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EXAMPLE #3:

Mrs. B. has SNAP and QMB-only Medicaid coverage. medical expenses are as follows: $135 in prescriptions $500 in monthly oxygen rental (Medicare covered)

$100 ($135 minus the $35 threshold) is allowed in the SNAP budget because Mrs. B. has no out-of-pocket expense for the oxygen.

3440.47.00 ENTERING MEDICAL EXPENSES IN ELIGIBILITY SYSTEM (S)

Medical expenses must be correctly entered to be reflected in the SNAP budget. Any amount of an expense that is shown as the reimbursable amount will be deducted from the total amount of the expense to be included in the SNAP budget.

For Medicare covered services, the “Medicare approved amount” is the amount of the expense to enter, not the provider's private rate. This amount is discernible on the provider bill to the patient and on the Medicare Summary Notice that the individual receives. Amounts shown as “Medicare write off” are not allowed in the budget. If the provider does not know the Medicare approved amount, the amount that the provider would charge a non-Medicare beneficiary is to be entered. This will likely happen if a bill is presented to the eligibility worker prior to adjudication by Medicare or other insurance. In this situation the verification code for both the expense and the reimbursable amount must be entered as ‘unverified’. Follow regular program verification guidelines. If the eligibility worker does not receive verification of a third-party payment or medical expense amount, the expense is disallowed. 3440.48.00 VERIFICATION OF MEDICAL EXPENSES (S)

Verification of medical expenses will include: • the type and amount of the expense, • the date the expense is incurred, • whether it is reimbursable by a third party, and • the reimbursed amount. • For bills on which a monthly payment has been arranged, verification must be obtained from the provider to prove the arrangement.

Medical expenses and third party reimbursed amounts can be verified by the following: • Bill from a provider; • Receipt from a provider; • Written statement from a provider (written statements from third parties must include contact information including phone number of the person signing the statement); and/or • Telephone contact with the provider, as a last resort.