1115.035.00 Income Deductions

1115.035.15.10 Types of Medical Expenses Allowed

IM-07 February 14, 2024; IM-03 January 5, 2022; IM-115 July 17, 2020; IM-69 April 8, 2019; IM-20 March 25, 2014; IM-87 September 30, 2013; IM-29 May 11, 2009; IM-95 November 3, 2008; IM-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 incurred or anticipated during the certification. Only individuals who meet the SNAP definition (1100.010.00 Definitions) of “elderly or disabled” are entitled to deduct medical expenses.  For a medical expense to be deductible, it must be prescribed or approved by a state-licensed or qualified practitioner.

Note: Special diets are not an allowable medical expense.

The following types of medical expenses are allowed:

  • Medical care including psychotherapy, dental care and rehabilitation services.
  • 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, skilled nursing facility or intermediate care facility recognized by the state.
  • Prescription drugs and other over-the-counter medication.
    • Postage expense for mail-order prescription drugs can be included with the prescription expense.
    • Services such as MedBox and PillPack group and sort a patient’s medication by the time of day are to be included in the prescription or over the counter expense if the service is prescribed or approved by a state-licensed or qualified practitioner.
    • CBD oil, which has been certified to contain no more than 0.3 percent of Tetrahydrocannabinol (THC) on a dry weight basis, can be included. Oils with more than 0.3 percent are not allowed. If the patient’s prescription does not specify the amount of THC contained in the CBD oil, request additional verification.
  • Medical supplies, sick-room equipment (including rental) or other prescribed equipment.
  • Mileage and transportation expenses for trips to a pharmacy or other location to fill prescriptions.
  • Transportation expense and lodging to obtain medical treatment or services. This includes ambulance and air evacuation services.
    • Transportation expense is budgeted as actual amount or mileage at the current rate of mileage reimbursement for Family Support Division (FSD) employees.
  • Health and hospitalization insurance premiums. This includes the premiums of cancer treatment, nursing home care, ambulance service, and air evacuation insurance policies, if the policies state benefits are intended to cover medical expenses.

Note: The costs of health and accident policies payable in lump sum settlements for death or dismemberment or policies covering expenses to continue mortgage or loan payments while the beneficiary is disabled are not deductible.

  • Ticket to Work Health Assurance (TWHA) premium, once the case is approved.

Note: The TWHA premium is entered as a medical expense for SNAP for the length of time the TWHA premium case is open, regardless if the individual is actually paying their premium.

  • Cost-sharing or Spend Down expense for MO HealthNet, once the case is approved.
    • Investigate third-party liability first.

Note: The spend down amount is entered as a medical expense for SNAP for the length of time the spend down case is open, regardless if the individual is actually paying or meeting their spend down.

  • Medicare premiums (SMI Premium Part A and SMI Premium Part B) related to coverage under Title XVIII of the Social Security Act and Medicare Part D drug coverage.
  • Premiums for prescription insurance plans and prescription discount plans.
  • Dentures, hearing aids, and prosthetics.
  • Eyeglasses or contact lenses prescribed by a physician skilled in eye disease or by an optometrist.
  • Maintaining an attendant, homemaker, home health aide, childcare services or housekeeper as prescribed.
    • Deduct an amount equal to the one person benefit allotment if the SNAP household furnishes the majority of the attendant’s meals. The amount for this meal-related deduction is the allotment in effect at the time of initial certification. Adjust the allotment amount, if necessary, at the time of recertification.
    • The medical expense paid by an individual in a Department of Mental Health (DMH) apartment living arrangement for a health attendant is an allowable medical deduction. If DMH is paying part or all of the expense, only allow the medical expense paid by the SNAP participant.

Note: If a household incurs attendant care expenses qualifying under both the medical deduction and dependent care deduction, consider the expense as a medical expense.

  • Medic alert system. Only the expense of the medic alert system is included as a medical expense. The telephone expense is allowed under utility expenses.
  • Payment on the principal of a loan to pay a onetime medical expense. Interest payments are not an allowable expense.
  • Monthly telephone fees for amplifiers, signals, and typewriters for handicapped persons. The basic fee for the telephone is handled as a utility expense.
  • Adaptive equipment in vehicles and homes.
  • The expense of securing or maintaining any service animal trained to perform a certain task for the elderly or disabled SNAP participant, such as a seeing-eye dog, hearing guide dog, or housekeeper monkey. Include the cost of food and veterinary bills.