FAA6.A Changes : 03 Effecting Changes : H NA Medical Expenses – Effecting Changes
NA Medical Expenses – Effecting Changes
Information on this page refers to the Nutrition Assistance program
Effecting changes to a participant’s NA Medical Expense deduction.
Policy
Changes in medical expenses are not required to be reported until the next renewal.
When an NA budgetary unit member that is elderly or has a disability does not report a change in medical expenses that occurred during an approval period, both of the following apply:
The NA budgetary unit is not eligible for supplements
The NA budgetary unit is not subject to overpayments
When changes are reported during the approval period, the following applies:
When an NA budgetary unit is receiving the Standard Medical Deduction (SMD), a participant statement can be used as verification unless it is questionable(g) or unclear(g).
When an NA budgetary unit is not receiving the SMD and reports during their approval period that they now have out-of-pocket medical expenses, the new medical expense must be verified. (See Example 1)
When the NA budgetary unit is receiving the actual medical expense deduction, the new medical expenses must be verified when the change is over $25. (See Example 2)
Verification
Documented verification is required when the budgetary unit is adding the NA Medical Expense deduction for the first time. When the budgetary unit had a previous NA Medical Expense deduction, a participant’s statement is acceptable verification unless questionable. A participant’s statement cannot be used when the budgetary unit is receiving the actual medical expense deduction and the new expense exceeds $25.
Acceptable documents that can be used to verify NA medical expenses include, and are not limited to, the following:
Medical bills
Insurance receipts (latest payment or billing)
Current statement from a medical provider(g) responsible for providing care
Collateral contact with the medical provider or insurance company
Acceptable verification of a Medicare(g) expense includes, and is not limited to, the following:
Award or benefit letter from the Social Security Administration (SSA)
State Verification Exchange System (SVES)
Collateral contact with SSA
Examples
1) Michael has a disability and at his interview he did not have any out-of-pocket medical expenses. After his initial approval he reports a change that he now has a $55 monthly out-of-pocket medical expense that is not covered by any insurance. Michael provides the agency with the verification.
The agency allows the Standard Medical Deduction of $160 minus the $35 disregard and AZTECS deducts the $125 from the budgetary unit’s income. This causes the NA benefits amount to increase.
Michael receives a notice in the mail advising him of the NA increase.
2) Michael and Wendy are married to each other, and both are over 60 years of age. They are currently receiving the actual cost of their medical expenses because it exceeds the SMD amount.
During their NA approval period Michael reports an increase in their actual monthly medical expenses. The change is more than $25.
The agency requests verification of the change and Michael provides the verification. The agency then enters the additional medical expense to the EXNS screen and redetermines the NA benefits. The agency then sends an increase notice to the budgetary unit.
Legal Authorities
7 CFR 273.9 (d)(3)
Approved Food and Nutrition Service (FNS) Demonstration Project until 2025.
last revised 12/20/2021