Standard Medical Deduction Waiver

Overview

The Standard Medical Deduction (SMD) is a $155 deduction that is credited toSNAP clients who are elderly and/or disabled who incur medical expenses greater than $35 and less than (or equal to) $190 per month (this is known as “the SMD range”). SNAP clients who are elderly and/or disabled and incur medical expenses above $190 are credited with the actual cost of the medical expenses minus $35. These deductions usually result in a higher SNAP benefit level.

In preparation for the end of the public health emergency and the expiration of the associated waivers, the USDA Food and Nutrition Service has approved DTA’s request to allow clients who are elderly and/or disabled to self-declare medical expenses, provided that these expenses are in the SMD range. This flexibility will not only allow clients to access the SMD deduction without the undue burden of collecting multiple receipts and documents, but it will also maximize their SNAP benefits.

Important Considerations for Elderly/Disabled Households

If you are processing a case with a client who is elderly and/or disabled, it is important to screen for medical expenses. You must explain to the client that reporting medical expenses may result in more SNAP benefits.

When asking clients about medical expenses, you must ask questions in general terms. For example, instead of asking “What prescription medications do you pay for?”, ask “Do you pay for any prescription medications?” Similarly, instead of asking “What did you go to the hospital for?”, ask “Do you have any hospital bills?” For more information, refer to the How to Discuss Medical Expenses with Clients page.

During the course of this conversation, you must determine what medical expenses the client has, and whether they are eligible for the SMD or an actual medical expense deduction.

Acceptable Verification of Medical Expenses

If an elderly and/or disabled client declares that they incur medical expenses in the SMD range, they can verify these expenses by telephonic or written self-declaration.

If an elderly and/or disabled client indicates that they incur medical expenses above $190 per month, they must submit documentary evidence to receive credit. A self-declaration is no longer acceptable. Examples of acceptable verifications include receipts, bills, invoices, etc. However, if they subsequently fail to provide the verification, you must credit them with the SMD of $155.

Important Considerations Regarding the SMD Waiver

Although DTA is allowed to accept a self-declaration of medical expenses within the SMD range, you must continue using SVES and BENDEX to verify medical expenses if the information is available through these data sources. For example, if the client at application provides a self-declaration that includes the monthly cost of Medicare Part B, SVES is still to be used to validate the Part B information (in accordance with the guidance in SSA Data).

When calculating total medical expenses to determine whether the household is within the SMD range, medical expenses available through data sources must be factored into the total medical expense amount. Although you can usually verify them without the client’s self-declaration, you cannot omit them from this total.

Example: An elderly client at application self-declares that their monthly medical expenses include Medicare Part B ($164.90) and prescriptions ($30). Because the total amount is above $190 ($164.90 + $30 = $194.90), staff must send a VC-1 for medical expenses. Even though staff will no longer need the client to verify Part B once it is verified through BENDEX, the VC-1 must be sent because the initial calculation of total medical expenses is above $190.

Collecting Medical Information During Application Interview

If you are doing a SNAP application interview with a household with at least one elderly or disabled member, you must ask about medical expenses. Even if the application indicates no medical expenses, you must explore this information to ensure that the client did not make a mistake. For example, the client may have indicated no medical expenses because they incorrectly believed their expenses were non-countable.

Collecting Medical Information When Recertification Interview is Waived

If you receive an Action to work on a SNAP recertification for a household with at least one elderly or disabled member, you must call the client to ask about medical expenses if the household:

• is not already receiving the maximum SNAP benefit level for their household size, and there are no medical expenses on file; or

• indicates on the form that they have new medical expenses or that the medical expenses on file have changed.

If one or both conditions are met, you must cold call the household two times. If one of the cold calls is successful, you must ask about medical expenses. If both calls are unsuccessful, you must send an optional VC-1 for medical expenses.

If the client is not already receiving the maximum SNAP benefit level for their household size, and they indicate on the recertification form that they have no medical expenses, you must attempt to courtesy call them to ensure that they did not make a mistake (e.g., the client said no because they incorrectly believed their expenses were non-countable). However, if the call is unsuccessful, you must not send an optional VC-1 for medical expenses.

The Medical Expense Tracker

To facilitate the implementation of the SMD waiver, staff can utilize the new Medical Expense Tracker to gather medical expense information from a household. The Medical Expense Tracker is a Microsoft Excel spreadsheet that aims to streamline the process of recording medical deductions, differentiating between recurring and non-recurring expenses, and determining whether a household must verify the medical expenses via self-declaration or documentary evidence. However, this tool is optional.

The first portion of the Medical Expense Tracker is used to document the medical expense information, both recurring and non-recurring, that the household is reporting to determine whether the total medical expenses will fall into the SMD range.

The second portion of the Medical Expense Tracker is used to record the household information that is needed to determine the benefit amount based on the number of months over which the non-recurring medical expenses are prorated. The non-recurring medical expenses are entered under question 2A in the Medical Expense Tracker.

Once completed, this spreadsheet must be attached to the BEACON narrative. Below is a screenshot:

1. Displays the sum total of the medical expenses entered into the spreadsheet.

2. Displays the total medical deduction (Total Monthly Medical Expenses - $35) based on the information entered into the spreadsheet.

3. Displays whether the household qualifies for the standard medical deduction of $155 based on the medical expense figures entered under each Total Cost column. If yes, the indicator will change from “No” to “Yes,” which entails that the household can verify the medical expenses via telephonic self-declaration.

4. Displays whether the household’s total medical expenses exceed $190 based on the medical expense figures entered under each Total Cost column. If yes, the indicator will change from “No” to “Yes,” which entails that the household must submit documentary evidence of the medical expenses to be credited with a medical deduction higher than $155.

5. Displays the household’s potential benefit level based on the medical expense figures entered under each Total Cost column and the information entered in the household table at the bottom of the spreadsheet.

6. Used to record the name of the elderly/disabled individual to whom the spreadsheet information applies.

7. Yes/No dropdown for indicating whether the individual named in the Elderly/Disabled Household Member cell has recurring medical expenses.

8. Displays the various categories of medical expenses based on the available dropdown options in the Medical Expense and Health Insurance pages in BEACON.

9. Used to record the total cost of each medical expenses.

10. Used to record the frequency of the recurring medical expenses. Clicking the cell opens a dropdown menu with the following options: Weekly, Monthly, Quarterly, Annually.

11. Used to indicate the number of months by which to divide non-recurring medical expenses. Entering a number of months in this field will change the Total Monthly Cost of the non-recurring medical expenses.

12. Household information table for entering the information that the spreadsheet needs to determine the household’s benefit level based on the medical expense information entered throughout the spreadsheet.

Using the Medical Expense Tracker

To complete the Medical Expense Tracker for each elderly/disabled member of a SNAP household, follow these steps:

1. Open the Medical Expense Tracker. In the cell underneath the heading “Elderly/Disabled Household Member 1,” enter the name of the household member to whom the medical expenses apply.

2. Ask Question 1: Select Yes or No based on the response.

3. If yes, ask Question 1A. Based on the response, fill in the total cost and frequency in each appropriate category.

As you key in medical expenses, information will be displayed at the top of the spreadsheet. If the total medical expenses entered are in the SMD range, then “SMD” will change to Yes. If the total medical expenses are above $190, then “Above SMD” will change to Yes:

4. Ask Question 2. Select Yes or No based on the response.

5. If yes, ask Question 2A. Based on the response, fill in the total cost in the appropriate category.

6. Determine the number of months by which to divide the one-time medical expenses following the procedures in Non-recurring Medical Expenses. Enter the appropriate number of months in the “Number of Months to Divide One-Time Medical Expenses By” field:

7. If there is another elderly/disabled member in the household, enter their name in the cell underneath the heading “Elderly/Disabled Household Member 2” and repeat steps 2 through 6.

Medical Expenses within SMD Range

8. If the total medical expenses are greater than $35 and less than (or equal to) $190, follow the Telephonic Signature procedures to have the client self-declare that the medical expenses are in the SMD range.

Example A: If the client has a hospital bill for $55, copay for $38, prescriptions for $42, and over-the-counter medication for $37, you must have the client self-declare all of them because their sum total is within the SMD range.

9. Enter the medical expense information into BEACON and mark each item as verified by selecting Other and then typing: “Self-Declaration.” Upload a copy of the Medical Expense Tracker to the narrative.  

Medical Expenses Above $190

10. If the total medical expenses are above $190, follow the Telephonic Signature procedures to have the client self-declare the total value of those medical expenses that are in the SMD range (i.e., below $190).

Example B: If the client has a hospital bill for $250, copay for $60, prescriptions for $50 and over-the-counter medication for $45, you must have the client self-declare the copay, prescriptions and over-the-counter medications. The client must submit verifications to receive credit for actual medical expenses above $190. 

Example C: If the client has a hospital bill for $75, copay for $50, prescriptions for $50, over-the-counter for $30, you must have the client self-declare any three out of the four items to get into the SMD range. However, the client must submit verification of all four items to receive the actual medical expense deduction.

11. Enter all the medical expenses into BEACON. You must select the appropriate Expense Type in the Health Insurance and/or Medical Expense pages and enter the self-declared amounts.

12. Send an optional VC-1 for all of the medical expenses (including those that client already telephonically verified, as this will allow for clients to send in verification of actual medical expenses).

13. Mark the self-declared items of the medical expenses as verified by selecting Other and then typing: “Self-Declaration.” Do NOT mark as verified the portion of medical expenses that need documentary evidence and cannot be verified via telephonic or written self-declaration. Attach a copy of the Medical Expense Tracker to the narratives.

Medical Expenses > $190 at Application

14. If the case is at application, you must not process the case until the verifications are received or Day 30, whichever occurs first.

It is crucial that you properly record the medical expenses that were self-declared. Otherwise, if the client subsequently fails to provide verification, the FAW who processes the case on Day 30 will not know which medical expenses were already telephonically verified.

Medical Expenses > $190 at Recertification

15. If the case is at recertification, you must follow steps 10 through 13 above. If there are no other no other verifications missing, mark the self-declared medical expenses as verified by selecting Other and then typing: “Self-Declaration.” This will credit the household with the SMD.

However, if not crediting medical expenses above $190 results in the case getting denied or approved at $0, the recertification must not be processed at this time. Rather, you must:

• remove the authorization to process the case

• create an Action to process the case on the BEACON Release Date that occurs right before the reevaluation end date

• for more information on creating an Action, see Creating Follow-up Actions

• if the medical expense verification is received on or before the BEACON Release Date, enter all the medical expenses into BEACON and approve the Recertification. Credit the household with the medical expenses above $190.

• if the medical expense verification is not received by the BEACON Release Date, process the case without entering the portion of the medical expenses that brings the total medical expenses above $190. Only credit the household with the SMD.

Client Reports Medical Expenses > $190 at Case Maintenance

16. If the client calls during the case maintenance to report medical expenses, you must follow steps 10 through 13 above. Be sure to write a detailed narrative.

17. If the client subsequently follows up with the verification, the FAW who receives the Action to review the documents must add them to the BEACON record and recalculate the benefits.

18. If the client does not follow up with verification, the FAW who receives the Verification Due Action on the VC-1 due date is limited to recalculating the SNAP benefits using only the self-declared medical items that bring the household within the SMD range.

Example of New Procedures

Note: This example is current as of October 2023. However, the results will likely be different from year to year due to the COLA and SUA adjustments. For more information, see SNAP Annual Cost-of-Living Adjustment (COLA).

Jane is applying for SNAP benefits with their husband John. Both Jane and John are elderly. John receives an employment related pension of $3,939 per month, and Jane receives $821 per month in RSDI. They are responsible to pay a mortgage of $1,239 per month and their SUA is for heating. Jane pays $50 per month for prescription medications. John pays $2,666 per month for a home health aide.

Since Jane’s prescription costs are in the SMD range, the case manager asks Jane to provide a telephonic self-declaration of these expenses. However, since the cost of John’s home health aide places the total medical expenses above $190, the case manager must request verification of both Jane’s prescriptions and John’s home health aide.

After Jane provides the telephonic self-declaration of their prescriptions, the case manager enters Jane’s medical expenses into the Medical Expense page in BEACON and then sends the optional VC-1 for both the prescriptions and John’s home health aide. After the VC-1 is generated, the case manager only marks Jane’s medical expenses as verified by opening the Verification tab, selecting Jane’s prescriptions in the verification item list, selecting other and typing “Self-Declaration.” The case manager will not mark John’s home health aide cost as verified until documentation is received.

The case manager then will attach the Medical Expense Tracker to the case narrative.

The Out-of-Pocket Medical Expenses Form

The Out-of-Pocket Medical Expenses Form is a fillable PDF file that clients can print and complete by hand, or by telephonic signature. The form includes a checklist of common medical expenses with fields for indicating each one’s cost and/or frequency. You can download the form by clicking here.

Providing the Out-of-Pocket Medical Expenses Form to the Client

If an elderly or disabled client communicates to you that they have medical expenses but are unable to provide essential information such as the type, cost, frequency, etc., you must mail them a copy of the Out-of-Pocket Medical Expenses Form or advise them that the form is available for download at https://www.mass.gov/resource/dta-documents-forms.

You must advise the client that the form is for them to complete and sign once they obtain the relevant information about their medical expenses. However, you must also tell them that the form is optional, and they may submit their own written/signed self-declaration or call back to provide a telephonic self-declaration.

Clients can submit the Out-of-Pocket Medical Expenses Form by mail, fax, scanning at a local office, or uploading it online through DTA Connect. If you complete the form for the client and they sign it telephonically, you must manually save the document into the ECF by attaching it to the narrative or scanning it to the DPC.

Tool for Determining Best Proration Option for Non-Recurring Medical Costs

The Medical Expense Tracker includes a benefit calculation tool for helping you determine the most beneficial non-recurring medical expense proration option. To utilize this tool, scroll down to the household information table at the bottom of the spreadsheet:

Fill in the household information in the yellow spaces:

Then scroll back up to the top of the spreadsheet to see the results. As you enter the medical expense information, the resulting benefit amount will display in the yellow Benefit Level cell on the top of the sheet:

If you need to determine the best way to prorate a one-time medical expense, you can continuously adjust the number of months in the “Number of Months to Divide One-Time Medical Expenses By” field and any impact on the benefit level will be immediately displayed in the Benefit Level cell.

Example

Note: This example is current as of October 2023. However, the results will likely be different from year to year due to the COLA and SUA adjustments. For more information, see SNAP Annual Cost-of-Living Adjustment (COLA).

Household of one. Client is 65 years old. Grantee reports and verifies a one-time medical expense during the 6th month of the 36-month EDSAP certification period. Client receives monthly RSDI in the amount of $1,289.00, pays $1,000.00 for rent and is not credited with any SUA. Client has a one-time eyeglass expense of $300.00.

For more information, see Non-recurring Medical Expenses.

  Last Update:  September 19, 2023