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Title 7: SNAP Page 46 Iowa Department of Health and Human Services Employees’ Manual Chapter E: Income Deductions Revised September 27, 2024 Medical Expenses of Elderly or Disabled… • When a bill is not sent (or due) regularly, average the expense over the period of time the expense is intended to cover. This may be a longer period than the certification period. If a household expects any reimbursement for medical expenses, allow the deduction only after:  The household has received the reimbursement, or  The anticipated amount of the reimbursement has been verified. Start averaging in the month following the month when the expense was reported. A household may report and verify one-time allowable expenses for a month during the certification period. Add these expenses to the averaged medical deduction. The household may either:  Add the expense for one month, or  Have these expenses averaged over the remaining months of the certification period. If a one-time medical expense is billed in the last month or the next to the last month of a certification period and there is no time to allow the expense in that certification period, the expense can be averaged over the months of the new certification period provided there is not a break between the certification periods.

Mr. K is billed for a one-time medical expense on May 27. He reports the expense on June 2. June is the last month of his certification period. Since there is not time to allow the expense for June, the worker allows the expense in the new certification period (provided Mr. K is recertified for July). Mr. K has the option of using the expense in July only or having it averaged over the new certification period. The only other time a one-time medical expense may be allowed outside of the certification period is if the household has made an agreement with the provider to pay the bill in installments. This can only be allowed if the agreement was arranged at the time of the first billing, prior to the initial bill becoming past due. Consider a medical expense billed through a charge account as a one-time medical expense. The expense is “billed” when the household receives the charge account statement. Do not allow charge account expenses, such as interest, as part of the medical expense.