1115.035.15 Excess Medical Deduction – DSS Manuals

IM-90 August 24, 2005

An eligibility unit (EU) is entitled to the excess medical deduction if the allowable medical expense is incurred by:

an elderly or disabled EU member

any elderly or disabled individual who would be an EU member except he/she is hospitalized, in a nursing home (ICF, SNF), or deceased if the EU is responsible for the expense; or

persons receiving the following types of payments: SSI presumptive disability payments: regular benefits for a three-month period are paid to persons most likely to meet SSI disability criteria; these are considered SSI eligible by SSA and receive a federal SSI check for the amount of entitlement.

NOTE: If a medical expense is allowed for a person receiving SSI based on presumptive eligibility, and eligibility is later terminated, remove the medical deduction from the Medical Expense (FMXA) screen. If the individual’s categorical eligibility status changes, update the Categorically Eligible (FMMK) screen. Also, update the Disabled (FMMX) screen.

SSI emergency advance payments: a single $100 payment is provided to applicants who appear to meet the eligibility criteria and considered in need of immediate assistance; these are considered SSI eligible by SSA.

NOTE: Spouses or other persons receiving benefits as a dependent of the above SSI recipients are not eligible to receive this deduction. SSI essential persons do not qualify for a medical deduction.

Disabled EU members must be coded as disabled, have a valid disability reason for food stamps, and the disability must be verified on the Disabled (FMMX) screen before FAMIS will recognize the person as being disabled and allow the excess medical deduction. If an EU member claims a disability but verification of the disability is not provided, the application can be processed with no verification of disability and the medical expenses are not allowed.

Always review the Budget Summary (Food Stamps) screen (FM4A) prior to authorizing a case action. From the Budget Summary screen, press F15=EXPSUMM to review the Expense Summary (FM34) screen to ensure expenses you expect to be budgeted are included in the budget. If the expense is incorrect, return to the Medical Expense (FMXA) screen and correct the expense.