Food Stamp Excess Medica l Deductions Revised April 2007

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

WHO IS ELIGIBLE? Medical expenses of a former AU member may 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: being hospitalized and is age 60 or older, or FS disabled being institutionalized and is age 60 or older, or FS disabled Medical expenses can be allowed as a deduction even if the individual did not participate in the FS program. death and was age 60 or older,or FS disabled

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

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

Allow the medical expense when the AU can provide current verification of the medical expense NOTE: Current bill is: not more than 30days old and shows a current 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.

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.

Reimbursement of a medical expense MUST BE VERIFIED prior to allowing the medical expense. REIMBURSEMENT 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. 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.

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

Do not allow a medical expense for nutritional supplements which can be purchased with food stamp benefits. Examples: Ensure Nutritional Product, Complete Regular Formula, Enrich, Jevity, Osmolite, Glucerna

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

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

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

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

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

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

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

Verify current, non-reimbursable medical expenses for all AU members who are 60 years old or older and/or disabled even 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. Verification Requirements for Excess Medical Deductions ACTIONVERIFICATION REQUIREMENTSIF NOT PROVIDED INITIAL APPLICATIONSVerify by Third Party Source: current, non-reimbursable expensesDo Not Allow Expense INTERIM CHANGE(S) That Causes an INCREASE IN BENEFITS: Verify by Third Party source Exceptions: Medical expense reported via third party which requires verification from A/R - do not act on until review That Causes a DECREASE IN BENEFITS: Accept AU statement, process change Leave at Original / Lower Amount N/A REVIEWSThird Party Source: New non-reimbursable expenses or if amount of existing expense has changed by more than $25 per month since last review and was not previously verified Do Not Allow Expense

SUGGESTED FORMS OF VERFICATION: paid receipts written statements from attendants or providers health policies or payment books which indicate type of policy (health) and amount of premium current bills for physician and pharmacy services pharmacy printout for prescriptions 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. BEST IDEA for Rx

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

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 BUDGETING ONE-TIME ONLY MEDICAL EXPENSES

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. CHART BUDGETING RECURRING MEDICAL 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

MEDICALLY NEEDY SPENDDOWN IS: Not automatically allowed as a medical expense The medical cost that the client is responsible for (the non-reimbursable amount) 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.

COMMUNITY CARE SERVICES PROGRAM CCSP cost share is the medical cost that the client is responsible for paying. 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. The monthly cost share paid by an individual for services received through the Community Care Services Program may be considered an incurred medical expense. 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. Cost share is the maximum amount an individual is required to pay for services in any given month.

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.).

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

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

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

CF-CONVERSION FED VERIFIED CO-CONVERSION DA-DAS APPROVED DP-DAS PENDING EW-EW APPROVED MO-FS OFFICER APPROVED MC-MEDICARE MP-SMEU PENDING RR-APPROVED RAILROAD BOARD  RS-SSA  SM-SMEU APPROVED  SS-SSI  VA-VETERAN 100% DISABLED  Disability Approval Source Code identifies the AU member as eligible for FS Medical Deduction based on Disability DEM2

FSME

O-ONE TIME P-PRORATED R-RECURRING One Time: The expense is a one-time expense and will be budgeted in SUCCESS one time only NOTE: SUCCESS will not delete the one-time only expense correctly. The EW must create an alert or make a note to delete the expense the next month. Prorated: The expense is a one-time expense, but will be prorated over the length of the POE NOTE: The AU makes the decision whether the expense is counted one time only or prorated. The EW should assist the AU by determining which method is most advantageous to them. Recurring: This is a regularly occurring expense that is budgeted on a monthly basis.

Pro(rate Num(ber) of M(on)ths: Over how many months do you want this expense to be prorated? (Use Policy Guidelines) If this expense and the number of mos. for proration is entered for the ongoing benefit month, the prorated amt. will be deducted in the Food Stamp budget until the expense is deleted. If you prorate the expense, indicate the number of months of proration. This should equal the number of months remaining in the POE. For example, at review or application, the number of months would simply be the POE. But if the A/R reported a change in their medical expenses in the middle of their POE, then the expense would be prorated over the remainder of the POE.

AC-ATTENDANT CARE DN-DENTAL DR-DOCTOR EQ-EQUIPMENT HO-HOSPITAL IP-INSURANCE PREMIUM OT-OTHER RX-PRESCRIPTION TR-TRANSPORTATION This indicates the type of Medical Expense. “Other” is a major category that includes such common expenses as eyeglasses and hearing aids and such uncommon expenses as seeing eye dogs and artificial limbs. Document on REMA what the “Other” expense is.

Am(oun)t: What is the full amount of the Medical Expense? This indicates the full amount of the expense before any reimbursements have been deducted.

AV-AVERAGE ACTUAL AMOUNT BI-VERD BILL CH-VERD CHECK CO-NOT VERD CONVERSION CS-CLIENT STATEMENT LE-VERD LETTER NV-NOT VERD FAILED RC-RECEIPT TC-VERD PHONE Date Incurred: This is the date that the expense was incurred. This is different from the date of the bill. For example, an A/R may incur a dental expense on March 3, but provide verification of that expense as a bill dated June 10. The expense may be incurred at any time, but the bill must not be older that 30 days. NOTE: An expense can only be allowed as a deduction once. Once it has been allowed as a deduction, even if the A/R still has the expense, it cannot be allowed again. Verification: These codes indicate how the expense was verified. A bill must be current which means that the bill is not more than 30 days old. This is a method of insuring that the expense is a current one.

T(hird) P(arty) L(iability) Amt(oun)t: How much of this expense will be covered by Medicare or other health insurance coverage? The TPL refers to the portion of the bill that will be paid for by someone other than the A/R. An excess medical deduction can only be allowed for that portion of a bill that the A/R is responsible for paying and is billed for. Usually the TPL is Medicare or other health insurance, but it can also be relatives or even a hospital writing off the expense. An expense cannot be allowed until TPL payments have been verified. Prorated Amount: This is the prorated medical expense deduction for this medical expense that was calculated by the system. This prorated amount was determined by the following calculation: (Full amount of expense – amount of expense paid by TPL)  number of prorated months

Provider Name: Who provided the medical service (hospital, doctor, pharmacy, etc.) that generated this medical expense? Indicate the source of the medical expense. 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.

DOCUMENTATION Document the case record with the following information: allowable deductions 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 amount of reimbursement and source source of verification of medical expense computation or explanation of expenses allowed, if needed

FS FSME ADT

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