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Title 7: SNAP Page 45 Iowa Department of Health and Human Services Employees’ Manual Chapter E: Income Deductions Revised September 27, 2024 Medical Expenses of Elderly or Disabled… Allow that part of the medical insurance premium assigned to all eligible elderly or disabled household members. If you cannot determine how much of the premium is for these members, prorate the total premium amount among all people covered. Exclude the amount for the members who are not elderly or disabled. NOTE: Do not allow the cost of special diets (like Ensure, juices, or nutritional supplements), or the costs for payee services, as a medical expense. Expenses in a Residential Care Facility Legal reference: 7 CFR 273.9(d) When a client lives in a residential care facility, determine if the facility can separate out the cost of allowable medical expenses. Allow housekeeping, attendant costs, etc., as a medical expense. See Shelter Expenses to determine the shelter cost of a household living in a residential care facility. Determining Medical Expenses Legal reference: 7 CFR 273.9(d), 273.10(d) At each certification, anticipate the amount of a household’s monthly medical deduction that will be used for the entire certification period. Base the calculation on information about the member’s medical condition, current verified medical expenses, and public or private medical insurance. To determine how to handle an expense when calculating the monthly amount of the deduction, use the following methods.  One-time medical expenses. Households with one-time expenses reported and verified during the certification period have an option. They can either use the expense once (for only one month), or average it forward over the months remaining in the certification period.  Monthly medical expenses. When the household has an arrangement for monthly installment payments, allow the expense as a deduction in the month when the payment is due. Payment arrangements do not have to be formal. Verify anything that is questionable.  Nonmonthly ongoing medical expenses. • When a bill is sent (or is due) regularly, but less often than monthly, average it forward over the interval between billings.