1115.035.15 Excess Medical Deduction

IM-#90 August 24, 2005

An eligibility unit (EU) is entitled to the excess medical deduction if the allowable medical expense is incurred by:

Disabled EU members must be coded as disabled, have a valid disability reason for food stamps, and the disability must be verified on the Disabled (FMMX) screen before FAMIS will recognize the person as being disabled and allow the excess medical deduction. If an EU member claims a disability but verification of the disability is not provided, the application can be processed with no verification of disability and the medical expenses are not allowed.

Always review the Budget Summary (Food Stamps) screen (FM4A) prior to authorizing a case action. From the Budget Summary screen, press F15=EXPSUMM to review the Expense Summary (FM34) screen to ensure expenses you expect to be budgeted are included in the budget. If the expense is incorrect, return to the Medical Expense (FMXA) screen and correct the expense.

1115.035.15.05 Amount of Medical Deduction

IM-#59, October 1, 2018, IM-#55 September 13, 2011IM-#90 August 24, 2005

FAMIS determines the medical expense deduction as follows:

Refer to the Budgeting Medical Expenses procedure guide for instructions on how to enter the medical expenses in FAMIS.

1115.035.15.10 Types of Medical Cost Allowed

IM-#20 March 25, 2014, IM-#87 September 30, 2013, IM-#29 May 11, 2009, IM-#95 November 3, 2008IM-#148 December 15, 2005 IM-#90 August 24, 2005, IM-47 May 19, 2005

Prior to certification, verify deductible medical expenses totaling more than $35 per month, anticipated to be incurred during the certification. The following types of medical costs are allowed. The expense codes used on the Medical Expense (MEDEXP/FMXA) screen follows each in parenthesis.

1115.035.15.15 Third Party Liability (TPL)

IM-#90 August 24, 2005

Any medical expense that will be covered by a third party liability (TPL) reimbursement or an excluded vendor payment is not allowed as a deduction. The portion of the medical expense not covered by TPL or excluded vendor payments is allowed as a medical expense to the EU. TPL includes Medicare, Medicaid, or other health insurance.

1115.035.15.16 Achieving a Better Life Experience (ABLE) Account

IM-96, October 26, 2015

Any medical expense that will be paid as a qualified disability expense from an ABLE account is not allowed as a cost for the excess medical deduction.

1115.035.15.20 Payment Plans

IM-#55 September 13, 2011, IM-#90 August 24, 2005

Budget an allowable expense as long as a payment plan was made or loan applied for by the due date of the original billing. (Refer to example below.) Otherwise, consider the expense past due and do not budget it. A bill is considered past due either as indicated on the bill, or, as a general rule, 30 days after the billing date, or 30 days after the date of TPL reimbursement. (Past due is the date the payment is overdue to the provider.)

EXAMPLE: Ms. Z. incurred an expense of $1000. The original bill is received on 5/1. By 5/30, the EU has arranged with the hospital to pay $100 each month from June through March. The $100 is entered on the Medical Expense screen. FAMIS excludes the first $35 each month as a deduction for the next ten months allowing Ms. Z the $200 medical expense standard. If the EU is certified beyond March, set a reminder to remove the medical expense and run a new eligibility determination for the month of April through the remainder of the certification.

1115.035.15.25 Budgeting Guide

IM-#90 August 24, 2005, IM-#110 June 8, 2001

Medical expenses are budgeted either as ongoing expenses or one time expenses and can include fluctuating expenses, changes to expenses, loans, and responsibility after third party payments

Refer to the procedure guide Budgeting Medical Expenses for further instructions regarding entry in FAMIS and procedures for budgeting medical expenses.