating provider, if questionable.

These are just examples! Try to save your pharmacy, co-payment and travel receipts for a couple of months, just to keep track. If your monthly medical expenses are the same at recertification, you do not need to re-verify. You can self-declare on your recertification form that the medical expenses are on-going and have not changed. Appendix C: Medical Expense Flier and Screening Form contains an FAQ.