What is the Medical Expense Deduction?

Households with an elder (age 60 or over) or disabled member may be eligible for a medical expense deduction which can increase SNAP benefits. If the elder/disabled household member has at least $35/month in unreimbursed health care expenses--and can prove those costs with DTA--then they will get an income deduction.

In Massachusetts, once an elder/disabled household verifies over $35 a month or more, DTA allows a standard deduction of $155/month for medical expenses. If the household has over $190/month in expenses ($35 plus $155), the household can claim actual expenses for an even larger income deduction. 

Click here to see the MLRI Know Your Rights flier on the medical expense deduction. 

What is a disability for purposes of the Medical Expense Deduction?

You do not need to receive SSI to qualify as disabled. See the Food SNAP Advocacy Guide for more examples of who qualifies as disabled, including those receiving MassHealth for persons with disabilities, or those receiving certain other disability related benefits.

Why is the Medical Expense Deduction important for SNAP households?

This deduction is important because it can substantially increase monthly SNAP benefits. As a general rule of thumb, every $3 less in countable net income increases SNAP by $1 - up to the maximum benefit.

Because of the way the SNAP math works, claiming the medical expense deduction can also boost the value of the shelter deduction a household can claim. For clients in certain gross income brackets, claiming medical expenses can make a big difference in the SNAP math.

For other clients, especially those with “higher income” that live in subsizied housing, claiming expenses over $35 makes no difference in the SNAP benefit- but triggers extra work for DTA and higher expectations for SNAP clients.

This MLRI chart give you a general sense of when medical expenses make a difference for SNAP recipients with rent at 30% of unearned income. 

Remember, the SNAP medical expense deduction is often under-utilized by elder and disabled SNAP households. It is important to screen elder/disabled SNAP households to find out if the medical expense deduction would make a difference. Visit the SNAP Calculation Worksheet page to learn how SNAP benefits are calculated. 

What kind of expenses qualify for the medical deduction?

A wide range of expenses that are not reimbursed or covered by health insurance count for the medical deduction. The medical expenses can only be claimed for household members age 60 or older, or who are disabled and receive a disability-based benefit. (Medical expenses for non-elder/disabled household members unfortunately do not count). Countable expenses include, but are not limited to:

• The cost of health insurance premiums
• Co-payments for appointments or prescriptions
• Acupuncture, chiropractic or herbal treatments
• Health care supplies and equipment, incontinence supplies
• Home health aides, home maker services, care attendants
• "Medicine chest" items including over-the-counter drugs, ointments, other treatments that are recommended or prescribed by a licensed health care practitioner (nutritional drinks or other dietary supplments cannot be claimed)
• Eyeglasses, contacts, lens solutions; hearing aids, batteries; dental care, dentures 
• The costs of public or private car transportation to health care appointments and pharmacies - calculated by multiplying the number of round trip miles by the federal mileage reimbursement rate. Use MapQuest or Google Maps to determine mileage between locations.
• Any paid or outstanding medical bills (for which there is no 3rd party reimbursement). A bill can be averaged over the remaining months in a SNAP certification period or claimed in one month - whichever is better for the SNAP household.

What kind of documents does DTA need to verify medical expenses?

There are a wide range of documents a SNAP applicant or recipient can submit to DTA to prove medical expenses.

Clients can claim medical expenses with DTA at any point - at SNAP application, recertification or any time in between. Clients do not have to wait to do it during a recertification.

Per January 2010 guidance, DTA should NOT need an prescription to verify over-the-counter medical expenses.

DTA should also not request that clients submit an excessive amount of documentation--clients do not need to prove a year's worth of expenses to qualify for the deduction. 

Some ideas of documents to send DTA include, but are not limited to:

• A rent calculation worksheet showing medical costs from a housing authority, if the tenants are all 60 or older or disabled. For more information on this policy, see MLRI's How to Lower Your Rent and Boost Your SNAP Benefits: An Advocacy Tool Kit for Mass Tenants
• A print-out from a doctor or health provider showing co-payments and dates (the dates of the visits help prove transportation to and from the appointment).
• Pharmacy print outs of prescription drug costs and dates ( DTA only needs to know the cost and date of purchase, you can white out the name of the prescription to keep health information private). 
• Transportation receipts (for example, from the RIDE, MBTA pass, bus fare). Clients can verbally self declare transportation costs for medical expenses - make sure claim the federal mileage rate of 54.5 cents per mile (2018 rate) if driving a car to and from medical appointments, the pharmacy, etc.
• Receipts for over-the-counter medications or health supplies recommended by a licensed health care practitioner 
• Bills or statements showing private insurance premiums and deductables (DTA does get household data on Medicare paid through Social Security and Medex premium rates for SNAP recipients)
• Any other paperwork that shows medical expenses incurred by an elder/disabled member of the SNAP household

Remember: A SNAP household only needs to prove $35.01 in monthly medical expenses to receive the $155 standard medical expense deduction!

Additional materials for advocates and clients:

• MLRI's Know Your Rights flier on SNAP medical expenses.  MLRI FAQ also available in Spanish (to be updated soon with the 2018 Know Your Rights flier).
• MLRI's Advocacy Tool Kit for Mass Tenants: How to Lower Your Rent and Boost Your SNAP Benefits
• MLRI's Medical Expense Benchmarks Chart: Highlights when the medical expense deduction makes a difference in the SNAP math for elder/disabled clients with low rent (rent equals 30% of income). 
• AARP's SNAP Medical Deduction flier: The AARP Foundation has produced a clear and attractive flier for states on how seniors and persons with disabilities can claim medical expenses for SNAP. Also available on the Massachusetts AARP website. 
• SNAP Advocacy Guide (MLRI) -- Question 53: What medical expenses can I claim if I am elderly (60+) or disabled?
• DTA SNAP Medical Expense Brochure and DTA Medical Expense Checklist regarding scope of deductible medical expenses for elder and disabled households. The DTA brochure includes some FAQs clients. 
• National Council on Aging flier: Information regarding maximizing the medical expense deduction for older adults, which provides a good overview of the deduction nationally. 
• Webinar Powerpoint, March 2014: Using the SNAP Medical Expense Deduction for Seniors and Persons with Disabilities in Massachusetts. Presented by CBPP, AARP and MLRI. Overview of countable expenses, best practices in other states and help with overcoming obstacles in claiming the deduction. The powepoint and Webinar audio can be found on YouTube here. 
• Medical Release of Information -- If clients need help getting proofs of medical costs, they can sign a release form giving medical providers permission to share records with DTA or a helping organization or advocate. This should work for getting print outs of pharmacy co-payments, fees charged by providers, the dates of health care visits (for transportation purposes), etc.  Here is an example of a health care release form.
• SNAP’s Excess Medical Expense Deduction: Targeting Food Assistance to Low-Income Seniors and Individuals with Disabilities -- Report from the Center on Budget and Policy Priorities, August 2014
   

DTA Policy regarding the Medical Expense Deduction and verification of medical expenses:

• DTA clarification that clients can verbally self declare medical expense transportation costs: See DTA Online Guide page listed in the Online Guide Transmittal for more information. 
• DTA SNAP Medical Expense Brochure September 2015: DTA flier with information about types of deductible medical expenses. Also includes some frequently asked questions and answers about the medical deduction.
• From the DTA Mailbox August 2015: Questions and answers about verifying medical expenses
• DTA Operations Bulletin 2015-2: Email sent to DTA staff stating that clients do not need to get a letter or document from their doctor in order to claim over the counter medical expenses --they just need to verify the expense (unless questionable). 
• SNAP Medical Deductions Job Aid: The Job Aid, updated in March 2014, provides instructions to DTA case managers about allowable medical expenses, verification requirements and averaging medical expenses. 
• DTA Operations Memo 2014-16 : Announcing new $155 standard medical deduction effective March 2014. Includes sample notices sent to SNAP households who will get an increase in their SNAP.
• DTA Hotline Focus August 2012: Detailed DTA instructions on options for treating one-time medical bills for SNAP medical expense deduction.
• DTA FYI January 2010:  DTA guidance on scope of verification of medical expenses. Advises SNAP case managers to not ask for excessive verification. Confirms that recipients do need to verify the dollar amount paid or owed for over the counter drugs or health care supplies recommended by treating provider, but the household does not need to produce a prescription showing the MD or provider recommended the over the counter item unless the client information is questionable.  
• DTA Field Operations Memo 2009-10: DTA Q&A on SNAP Medical Expenses including maintenance costs of service animals (vs pets); disallowing nutrition supplements or special diets.
• DTA Field Operations Memo 2008-15:  Former guidance announcing the standard medical deduction. Now obsolete but includes attachments describing allowable medical expenses, medical expense verification requirements, sample calculations, and averaging medical expenses.
• DTA Hotline Focus March 2008: Full amount of health insurance for single person can be claimed as medical expenses for a disabled household member (e.g., more than just the incremental amount of the insurance).
• DTA FYI June 2007: Processing Non-Recurring Medical Expenses
• DTA FYI April 2007: Food Stamp Medical Deductions "Job Aid" --Instructions to DTA workers to explore medical expenses and assist clients with securing verifications.
• DTA FYI September 2006: Disabled recipients entitled to claim medical expense deduction whether individual is an adult or child; confirms that a household need not pay an outstanding bill to claim medical expense deduction for SNAP.
• DTA Hotline Focus August 2008: Medical expenses do not need to have been paid yet in order to qualify as deductible; hearing aids are deductible; household has choice of deducting a large medical expense in one month or averaging over the rest of the certification period; self-declaration of private transportation to medical appointments allowed, additional verification required only if questionable.