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VIRGINIA DEPARTMENT ELIGIBILITY DETERMINATIONS OF SOCIAL SERVICES AND BENEFIT LEVELS

10/24 VOLUME V, PART XIII, PAGE 6

4. Medical Expenses - Households that incur and verify medical expenses of more than $35 a month are allowed the medical standard deduction. Households that incur and verify allowable medical expenses of $235 or more per month may opt to use actual expenses instead of the medical standard deduction. The provisions of this chapter apply only to households with medical expenses of $235 or more per month.

At the time of certification, households must report and verify allowable medical expenses or, at recertification, report changes in expenses previously reported. Households may also report allowable medical expenses that the household expects to incur during the certification period.

Because of the different ways in which individual medical expenses are incurred, the method for counting each bill must be considered individually. Any portion of a medical expense that is reimbursable by insurance policies will not be given as a deduction until the household verifies the portion of the cost that is its responsibility. The portion of the cost that is not reimbursable will be allowed as a deduction at the time the reimbursement is received or otherwise becomes known, even though this may be in a later certification period.

When determining the monthly medical deduction, the BPS must consider each of the methods described below for each expense.

For a household comprised of elderly or disabled members who have a 24-month certification period, the BPS must review the household’s eligibility before the twelfth month. If the household reports a one-time medical expense incurred during the first 12 months, the BPS must give the household the option of deducting the expense for one month, averaging the expense over the remaining months of the first 12 months or averaging the expense over the remaining months of the certification period. If the household reports a one-time expense after the twelfth month, the household may elect to deduct the expense in one month or over the remaining months of the certification period.

a. Lump sum deduction. The household may get a deduction for medical expenses as a lump sum in the month the expense is billed or become due or, for items such as drugs that have no billing, the month the household incurs the expense. If the household cannot establish a due date for an expense, the due date will be the month after the original billing date or incurred date.

b. Averaging. One-time medical bills may be averaged over the certification period in which they are billed or become due. At certification, it will be the household's option whether to count a one-time bill as a lump sum or to average it. If the household reports a one-time bill during a certification period, the household may have the deduction as a lump sum, if possible, or averaged over the remainder of the certification period and reflected as an expense for those months.

Example

A household with an elderly or disabled member reports a one-time only medical expense of $325.00 on March 5. The household's certification

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