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Title 7: SNAP Page 47 Iowa Department of Health and Human Services Employees’ Manual Chapter E: Income Deductions Revised September 27, 2024 Medical Expenses of Elderly or Disabled… Changes in Medical Expenses Legal reference: 7 CFR 273.12(c) Households do not have to report changes in medical expenses during the certification period. If a household voluntarily reports and verifies a change in medical expenses, recalculate the amount of the medical expense to allow the deduction. Sometimes a source other than the household reports a change, as when changes are reported for Medically Needy cases. In these situations, act only if the information is available without contacting the household for verification. Change the amount of the deduction effective the first of the next month after the change is verified. Spenddown as a Medical Deduction Legal reference: 7 CFR 273.10(d) The following guidelines can help determine how to treat a Medically Needy spenddown:  If the household has not consistently met spenddown, do not use the spenddown amount. Use only verified medical expenses, as you would for any other case.  If the household has consistently met the spenddown amount in the past and this is expected to continue, use the monthly spenddown amount as the medical deduction. The household may report and verify expenses that are not allowed to meet spenddown but are allowed for SNAP. For example, any over-the-counter medications (that are not used to meet spenddown) are allowed as a SNAP deduction if a physician prescribes them. In this case, add that amount to the spenddown amount. Allow insurance premiums as a medical expense in addition to the spenddown amount in Medically Needy cases where premiums are subtracted from spenddown to determine the spenddown amount entered into the ABC system. Remember that the ABC system adds in the standard Medicare premium for SNAP medical expenses.