Department of Human Services

Food Stamp Online  Policy Manual

I.      What Is a Medical Deduction?

Revised: 

25.4

REIMBURSEMENTS

Food Stamp Table of Contents

Medical Deductions Supplement

 

Section D

(1)   General

 

Allow medical expenses only after reimbursements have been determined. Possible reimbursements for a medical expense exist anytime the individual has Medicare, health or hospitalization.

 

(2)   When Reimbursements Cannot Be Established

 

Do not allow the medical expense if the amount of the reimbursement cannot be established.

 

Allow the medical expense only when the client is able to verify the amount of reimbursement, even if it is at a later day.

 

For a one-time expense, allow only the currently existing balance still owed at the time the amount of reimbursements is verified.

 

Example:  Mrs. Jones, who is 68, reports a one-time medical expense of $200 on March 7. The EW establishes that a portion of the expense is reimbursable, but the amount of the reimbursement cannot be established at this time.

 

In May, Mrs. Jones provides verification that the insurance company will reimburse $100 of the expense.

 

She has already paid $60 on the one-time expense. Thus, the balance owed is $40 ($200 – 160 = 40).

 

Consider only $40 balance as a one-time medical expense.

 

(3)   Verification and Documentation

 

Accept the household’s statement that no reimbursement will be received, unless questionable.

 

Example:  A client’s statement that no reimbursement will be received might be questionable if it is known that his employer provides a group medical insurance plan, or if the client is a Medicaid or Medicare participant.

 

Verify reimbursements by using the A/R’s insurance policy, payment records, the actual reimbursement check, or by contacting the client’s employer, or the reimbursing agent.

 

Document the case record, stating that reimbursements were discussed with the household, whether or not the possibility of reimbursement exists, the amount and expected date of the reimbursement, and how it was verified.

 

Glossary of Terms

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Food Stamp Table of Contents

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