6510 Determining Allowable Medical Costs

Each category of allowable medical costs is explained below.

1.Attendants, home health aides, disabled child care services, or homemakers - These costs are deductible when such services are necessary due to the age, disability, or illness of the aged or disabled member.

In addition to the salary paid, an amount equal to the maximum food stamp allotment for one person will be deducted if the household incurs the cost of providing the attendant (or attendants) with more than 50% of the meals served in the household in a month. For example, a household may have two attendants who come each day. Therefore, the household is providing a meal to an attendant at each meal time. This household would be entitled to deduct the full coupon allotment for one person even though neither attendant takes more than 50% of his or her meals in this home in a month's time.

*The food stamp allotment for this meal-related deduction is the one-person allotment in effect at the time of the household's

certification (initial or recertification).If a coupon

allotment change (NBI) occurs, the county office is not required to update this deduction until the next scheduled recertification or mid-point review but may choose to do so sooner.

If a household incurs costs for an attendant which could either be deducted as a dependent care expense or a medical expense,

the costs will be handled as a medical expense. If a mother

pays dependent care costs for two or more children and not all the children are disabled, then the portion of the expense identifiable as care for the disabled child or children will be allowed as a medical expense. If the portion of the cost paid for the care of the disabled child or children is not identifiable, the entire child care expense will be allowed as a dependent care deduction as specified in FSC 6400.

2.Corrective Devices - Examples are:

Dentures - full or partial;

Braces worn on the teeth for orthodontic purposes;

Eye glasses and contact lenses prescribed by a physician skilled in eye diseases or by an optometrist;

Hearing aids (including batteries for the operation of the hearing aid);

A prosthesis; or

Corrective braces to be worn on the limbs.

3.Hospital and nursing home care - This includes costs incurred during confinement or out-patient care ~ a medical facility such as a hospital or nursing home recognized by the State.

Such costs include, but are not limited to:

Room and board charges;

Nursing care;

Drugs and medical supplies;

Therapy;

Surgery; and

Tests.

Non-medical charges such as television rental fees are not allowed.

NOTE:Costs incurred for an aged/disabled individual who was a member of the household immediately prior to entering the hospital or nursing home are allowable If the household is responsible for the costs. The caseworker must insure that a code 1, 2 or 3 appears in Field 63 of the EMS-233 when such costs are to be allowed.

4.Insurance - Health and Hospitalization Policy Premiums - This includes payments for aged/disabled members:

For medical and hospital insurances;

For cancer and intensive care insurances; and

For premiums deducted from paychecks for medical insurance.

Some health insurance policies cover household members who are not entitled to a medical deduction as well as those who are. When the amount of the premium paid for the members entitled to a medical deduction cannot be determined, the premium will be prorated among all members included on the policy. The prorated amount for one member will be multiplied by the number of members entitled to a medical deduction. The resulting amount will be considered a medical cost.

Exceptions:Do not allow health and accident policies such as those payable in lump sum settlements for death or dismemberment. Do not allow income maintenance policies such as those which continue mortgage or loan payments while the beneficiary is disabled.

5.Medicaid Cost Sharing These are medical expenses incurred by aged/disabled Medicaid recipients which are not covered by Medicaid.

Example:Medicaidrecipientsareallowedtoobtainsix

prescriptions free of charge each month. Any additional prescription costs incurred by the Medicaid recipient are allowed as a medical expense if the Medicaid recipient is aged or disabled.

6.Medical and Dental Care - This includes a dentist's or a physician's charges for:

Office calls;

Hospital visits;

Nursing home visits;

House calls;

Special treatments;

Tests; and

Other medical procedures.

This also includes other services provided by a licensed practitioner or other qualified health practitioner such as:

Psychotherapy;

Rehabilitative services; and

Chiropractic services.

7.Medical Equipment and Supplies - This includes costs such as:

Needles and syringes used for the injection of insulin or prescription medication;

Costs for the purchase of sickroom supplies such as bandages and gauze for a surgical patient or bed pads and protective linens for bedfast patients;

Costs for the lease or purchase of medical equipment such as crutches, wheelchairs, hospital beds and portable oxygen tanks.

Costs for the purchase, maintenance, and training of seeing eye dogs for the blind. This includes the cost of food and veterinarian's bills for the dog. If a deaf person is otherwise aged or disabled, the costs of the purchase, maintenance and training of a dog used to ~hear" for the deaf person are also considered a medical expense.

8.Medicare Premiums - These are premiums deducted from Social

Security checks or paid by certain Railroad Retirement, VA and

Social Security recipients for medicare coverage under Title

XVIIIof the Social Security Act.

9.Prescription Drugs - This includes:

Drugs prescribed by a licensed practitioner - e.g., doctor, dentist, chiropractor; and

Over-the-counter medication recommended or approved by a licensed practitioner.

Examples of allowable over-the-counter medications are insulin for diabetics and aspirin for arthritics.

10.Transportation and lodging - This is a reasonable cost-for transportation and/or lodging incurred to obtain medical treatment.

Transportation and lodging costs are determined on a case-by-case basis.

Transportation costs are based upon the type of transportation used. If the aged or disabled member uses his or her own vehicle, the current Medicaid reimbursement rate of $.09 per mile will be allowed. If the member used public transportation, the actual cost of the transportation will be allowed. If the member pays a non-household member for transportation, the amount charged by the individual will be allowed. The type of transportation used and the reason for the trip must be documented. Verification of the cost must be obtained.

Lodging may be allowed if the aged/disabled member is required to spend the night away from home to receive medical services. The reason the lodging was necessary must be documented in the case record. Verification that medical treatment did occur, as well as receipts to verify the lodging expense must be obtained.

Lodging expenses are allowable for the parent or parents of a

disabled child who is hospitalized or receiving treatment at a

site which requires the parent or parents to obtain lodging.

The cost of lodging does not include the cost of meals or other incidentals.