County of San Diego Health and Human Services Agency HHSA CalFresh Program Guide Excess Medical Deduction Standard Medical Deduction Number Page 63232 1 of 4 Revision Date 08012021 BackgroundIndividuals who meet the CalFresh definition of elderly andor disabled are eligible to deduct qualifying medical expenses from their income to determine CalFresh eligibility The California Department of Social Services CDSS has been authorized to operate a Standard Medical Deduction SMD Demonstration Project Purpose This section has been updated to include recent clarification received from CDSS and as a result of a sunset review Policy The excess medical deduction is the portion of medical expenses in excess of the allowable amount per month excluding special diets incurred by any household HH member who is elderly andor disabled See 631103 for the definition of elderly and disabled Elderly andor disabled household members who verify medical expenses within the range of 3501 to 155 a month will be given an SMD of 120 a month HHs with verified medical expenses over 155 a month may claim actual expenses in excess of 35 Spouses or other household members receiving benefits as a dependent of the disabled recipient are not eligible to receive this deduction Verified Medical Expenses Eligibility Under 35 a month Not eligible for a medical deduction 3501 to 155 a month Eligible for the SMD ie 120 15501 a month and over Eligible to deduct actual expenses over 35 ie 120 A wide range of expenses that are not reimbursed or covered by health insurance count as a medical deduction Countable medical expenses may include but are not limited to the items listed below 1 Medical Dental and Eye Care Medical care including psychotherapy and rehabilitation services dental care including dentures and orthodontics provided by a licensed practitioner or other qualified health professional authorized by state law Hearing aids and batteries Eyeglasses contacts lens solutions prescribed by a physician skilled in eye disease or by an optometrist Acupuncture chiropractic or herbal treatments Health care supplies and equipment incontinence supplies Prosthetics including assistive devices 2 Hospitalization or Outpatient Treatment Hospitalization or outpatient treatment Nursing care and nursing home care including payments by the household for an individual who was a household member immediately prior to entering a hospital or nursing home provided by a facility authorized under state law County of San Diego Health and Human Services Agency HHSA CalFresh Program Guide Excess Medical Deduction Standard Medical Deduction Number Page 63232 2 of 4 3 Prescription Drugs and Costs of Medical Supplies Prescription drugs and overthecounter medication including insulin when prescribed by a licensed practitioner or other qualified health professional authorized under state law excludes special diets nutritional drinks and dietary supplements such as vitamins Costs of medical supplies sickroom equipment including rental or other prescribed equipment NOTE The cost of any substance considered illegal under Federal Law including medical marijuana even when prescribed is not allowed 4 Health Insurance Premiums Copays and Share of Cost The costs of health and hospitalization insurance policy premiums and copays Any ShareofCost or spend down expenses for medical costs incurred by MediCal recipients EXCEPTIONS The following are not allowable medical expenses The costs of sickness and accident policies such as those payable in lumpsum settlements for death or dismemberment Income maintenance policies such as those that continue mortgage or loan payments while the beneficiary is disabled 5 Medicare Premiums Medicare premiums related to coverage under Title XVIII of the Social Security Act 6 Maintaining Service Animals Service animals are animals that serve the needs of customers who are elderly andor disabled Service animals must be specially trained to assist the individual with the medical issue for which the animal is prescribed Emotional support animals that meet the criteria outlined above are treated as service animals The cost of securing and maintaining any service animal such as but not limited to seeing eye hearing or service dogs and the cost of related food and veterinarian bills If it is evident that an animal is specially trained to perform a function that an elderly andor disabled person cannot readily perform on their own staff will consider this animal a service animal and allow the medical expense A case comment noting staff observation is considered verification for this purpose If it is questionable if an animal qualifies staff may only ask the customer the following questions Is the animal required because of a disability What tasks is it trained to perform A case comment that states the animal is required because of a disability and lists the tasks the animal is trained to perform is sufficient verification Do not require formal documentation or proof of certification or licensing as a service animal 7 Transportation The outofpocket nonreimbursed costs of travel to health care appointments and pharmacies by a third party such as public transportation taxis or ridesharing Medical travel by private vehicle will be verified by verbal or written customer statement that travel was required for medical reasons unless questionable The expense will be calculated by multiplying the number of roundtrip miles by the federal business standard mileage rate current reimbursement rates can be found at wwwirsgov MapQuest or Google Maps may be used to determine mileage between locations 8 Homemaker or Health Aid Maintaining an attendant homemaker home health aide childcare or housekeeper services necessary due to age infirmity or illness County of San Diego Health and Human Services Agency HHSA CalFresh Program Guide Excess Medical Deduction Standard Medical Deduction Number Page 63232 3 of 4 9 Verification Qualifying medical expenses must be verified for a HH to claim the excess medical deduction or the SMD If medical expenses cannot be verified electronically such as Medicare premiums the HH must submit verifications to claim the expense However staff will not require a specific type of verification and will assist the HH in obtaining verification if needed If obtaining verification of a medical expense may delay the HH certification the HH will be advised that its eligibility and benefit level may be determined without allowing a deduction for the unverified expense Do not deny or discontinue a case for failure to provide verification of medical expenses Once verified staff will not reverify medical expenses at the next report including medical travel if they are unchanged or change by 25 or less In addition qualified HH remain eligible for the SMD at subsequent recertification if they report that their medical expenses continue to exceed 35 per month Reverification is not required unless the reported expense is questionable 10 Reported Change of Medical Expenses If the report of a new or changed medical expense results in an increase in benefits the change must be effective no later than the first allotment issued 10 days after the date the change was reported Do not issue a supplement for a previous month or the month the medical expense is reported when benefits are adjusted timely Example 1 A new medical expense reported and verified on Increase the benefit allotment beginning April 15th would result in a benefit increase with the May benefit month Do not issue a supplement for April Example 2 A new medical expense is reported and verified on Increase the benefit allotment beginning April 27th will result in a benefit increase and the with the June benefit month Do not issue HH normal issuance is on May 1st a supplement for April or May Example 3 A new or changed medical expense reported and Do not take action on the case Enter case verified on April 15th would result in a benefit comments and place in held changes for decrease review at the next periodic report or recertification Other Program ImpactsNo Impact References FNA 2008 Section 17b1A and Section 55 CFR 2712 ACL 1735 1989 and 2113 ACIN I6305 I0696 and I4511 MPP 635023 Sunset Date This policy will be reviewed for continuance by 07312024 County of San Diego Health and Human Services Agency HHSA CalFresh Program Guide Excess Medical Deduction Standard Medical Deduction Number Page 63232 4 of 4 Approval for Release RICK WANNE Director SelfSufficiency Services