WAG 13-01-05-a

new textAllowable Medical Expenses

Medical expenses are not allowable if:

  • reimbursable by insurance or a third party, or
  • paid by a vendor payment, or
  • paid by a non-SNAP unit member, unless the amount paid is counted as income.

Regardless of intent to pay, allowable medical expenses include but are not limited to bills received or expected to be received for the following services:

  • Medical and dental care.
  • Psychotherapy and rehabilitation services provided by a state licensed practitioner or other qualified health professional.
  • Hospitalization or outpatient treatment.
  • Nursing care or nursing home care including bills received by the unit for a person who was a unit member immediately before entering the hospital or nursing home.
  • Prescribed drugs, including insulin and other over-the-counter medications when approved by a physician or other qualified health professional.
  • Cost of medical supplies, sickroom equipment, including rental, or other prescribed equipment.
  • Health and hospitalization insurance policy premiums.

    NOTE:Do not allow deleted text for the costs of:

    • health and accident policies such as those payable in a lump sum for death or dismemberment, or
    • income maintenance policies such as those that make mortgage or loan payments while the beneficiary is disabled, or
    • health insurance premiums paid by the Health Insurance Premium Payment (HIPP) Program.
  • Medicare premiums, Supplementary Medical Insurance Benefits (SMIB), and/or the Hospital Insurance Benefits (HIB), regardless of whether the qualifying member pays the premium directly or has it deducted from their Social Security check.

    NOTE: Do not allow revise textcosts for SMIB and/or HIB premiums if the person is enrolled in DPA's SMIB/HIB buy-in agreement, or in the QMB or SLIB program. 

  • Pay-in Spenddown payments. Pay-in Spenddown payments are centrally entered by the system see (PM 13-01-05-f and WAG 13-01-05-f).
  • Dentures, hearing aids, and prosthetics.
  • Cost of securing and maintaining an animal specially trained to serve the needs of a disabled person. When determining the cost, include the cost of food, veterinary bills, and other maintenance costs.
  • Eyeglasses prescribed by an optometrist or a physician trained in eye disease.
  • Physician's charges to complete medical or insurance reports.
  • Reasonable cost of transportation and/or lodging to obtain needed medical treatment or services. If the unit's automobile is used for medical transportation, the allowable rate is 24¢ per mile.
  • Costs of maintaining an attendant, homemaker, home health aide, housekeeper, or child care provider, when needed due to age, infirmity, or illness of a unit member. In order to allow the costs, the provider cannot be a SNAP unit member.

    In addition to other costs, if the unit provides the attendant with a majority of their meals, allow an amount equal to the maximum benefit amount for a one-person SNAP Unit as a medical expense.

    If a unit has attendant care costs that could qualify as either a medical care deduction or as a dependent care deduction, consider the cost a medical expense. 

  • Group home services, such as CILA services, for persons living in group homes. See PM 06-11-02-b for an explanation of CILAs.

    Accept the group home's statement of the amount of the client's income the group home keeps and what portion of the amount is for shelter expenses. Count the rest of the amount the group home keeps as a medical expense. See WAG 13-01-05.

    NOTE: CILA services are allowable medical expenses, even when the client resides in their own home. 

  • Supportive Living Facility (SLF) services. If the resident receives Medical assistance, the amount of the medical expense is the SLF credit amount. See WAG 05-11-05.

revised textCosts for special diets, such as a diabetic diet, are not allowable.