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Title 8: Medicaid Page 66 Iowa Department of Health and Human Services Employees’ Manual Chapter E: Income Non-MAGI-Related Deductions Revised April 11, 2025 Deduction for Impairment-Related Work… Deduct expenses for items or services that enable the impaired person to work, and that are incurred by the person because of a physical or mental impairment. Examples include a one-handed typewriter, typing aids such as page-turning devices, and telecommunications devices for the deaf. Deduct payments for residential modifications for a person employed outside the home that permit the person to get to work. This deduction also applies to residential modifications for a person who works at home to create a work space that accommodates the person’s impairment and to provide access to that work space. Other changes in the home are not deductible as impairment-related work expenses. Expenses may involve payment for the purchase, installation, maintenance, and repair of an impairment-related item or payment for an impairment-related service. In order for an impairment-related expense to be deducted, the following criteria must be met:  The type of expense and the charge must be verified.  The client must pay for the item. Payment can be cash, check or credit card, installment payments, or rentals or leases.  The item cannot be reimbursable or payable through another source.  The cost of the expense must be the reasonable cost based on going rates in the community.  The cost cannot be a deductible self-employment expense.  The expense would not be incurred by someone without the impairment. For example, everyone must have clothing but the client may need a certain type of shoes solely because of employment and the client’s disability. Impairment-related work expenses are not deductible in determining client participation for people in medical facilities. Deduct impairment-related payments according to one of the following methods:  Down payment. A person may make a down payment on an impairment- related item or service, then make regular monthly payments. Either deduct the down payment entirely in one month, or allocate it over a 12-consecutive-month period beginning with the month of purchase. The client chooses the method.