1115.035.00 Income Deductions

1115.035.15.10 Types of Medical Cost Allowed

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 that is incurred or anticipated during the certification. The following types of medical costs are allowed:

  • Medical and dental care including psychotherapy and rehabilitation services provided by a licensed practitioner authorized by State law or other qualified health professional. (OV, OT, PT)
  • 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 (ICF, SNF) provided by a facility recognized by the State. (HB, OT, DC, NM)
  • Prescription drugs when prescribed by a licensed practitioner authorized under State law and other over-the-counter medication (including insulin and certain Cannabidiol [CBD] Oil) when approved by a licensed practitioner or other qualified health professional.

NOTE: Only 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, additional verification should be requested.

  • Costs of medical supplies, sick-room equipment (including rental) or other prescribed equipment are also deductible. (RX, OC, ME)
  • Allow mileage and transportation costs for trips to a pharmacy or other location to fill prescriptions. (MI, TL)
  • When medically necessary, reasonable cost of transportation and lodging to obtain medical treatment or services. Transportation cost budgeted is actual cost or mileage at the current rate of mileage reimbursement for FSD employees. This includes ambulance and air evacuation services. (AM, AE TL, MI)
  • Postage expense for mail-order prescription drugs can be included with the prescription expense. (RX)
  • Services such as MedBox and PillPack that group and sort a patient’s medication by the time of day should be included in the prescription or over the counter expense (RX, OC) if the service is prescribed or approved by a State-licensed or qualified practitioner to help a patient with their medical condition.
  • Health and hospitalization insurance premiums. This includes the premiums of cancer treatment, nursing home care, ambulance service, and air evacuation service insurance policies, if the policy states benefits are intended to cover medical costs. The costs of health and accident policies such as those payable in lump sum settlements for death or dismemberment or policies that cover expenses such as those that continue mortgage or loan payments while the beneficiary is disabled are not deductible. (CI, DI, HI, NI, MS, VI, AM, AE)
  • Ticket to Work Health Assurance (TWHA) premium. When the TWHA premium case is approved, the premium amount is an allowable medical expense. (TW)

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

  • Spend Down expense for MO HealthNet. When the Spend Down case is approved, the spend down amount is an allowable medical expense. (MC)

NOTE: The spend down amount should be 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 related to coverage under Title XVIII of the Social Security Act (SMI Premium Part A and SMI Premium Part B) and Medicare Part D drug coverage. (PA, SM, PD)

NOTE:  Budget the SMI premium until the SMI premium is no longer deducted from the Social Security payment, even if the individual will be reimbursed for the premiums.

  • Dentures, hearing aids, and prosthetics. (DE, HE, PR)
  • Cost-sharing or spenddown expenses owed by Medicaid recipients. Investigate third-party liability first. (MC)
  • Eyeglasses or contact lenses prescribed by a physician skilled in eye disease or by an optometrist. (GC)
  • Maintaining an attendant, homemaker, home health aide, child care provider or, housekeeper necessary due to age, infirmity, or illness. Also, deduct an amount equal to the one person coupon allotment if the household furnishes the majority of the attendant’s meals. The allotment 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 DMH apartment living arrangement for a health attendant is an allowable medical deduction. If DMH is paying part or all of the expense, however, only allow the medical expense paid by the individual. If a household incurs attendant care costs that qualify under both the medical deduction and dependent care deduction, consider the cost a medical expense. (IH, DC, MP)
  • The cost of a medic alert system. Only the expense of the medic alert system is included as a medical expense. The telephone cost is allowed under utility expenses. (MA)
  • Payment on the principal of a loan to pay a onetime medical expense. Payments on interest are not allowable as an expense. (LP)
  • Monthly telephone fees for amplifiers, signals, and typewriters for handicapped persons. The basic fee for the telephone is handled as a utility expense. (HA)
  • Cost of building a ramp for a handicapped person. (HA)
  • Any cost of securing or maintaining service animals that have been trained to perform a certain task, such as a seeing-eye dog, hearing guide dog, or housekeeper monkey is allowable, including food and veterinarian bills.


Mrs. Garrison has a service animal that she has trained herself according to ADA guidelines to pick up dropped items for her child with muscular dystrophy. She has provided the certificate for the monkey’s training to perform this task. Mrs. Garrison provided a receipt for pet food in the amount of $40.00; this is an allowable medical expense.

Ms. Flora has a prescription from her doctor that states: “This patient needs a cat as a pet for mental health therapy.” The issue is not whether the animal’s presence is therapeutic; the issue is whether or not the animal has received special training to perform a specific task to aid in the service of Ms. Flora’s mental health. The cat’s expenses are not allowable since there is no training or specialized skill the cat performs.

NOTE: Special diets are not an allowable medical cost.