MR #20.06: SNAP Medical Standard Change and Allowable Medical Deductions

Illinois Department of Human Services logo

02/07/2020

Summary

The policy change to implement the SNAP Standard Medical Deduction from $245 to $200 was included in Manual Release #19.12: October 2019 Increase in SNAP Allotments, Utility Standards, Income and Deduction Standards, dated 08/21/19. This release provides more information on that change and includes the following:

- an update to the allowable medical expenses in PM 13-01-05-a;
- policy on allowing a medical expense at expedited service;
- a method to determine allowable medical expenses;
- procedures to end date old medical expenses from conversion in IES.
The Standard Medical Deduction of $200 was reflected in the SNAP calculations effective October 2019 for eligible qualifying member households. Active SNAP cases with a $245 medical deduction were centrally updated to the $200 amount. SNAP benefits were recalculated and Notice of Decision (Form 360C) was mailed to the customer if a change occurred in the SNAP benefit amount.
The Standard Medical Deduction for residents of Group Homes and Supportive Living Facilities remains unchanged at $485.
A qualifying member may still use actual medical expenses instead of the Standard Medical Deduction, if their actual allowable medical expenses exceed the $200 or $485 standard, whichever is applicable.
Form 683B, SNAP calculation sheet is revised with the $200 Medical Standard Deduction amount.
At the request of the Bureau of Training & Development, for consistency, revises the sentence on reporting changes on the Mid-Point Report (Form 2890) in PM 19-07-00, PM 19-07-06. and PM 19-07-07.
Also includes a revision to the income and asset amount in PM 05-08-02.

Standard Medical Deduction Change

As a result of the annual review of the State's Standard Medical Deduction Demonstration Project, Food and Nutrition Service (FNS) determined that the Standard Medical Deduction for qualifying member SNAP households (excluding Group Homes and Supportive Living Facilities) should be reduced from $245 to $200 in order to maintain cost neutrality for this project.
The new Standard Medical Deduction of $200 was reflected in the SNAP calculations for October issuances for eligible qualifying member households, if appropriate. SNAP benefits were recalculated using $200 for qualifying member households with an existing medical deduction of $245. Form 360C was mailed to the customer if a change occurred in the benefit amount.
The Standard Medical Deduction for residents of Group Homes and Supportive Living Facilities remains unchanged at $485.
A qualifying member may still use actual medical expenses instead of the Standard Medical Deduction, if their actual allowable medical expenses exceed the $200 or $485 standard, whichever is applicable.

Allowable Medical Expenses

The following allowable medical expenses are added to PM 13-01-05-a.

The cost for acupuncture, massage therapy, or herbs, prescribed for therapeutic purposes, if a state licensed practitioner or other qualified health professional prescribes or approves as an alternative therapy or medicine. The costs for the practitioner and the therapy or medicine may be allowed as a medical expense, if they cannot be otherwise purchased with SNAP benefits and are not prescribed as a part of a special diet.
Postage for mail order prescription drugs.
Adaptive equipment in vehicles and homes as well as monthly telephone fees for amplifiers and warning signals for elderly or disabled individuals (PM 05-06-01) and the costs of telecommunications devices for the elderly or disabled may be allowed as a medical expense deduction.
Insurance premiums for policies intended to cover cancer treatments.
Insurance premiums for ambulance insurance.
Payments made on a conventional loan when the loan is used to pay a one time only medical expense, but loan expenses, such as interest, are not allowed as part of the deduction. If a mortgage is obtained for the purpose of financing a large medical expense, the mortgage payment should be allowed as a shelter cost and is NOT allowed as a medical expense.
Contact lenses prescribed by an optometrist or a physician trained in eye disease.
Hemp derived CBD (cannabidiol) oil may be allowed as a medical deduction ONLY if verification is provided that specifically indicates:
1. a State licensed practitioner or qualifying health professional has approved or prescribed the product; AND
2. certifies that the product contains a delta-9 tetrahydrocannabinol (THC) concentration in an amount that does not exceed 0.3 percent on a dry weight basis.
  - When requesting verification from a customer claiming CBD oil as a medical expense, make sure the customer understands what needs to be provided as proof of their usage. Specifically state what is needed on the 267 VCL. If the customer's verification does not specifically include #1 and #2 above, do not allow a medical deduction for CBD oil. There is no exception to this requirement.

Health/Hospitalization Insurance Policies

Premiums paid for insurance policies are allowed as a medical expense if intended to cover medical expenses.
Only the portion of a medical insurance premium assigned to the elderly or disabled household member may be considered when calculating the deductible amount. If the policy does not specify how much of the premium is for each household member, prorate the premium amount among all household members. Only the prorated amount for the eligible member would be considered a deduction.
If the policy holder is not elderly or disabled, but the family policy includes a qualifying member who is eligible for the medical expenses deduction, that part of the premium for the qualifying member may be used in calculating the deduction.
Insurance policies that pay a household a specific amount of money for each day a person is in the hospital are only allowable expenses if the policy states that the money received from the policy is intended to be used to cover medical expenses and it is reasonably expected that the household will use the money to pay for medical bills and not for everyday living expenses.

Payments on Loans and Credit Card Interest

Medical Expenses on Credit Cards

Medical expenses paid on a credit card are allowable and considered paid when the charge account statement is received. The interest may not be included as a deduction.

Payments on Loans for Medical Expenses

A medical expense deduction for payments made on a conventional loan when the loan is used to pay a one-time only medical expense is allowable. Loan expenses, such as interest, are not allowed as part of the deduction. If a household obtains a mortgage for the purpose of financing a large medical expense, the mortgage payments should be treated as shelter costs and are not deductible as medical expenses.

Medical Expenses Not Allowed

Adds additional nonallowable medical expenses to PM 13-01-05-e.

Schedule I controlled substances, such as medical marijuana, is not an allowable medical expense under Federal law, regardless of being prescribed in accordance with State law.
Hemp derived CBD (cannabidiol) oil with a delta-9 tetrahydrocannabinol (THC) concentration in an amount that exceeds 0.3 percent on a dry weight basis, regardless of being approved or prescribed by a licensed practitioner or other qualified health professional.
Costs for special diets are not an allowable medical expense deduction, even if they are prescribed or approved by a licensed practitioner or other qualified health professional. This includes:
- special diets prescribed for people with diabetes;
- prescribed liquid diets and nutritional supplements;
- allergy free foods; special diets necessitated by religious considerations; and
- any item (including organic or fresh food and bottled water) that can be otherwise purchased with SNAP benefits.
Over the counter medications are not allowable, unless approved or prescribed by a licensed practitioner or other qualified health professional; and
- not purchasable with SNAP benefits; and
- not part of a special diet as described above.

Example: Mr. B, age 65, submitted receipts of his out of pocket medical expenses to the HSC. He provided receipts for the purchase of gas to drive to his doctor in another county and for a prescription that was filled at the pharmacy. He also provided a receipt for the purchase of a nutritional shake mix and fresh fruit along with a letter signed by his doctor stating that these items are necessary for Mr. B to maintain a healthy weight. Mr. B included a receipt for the purchase of medical marijuana and proof that the prescription was signed by his doctor. The HSC reviews the receipts and determines that the costs of transportation to obtain medical treatment or services is allowable. The nutritional shake mix is not allowable because it is a nutritional supplement and therefore a special diet. The fresh fruit is not allowable because it is an item that could otherwise be purchased with SNAP benefits. Medical marijuana is prohibited for the SNAP program, regardless of State law.

Deciding What to Allow as a Medical Expense

	Follow the steps below to determine if a medical expense is allowed as a medical deduction for SNAP. See PM 13-01-05-a, PM 13-01-05-e, WAG 13-01-05-e
1.	Is the expense for medication, medical supply, equipment, or service prescribed or approved by a State licensed or qualified health practitioner?	Yes, continue to Question #2.	No, do not allow the expense.
2.	Is the expense for a special diet or an item that can be otherwise purchased with SNAP benefits. See PM 13-01-05-e).	No, continue to Question #3.	Yes, do not allow the expense.
3.	Is the expense a Schedule I controlled substance, such as medical marijuana?	No, continue to Question #4.	Yes, do not allow the expense.
4.	Is the expense CBD oil, approved or prescribed by a licensed practitioner or qualified health professional with a delta 9 tetrahydrocannabinol (THC) concentration that exceeds 0.3 percent on a dry weight basis?	No, allow the expense.	Yes, do not allow the expense.

Document in Case Comments

Document in Case Comments all medical expenses that were used to determine that the medical expense total exceeds $35 which qualifies the customer to the Standard Medical Deduction or use of their actual medical expenses. An HSC's documentation should provide sufficient detail so that anyone reviewing the case can determine the accuracy of the eligibility determination and benefit level or ineligibility. The documentation in Case Comments should include:
- the household members entitled to the medical expense deduction;
- which expenses are allowable and not allowable;
- treatment of reimbursements, when the verification for reimbursement was received, or verification that reimbursements are not applicable;
- the determination to average and the time periods over which the expenses have been averaged;
- any noncooperation by the household, or the nonreceipt of any requested verification;
- the determination that information provided by the household appeared incomplete, inaccurate, inconsistent, or outdated;
- if verification received from someone outside of the household was inconsistent with the household's statements, document why the information was considered inconsistent and how the issue was resolved;
- if the household reports an expense but chooses not to have it included as a deduction, that fact should be documented;
- if a household needs to provide missing verification, document the date verification was requested and the type of verification needed. Document the date verification was received. If the household does not provide the verification, document that fact to support subsequent action.
If the customer was previously allowed medical expenses in the prior certification but does not have expenses at REDE or MPR, end date the old expenses and document in Case Comments.

Adding New Medical Expenses When Conversion Expenses Exist

At Conversion, if a SNAP case was marked in Legacy as receiving the Standard Medical Deduction for SNAP, a medical expense of $245 was converted to IES.

When adding medical expenses to a case, check to see if an existing medical expense is on the case from conversion. The medical expense from conversion should be end dated when adding new expenses that will be applied toward the Standard Medical Deduction for SNAP. If both the converted expense and the new ongoing expense are on the case for SNAP budgeting, the expenses will be added together causing a potential over issuance of SNAP benefits.

This may occur if the:

SNAP household did not complete a redetermination (REDE) after conversion and are now reapplying for benefits; or
completed the REDE after conversion but the converted expense was not end dated when the new medical expenses were added.

Follow the procedures below:

Check the Medical Expense Page for "Other Allowable Expense" for a total of $245.
Check to see if existing "Other Allowable Expense" on the Medical Expenses page comes from conversion by looking at the expense details. Using the "silhouette" icon in the top icon bar should show a user id of "CV20171013" or similar for data created by conversion. The circumstance dates will also be 10/01/17.
If this expense is from conversion, end date the expense for the end of the month prior to the new expense starting. Example: If adding a medical expense to start 06/01/19, the "Other Allowable Expense" needs to be end dated for 05/31/19.
Add the new expense as normal by using the "+Add Medical Expense" button. If the expense is over $35 and under $200, the new Standard Medical Deduction of $200 will be applied automatically in the eligibility screens.
After running eligibility, check the SNAP EDG for Net Income Budgeting. The Medical Deduction should not exceed $200 unless there are separate expenses from post conversion that together total more than $200.

Medical Expenses and Expedited Service

A SNAP qualifying member household that is entitled to expedited service is entitled to a medical expense deduction, if they list medical expense amounts, even if verification of those expenses are postponed. Verification must be provided prior to the second month's issuance, or the third month of participation, if the household applied after the 15th of the month and were assigned a 2 month or longer certification period.
If the amount of an allowable expense is not known at this time or cannot be reasonably anticipated based upon available information about the customer's medical condition and public or private medical insurance coverage, consider the nonreimbursable portion of the medical expense only when the amount of the expense or reimbursement is reported and verified.
If the household does not want to deduct an expense, the expense becomes nondeductible (not allowed) and is not included in any SNAP calculation of net income. If the household later reports or verifies the expense, treat the information like the household reported a change in circumstances.

Form 683B

Form 683B, SNAP Calculation Sheet is revised with the new $200 medical standard amount.

Miscellaneous Manual Page Updates

At the request of the Bureau of Training & Development for consistency, revises the sentence on reporting changes on the Mid-Point Report (Form 2890) in PM 18-04-00, PM 19-07-00, PM 19-07-06, and PM 19-07-07.
Also includes a revision on the income and asset amount in PM 05-08-02.