Any member of your household who is elder (age 60+) or disabled is allowed to claim un-reimbursed medical and health-related expenses as an income deduction. This applies to disabled children as well as adults.
The more expenses you are able to verify, the lower your net countable income. The lower your countable income, the higher the SNAP benefits your household will receive – up to the maximum SNAP amount for your household.
There are two ways SNAP handles un-reimbursed medical expenses. 106 C.M.R. §364.400(C).
Standard medical deduction of $155: If your out-of-pocket medical expenses are at least $35 a month, you will receive a standard deduction of $155 off of your monthly income. You do not need to verify more than $35 per month.
Actual medical expenses: If you incur more than $190per month in medical expenses (the $35 threshold plus the $155 standard deduction), you can claim the actual expenses (minus the $35 threshold).
Example: Esther is 78 years old. She has MassHealth coverage, but the combination of small pharmacy co-pays plus her over-the-counter pain relief and skin treatments add up to over $35 per month. Her SNAP benefits will be calculated using a $155 medical expense deduction. If Esther verified more than $190/month in out-of-pocket expenses, she should claim actual, verifiable expenses that exceed the standard.
If you live in public or subsidized housing, see question 81.
If you have a 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 a number of months. 106 C.M.R.§364.440(C). DTA should look for the most advantageous option for averaging the one time bill.
At the time this Guide goes to print, DTA says it will not count one-time unpaid medical bills incurred more than a year before you told DTA about the bill. DTA may not be following the federal and state rules for medical expenses. Contact MLRI if DTA refuses to accept a one-time medical expense in your SNAP case.
Example 1: Esther is 70 and applies for SNAP. She works part-time at a school, so is certified for SNAP for 12 months. She is approved for $74 in SNAP ($100/week earnings, $850 RSDI, rent of $500/month plus utilities). A month later, she reports a one-time unpaid hospital bill of $500. DTA should average her bill out over the next 11 months (the rest of her certification period). Averaging the $500 by 11 months ($45/mo), Ester gets the standard medical expense deduction. Her SNAP increases to $144.
Example 2: Esther’s one-time unpaid hospital bill is actually $350. $350 over 11 months does not exceed $35 (is only $31). The DTA worker should average her bill out over 10 months in order give her the $155 standard medical expense deduction, which maximizes her SNAP.
Scope of allowable health care expenses
■ co-pays or premiums for Medicare, Medicare Part D, Medex or other health insurance, and your deductible for Medicare Part D;
■ any medical services from doctors, clinics, hospitals, laboratories or other facilities that are not reimbursed by a third party;
■ any custodial or attendant care services you need (even if the caregiver is a relative), as well as housekeeping services you pay for;
■ costs for child care even if not working, if you need to pay for care because of your age, disability, or illness;
■ 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 vitamins and over-the-counter drugs recommended by a licensed health care provider such as aspirin, laxatives, insulin, herbal and homeopathic remedies – a written prescription is not required;
■ eyeglasses, contact lenses/contact saline, hearing aids, batteries, communication equipment for the hearing or visually impaired;
■ health-related supplies recommended by a health provider including incontinence supplies, creams and ointments, commodes and walkers;
■ cost of a gym membership (if needed for health reasons);
■ private transportation costs at the current federal mileage rate (as of January 2020 it is 57.5 cents/mile). Note: Mileage can be verbally self-declared by telling a DTA worker over the phone or in person;
■ out-of-pocket parking and tolls, or the monthly cost of taxis, vans, or public transportation needed to get to medical appointments;
■ long distance phone calls related to obtaining medical services, or internet if needed for a medical device to function properly;
■ veterinary bills, dog food, and other needs for all animals recommended by a medical provider (including trained service animals and therapy and emotional support 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 show you paid the bill. 106 C.M.R. § 364.450(A). DTA automatically gets proof of any Medicare Part B premiums taken out of your Social Security benefits.
You do not need to give DTA multiple months of receipts or bills for recurring medical expenses, as long as you have at least one month worth of bills. You can tell DTA in writing or verbally how often you incur the expense.
Example: Martha buys hearing aid batteries every 3 months. She gives DTA one receipt and writes in a note to DTA that she buys hearing aid batteries every 3 months. DTA should accept Martha’s self-declaration unless questionable.
The following are examples of proofs you can submit for medical expenses, but you can also submit other items:
- Billing invoices, canceled checks or other proof of your health care bills or insurance premiums (that you paid or you owe).
- An Explanation of Benefits (EOB) health insurance statement showing how much you owe for co-pays or deductibles.
- A Medicare Claim Summary to show the dates of visits to your doctor and laboratory visits, which you can use to claim your transportation costs (You can also verbally self-declare mileage by calling DTA).
- A print-out from your pharmacy showing your co-pays and out-of-pocket payments for drugs. This is also useful to show all your visits to the pharmacy for claiming transportation. DTA does not need to know which medications you take. You can white out the medication names and dosages from the pharmacy print-out.
- Copies of receipts for things you bought at a pharmacy or health supply store such as pain relief, recommended vitamins, skin ointments, hearing aid batteries, incontinence supplies. You do not need a prescription or statement from your MD to claim these items.
- A written or oral statement from you with the dates and mileage if you used your car to go to your doctor, physical therapy, pharmacy or other providers. DTA can take verbal confirmation of your health care travel over the phone. DTA will help figure out the mileage. If you have a T-pass that you use for medical trips, show DTA the T-pass and receipt when you bought it.
- Medical expenses are one of the most under-claimed income deductions. Be sure to tell DTA about all health and medical-related expenses of any household member who is elder or disabled.
- Sometimes claiming medical expenses does not make a difference in the SNAP math unless you are already receiving the maximum SNAP grant, or your income is high but your shelter costs are very low. See MLRI’s chart for when claiming medical expenses can make a difference, along with other FAQs and screening forms: Masslegalservices.org/snap-medical
- If your monthly medical expenses have not changed when you do your Interim Report or Recertification, the SNAP rules say that you do not need to re-verify these expenses.
- DTA should make “a reasonable prediction” of the amount you “expect to be billed” for medical expenses during the certification period. You do not have to prove you paid your bills, only that you are responsible for the bill. However, you cannot claim a bill that an insurance company or other third party is going to pay or reimburse you for. 106 C.M.R. §§ 364.410(B)(3), 364.420, 364.430.
- If you are an SSI recipient getting Bay State CAP benefits, you can switch to regular SNAP if your benefits would be higher due to medical expenses or higher shelter costs. See question 4.
DTA Online Guide Sections: SNAP > Expenses and Deductions > Health Insurance/ Medical Expenses > Medical Expense Deduction
● DTA’s SNAP Medical Expense Brochure (revised Aug. 2015): Mass.gov/eohhs/docs/dta/snap-meb-brochure-english.pdf
● Over-the-counter: Reminder on scope of allowable medical expenses. Confirms SNAP household does NOT need a prescription to claim over-the-counter drugs. Transitions Feb 2015, Hotline Q &A. Clarification to this guidance: Food you need for a special diet is not an allowable expense. For example, you can buy Ensure with SNAP, but you cannot claim it as a medical expense.
● Expenses incurred still count: Medical bills need only be “incurred”—not necessarily paid—to claim for medical deduction (as long as not reimbursable by third party); Transitions Mailbox (August 2015)