Food Stamp

1. Food Stamp Excess Medical Deductions Revised April 2007

2. WHO IS ELIGIBLE? AU member who is elderly (age 60 or older) AU member who is FS disabled (as defined by FSP policy )

3. WHO IS ELIGIBLE? Medical expenses of aformer AU membermay be allowed if: The AU remains legally responsible for payment of the medical expenses. The expenses are allowed for a former AU member who was an AU member immediately prior to: • beinghospitalized and is age 60 or older, or FS disabled • being institutionalizedand is age 60 or older, or FS disabled • death and was age 60 or older,or FS disabled Medical expenses can be allowed as a deductioneven if the individual did not participate in the FS program. 

4. Disabled as defined under FSP regulations includes: NOTE: The term recipient includes those approved for and awaiting initial benefits or receiving zero benefits because of recoupment. SSI BENEFITS STATE MEDICAL ELIGIBILITY UNIT (SMEU) BENEFITS RSDI DISABILITY BENEFITS VETERAN DISABILITY BENEFITS RAILROAD RETIREMENT DISABILITY BENEFITS

5. INSURE: CAUTION! MEDICAL EXPENSES ARE FOR THE AU MEMBER WHO IS ELIGIBLE TO RECEIVE THE DEDUCTION!!!! MEDICAL EXPENSE HAS NOT BEEN ALLOWED AS A DEDUCTION IN A PREVIOUS FS BUDGET. ONCE AN EXPENSE IS ALLOWED AS A DEDUCTION.. IT CANNOT BE ALLOWED AGAIN!!!!

6. Allow the medical expense when the AU can provide current verification of the medical expense • NOTE: Current bill is: • not more than 30days oldand • shows acurrent balance • does not have to have been incurred within the past 30 days. AU must incur the expense, even if actual payments have not been made. Medical expenses are allowed AS BILLED, NOT AS PAID.

7. COLLECTION AGENCY: Verify current status of bills. Allow expense if AU incurs and is billed for the expense and it has not been previously allowed. MEDICAL EXPENSES BILLED THROUGH CHARGE ACCOUNTS (E.G., VISA, MASTERCARD); only the expense is considered, not the interest. Count expense as billed in the month charge account statement including the charge was received.

8. REIMBURSEMENT Reimbursement of a medical expenseMUST BE VERIFIEDprior to allowing the medical expense. Verify amount of reimbursement from a third party (health insurance, Medicare, Medicaid, etc.) and subtract that amount from the total medical expense before allowing the expense. If application for Medicaid, financial or other health insurance coverage is pending,do not allow medical expense until client’s liability for payment of bill is identified.

9. Do not allow a medical expense if the AU does not incur or is not billed for the expense BILL

10. Do not allowa medical expense fornutritional supplementswhich can bepurchased with food stamp benefits. Examples: Ensure Nutritional Product, Complete Regular Formula, Enrich, Jevity, Osmolite, Glucerna

11. DO NOT SHORTEN A POE TO ALLOW AN EXCESS MEDICAL DEDUCTION!!

12. ALLOWABLE MEDICAL COSTS CHART 3614.1 Medical & Dental Services Hospitalization Outpatient Treatment Nursing care Prescription drugs Over the Counter Medication Medical Supplies

13. ALLOWABLE MEDICAL COSTS CHART 3614.1 Sick Room or Emergency Response Equipment Eyeglasses, Contact Lens Dentures, Hearing Aids, Prosthesis Medical expense paid by a resident of a Group Living Arrangement

14. ALLOWABLE MEDICAL COSTS CHART 3614.1 Animals to assist a Disabled AU Member Transportation & Lodging to secure Medical Treatment or Medical Services

15. ALLOWABLE MEDICAL COSTS CHART 3614.1 Maintenance of Attendant, Homemaker, Home Health Aide, Child Care Services, or Housekeeper necessary because of age, infirmity or illness Health/Hospitalization Insurance Premiums Medicare Supplement Premiums, Prescription Drug Insurance Medicare Premiums

16. ALLOWABLE MEDICAL COSTS CHART 3614.1 Payments by Residents of Drug/Alcoholic Treatment Centers The cost of Telephone Equipment Specially Equipped for a Disabled Person TDD/TTY

17. What about Medicare Part D? • Ask if they have it & document! • Treat as we do for other medical costs • Allow any premiums paid • Allow co-pays, deductibles & out of pocket costs • Use ‘If/Then Chart’ prior to May 15

18. Verify current, non-reimbursable medical expenses for all AU members who are 60 years old or older and/or disabledeven if the total expenses do not exceed $35 monthly. If the verification of allowable medical expense is delayed, advise AU that benefit level will be determined without expense being allowed until verification is provided.

19. SUGGESTED FORMS OF VERFICATION: • paid receipts • current bills for physician and pharmacy services • pharmacy printout for prescriptions BEST IDEA for Rx • written statements from attendants or providers • health policies or payment books which indicate type of • policy (health) and amount of premium • EOB (Explanation of Benefit) from third party resource • (health insurance companies, Medicare). Note: Be sure to verify with healthcare insurance companies the expenses the AU actually incurs and is responsible for paying.

20. Medical expenses are categorized into two types: One-time only medical expenses Recurring medical expenses

21. ONE-TIME ONLY MEDICAL EXPENSES • Non-reimbursable amount of one-time only medical expense may be allowed as a deduction: • all in one month or • may be prorated over the POE. • Examples: charges for a hospital stay, dentures, eyeglasses CHART 3614.3 BUDGETING ONE-TIME ONLY MEDICAL EXPENSES

22. RECURRING MEDICAL EXPENSES • non-reimbursable amount of recurring medical expenses may be allowed as a deduction: • by either varying the basis of issuance (actual expense each month) OR • by averaging ongoing expenses. STABLE RECURRING EXPENSES: The expense is the same each month. Ex: Medicare premium, monthly insurance premium, FLUCTUATING RECURRING EXPENSES: The expense is not the same each month. Ex: prescriptions, doctor visits CHART 3614.4 BUDGETING RECURRING MEDICAL EXPENSES

23. MEDICALLY NEEDY SPENDDOWN IS: • The medical cost that the client is responsible for(the non-reimbursable amount) • Not automatically allowed as a medical expense • Not a medical expense on its own. • Bills used in a medically needy budget may be used as medical expenses only if they are allowable medical expenses in the Food Stamp Program.

24. COMMUNITY CARE SERVICES PROGRAM CCSP cost share is the medical cost that the client is responsible for paying. Cost share is the maximum amount an individual is required to pay for services in any given month. If the total cost of services received does not equal the established cost share, the individual is responsible only for the actual cost of services. The monthly cost share paid by an individual for services received through the Community Care Services Program may be considered an incurred medical expense. Client cost share amount is not automatically allowed as a medical expense in the Food Stamp program.The cost share paid must be for an allowable Food Stamp medical expense to be considered a Food Stamp medical deduction.

25. How to process Medicaid Spenddown and/or CCSP Cost Share Identify the bills that represent the spend down/cost share Example: doctor bills, hospital bills, prescriptions, etc. Review the Allowable Medical Cost Chart to determine if this expense is an allowable Food Stamp medical expense Determine if the expense is a one-time only or recurring expense & budget expense accordingly NEVER enter Spenddown or CCSP in the Provider Name field On FSME .The specific medical expense that represent the Spenddown or CCSP must be entered separately (prescriptions, doctor bill, hospital bill, eyeglasses, Medicare premium, health insurance premium, etc.).

26. WHAT IS EXCESS MEDICAL DEDUCTION? The first $35 of medical expenses are excluded per month per AU Enter the total non-reimbursable medical expenses for all AU members entitled to the deduction in SUCCESS SUCCESS will allow the excess of the total non-reimbursable medical expenses minus $35 per AU

27. Example: Jon and Mary are 75 yrs old Mary $60 /month of medical expenses JON $40 /month of medical expenses Total expenses for all entitled $100 SUCCESS allows excess of $35 per AU $ 100 - $ 35 $ 65 is the excess deduction for the AU

28. Date of birth identifies the AU member as eligible for FS Medical Deduction based on being elderly (age 60 or older) DEM1

29. Disability Approval Source Code identifies the AU member as eligible for FS Medical Deduction based on Disability DEM2

30. FSME

37. Delete): Do you want to delete this expense from the database to be effective for the benefit month listed on the screen? If so, enter “Y”, press PF24 and press enter. Delete the expense that you are no longer allowing as an excess medical deduction. NOTE: It is vital to document medical expenses so that you do not allow an expense to be counted twice.

38. DOCUMENTATION Document the case record with the following information: • allowable deductions • amount of reimbursement and source • source of verification of medical expense • reason medical expense was not allowed as deduction for potentially • eligible AU members (such as expenses not verified, reimbursement • not verified, no current non reimbursable medical expenses) • if Medicare Premium/medical expense is not allowed since we are • awaiting verification of reimbursement when application for Medicaid, • financial or other health insurance coverage is pending • computation or explanation of expenses allowed, if needed

39. FS FSME ADT

40. FOOD STAMP EXCESS MEDICAL DEDUCTIONS Thanks for all of your hard work and commitment to our customers! You are appreciated!!