Medical Deduction (FSM)

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SNAP households containing an elderly or disabled member (target population) are entitled to a standard medical deduction of $135 per month if the household’s monthly unreimbursed medical costs exceed $35 but are less than or equal to $135.

If the household’s verified monthly medical expenses exceed the $135 standard, the household is entitled to a higher monthly deduction equal to the household’s verified actual costs.

Allow only those expenses for the treatment of target population SNAP household members. Include expenses paid on behalf of individuals who were household members immediately prior to entering a nursing facility or hospital.

The household need only verify that monthly medical expenses exceed $35 to receive the standard. Care must be provided by a licensed practitioner or qualified health professional (e.g., chiropractor, Christian Science spiritual practitioner, doctor, sex therapist, clinical social worker, acupuncturist, clinical pastoral counselor, clinical psychologist).

●	Average reasonable estimates of anticipated unreimbursed medical expenses over the certification period.
●	Do not require verification or reporting of anticipated expenses as they occur during the certification period.
●	Treat verified one-time costs as a one-month deduction or average over the certification period, as the individual indicates.
●	Verify unanticipated changes reported by the household or sources outside the household that occur during the certification period only if such changes are verified upon receipt and without contacting the household.
●	Treat any verified changes that occur during the certification period as a one-month deduction or average them over the certification period, as the individual indicates.

Medical deductions include, but are not limited to:

●	Nursing facility care paid by an assistance group member for a SNAP target population member who was a household member immediately prior to entering the hospital or nursing facility recognized by the state.
●	Monthly installment payments for verified payment plans or loan agreements for medical bills for the target individual.
●	Over-the-counter drugs prescribed by a licensed practitioner or other qualified health professional.
●	Securing and maintaining a prescribed service animal (most commonly a dog) that is specially trained to perform a function the individual cannot readily perform on their own or that assists the individual with the medical issue for which the animal is prescribed. Allowable expenses include the cost to obtain the service animal, special equipment such as halters or coats that identify the animal as a service animal, food, and veterinary care. Request verification (receipts) of allowable expenses. Other items such as toys, clothing that does not identify the service animal, dishes, grooming supplies and services, bedding, et cetera are *not* allowable. The service animal must be prescribed by a healthcare provider; request verification in the form of a prescription or signed and dated statement from the healthcare provider. Specific types of training, credentials, and/or certifications are not required; verification of training may be in the form of self-attestation (written or verbal) and must be documented in case comments. Expenses related to a companion or emotional support animal are *not* allowable, even if the companion or support animal has been recommended by a healthcare professional.
●	Reasonable transportation costs, including, but not limited to, transportation costs to and from doctor’s appointments, testing, treatment, and pharmacies/drug stores to pick up medication, including both prescription and over-the-counter medicine. The allowable transportation cost for a private vehicle is determined by multiplying the number of miles traveled for medical needs by the federal mileage rate for medical travel, which is determined annually by the IRS (https://www.irs.gov/tax-professionals/standard-mileage-rates). If the individual uses public transportation (bus, taxi, Uber, et cetera), the actual cost is allowable.
	Trips to a pharmacy or drug store to buy over-the-counter medicines can only be considered a medical expense when the over-the-counter medicine is part of a medical treatment plan.
	Example 1: If a target individual’s doctor conducts lab work and determines that the individual needs to start taking an over-the-counter supplement to combat tiredness, the trip to the pharmacy/drug store to pick up the supplement will count as a medical expense.
	Example 2: If a target individual’s friend recommends that the individual take a potassium supplement to combat tiredness, this trip to the pharmacy/drug store would not count as a medical deduction.

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Costs of maintaining an attendant, homemaker, home health aide, housekeeper, or child care service if necessary due to the target individual’s age, infirmity, or illness.

Include an amount equal to the one-person benefit allotment in the cost if the household provides the majority of the attendant’s meals.

Changes in attendant care meal deductions are applied at the next scheduled recertification, or earlier at the individual’s request.

If the attendant care costs qualify under both the medical deduction policy and the dependent care deduction policy, treat the cost as a medical expense.

Exception: If the household is reimbursed for attendant care costs through the VA Aid and Attendance Allowance, the reimbursement must be manually subtracted from the total attendant care cost to determine the actual cost to the individual.

●	Cost of health or hospitalization insurances (including deductible and cost-sharing of expenses) as well as the following items:

	· dentures, hearing aids, prosthetics		· nursing care
	· eyeglasses/contact lenses		· prescription drugs
	· lodging to obtain medical care		· medical supplies
	· medical and dental care		· psychotherapy
	· hospitalization		· rehabilitation services
	· outpatient care		· sick-room equipment

Exceptions:

●	Exclude policies that pay lump sum benefits for death or dismemberment or pay expenses while one is disabled.
●	The costs of medical marijuana may not be used as a medical deduction.

References: He-W 742.01; He-W 758.01; 7 CFR 273.9(d)(3); 7 USC 2014(e)(5)(C); 7 CFR 273.2(f)(4)(i); FNS Demonstration Waiver Extension; FNS Memo Deductible Excess Medical Expenses 12/21/2015