What is the SNAP Medical Expense Deduction?
The medical expense deduction is an income deduction that eligible households can claim to boost their monthly SNAP benefits. Out-of-pocket, non-reimbursed health care expenses can be claimed by older adults (age 60 or over) and individuals with disabilities. Both adults and children qualify as disabled for SNAP if they receive SSI, Social Security as disabled, EAEDC cash assistance or MassHealth as disabled or another disability-based benefit.
The household member must have at least $35/month in unreimbursed medical costs to claim this deduction. Once the elder or disabled household member claims at least $35/month, DTA calculates SNAP with a standard medical expense deduction of $155/month. Medical expenses under $190/month can be self-declared under a special USDA approved state waiver. If the household member has over $190/month in verified expenses ($35 plus $155), the household can claim actual expenses for an even larger income deduction but must verify those expenses.
Why is the Medical Expense Deduction important?
The lower the "countable net income" DTA uses to calculate SNAP benefits, the higher the SNAP, up to the maximum SNAP allotment. As a general rule of thumb, every $3 less in countable net income increases SNAP by $1. Because of the way the SNAP math works, claiming medical expenses can also boost the value of the shelter deduction since the shelter deduction looks at shelter costs above 50% preliminary net income. Visit the SNAP Calculators page to learn how SNAP benefits are calculated. Or you can jump to the Online SNAP calculator here.
Note: Not every elder/disabled household will benefit from claiming medical costs. MLRI has created a series of "At-A-Glance Charts" that help you figure out how much a household will get, including a special chart to help you understand when medical expenses make a difference for SNAP recipients whose rent is 30% of their unearned income.
What kind of expenses qualify for the medical deduction?
A wide range of costs 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).
Examples of allowable health care expenses include:
- Health insurance premiums
- Co-payments for health care visits or prescriptions
- Acupuncture, chiropractic care, physical and occupational therapy
- Vitamins and 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
- Eyeglasses, contacts, lens solutions; hearing aids, batteries; dental care, dentures and adhesives
- The costs of public transport, taxis, ride shares to health care appointments and pharmacies
- Use of a private car to health care appointments and pharmacies - calculated by multiplying the number of round trip miles by the current federal mileage rate. (DTA calculates the mileage using MapQuest or Google Maps between locations.)
- One time medical bills for which there is no 3rd party reimbursement. A one-time bill can be averaged out in different ways to ensure the household's SNAP is maximized.
Can households self-declare their medical expenses?
YES! In 2022, USDA approved Massachusetts for a special waiver (pilot) that allows SNAP households to self-declare their medical expenses. The medical expenses can be self-declared on the SNAP application or renewal forms, when talking with a SNAP worker by phone, or whenever a household sends a letter to DTA about their medical costs. DTA also has a form you can use, posted here (and linked here in 5 languages) Under the special waiver, households can self-declare expenses that exceed $35/month, which allows them to get a "standard medical deduction" of $155/month in the SNAP math.
However, if a household claims more than $190/month in health care costs (that's the $35 threshold plus $155 standard deduction), the household must provide DTA with proofs of all expenses claimed.
Here are EXAMPLES of documents to send DTA for households claiming $190 or more in out of pocket expenses:
- For public/subsidized tenants, a copy of the "rent calculation worksheet" if medical expenses were claimed for rent purposes. For more information, see MLRI's How to Lower Your Rent and Boost Your SNAP Benefits: An Advocacy Tool Kit for Mass Tenants
- A print-out or bill from a health provider showing co-payments and date of service
- Pharmacy printouts of prescription drug costs and purchase dates.
- Receipts for over-the-counter medications or health supplies (herbal remedies, vitamins, etc) recommended by a health provider (a prescription is not required)
- Transportation receipts from the RIDE, the cost of an MBTA pass, taxi or ride share fees, bus fare. Note, for private vehicle transportation to a doctor, pharmacy or any health care location.
- Bills or statements showing private insurance premiums and deductibles (DTA should get information on a Medicare Part B premium paid out of Social Security directly from the Social Security Administration)
- Any other paperwork that shows medical costs incurred by an elder and/or disabled member of the SNAP household.
FAQs, Tool Kits and DTA Guidance on medical expenses:
- MLRI's Know Your Rights FAQ on SNAP medical expenses - in English and Spanish (not updated)
- MLRI's Advocacy Tool Kit for Mass Tenants: How to Lower Your Rent and Boost Your SNAP Benefits (not updated)
- MLRI's SNAP Medical Expense Benchmark Chart (updated 10/3/22), highlighting when the medical expense deduction makes a difference in the SNAP math.
- DTA SNAP Medical Expense Brochure and DTA Medical Expense Checklist regarding scope of deductible medical expenses for elder and disabled households (not updated).
- DTA's Online Guide on the SNAP Standard Medical Deduction Waiver (updated 9/21/22)
- Medical Release of Information -- If a household needs 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. Here is an example of a health care release form.
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