How do medical expense deductions change SNAP benefit calculations for elderly or disabled households?
Executive summary
Medical expense deductions reduce the net income used to calculate SNAP benefits for households that include an elderly (60+) or disabled member by allowing unreimbursed medical costs above $35 per month to be subtracted from countable income [1] [2]. That lower net income can both raise the monthly allotment—because benefits equal the program maximum minus 30% of net income—and help households meet SNAP’s net-income eligibility test that elderly/disabled households must satisfy [3] [4].
1. How the deduction is applied and who qualifies
Only households with an elderly or disabled member may claim the SNAP medical expense deduction; the program permits deduction of out‑of‑pocket medical expenses that exceed $35 per month and are not paid by insurance or someone outside the household [1] [5]. States typically require documentation of those expenses when claimed [5]. Some states also operate a Standard Medical Deduction (SMD) that simplifies claims by offering a fixed monthly deduction in lieu of itemizing every expense [2] [6].
2. The arithmetic: from expenses to higher benefits
SNAP benefit calculations start with gross income, subtract allowable deductions to reach net income, then set benefits as the maximum allotment for the household size minus 30% of that net income [3] [7]. By subtracting unreimbursed medical costs above $35/month, the medical deduction reduces net income, which lowers the 30% reduction and therefore increases the household’s monthly benefit or helps a household qualify if net income falls below the program threshold [3] [4].
3. What counts as an allowable medical expense
Allowable items are broad: prescription drugs, insurance premiums (including Medicare and private premiums), co‑payments and deductibles, medical supplies and equipment, home health aide or attendant costs, and transportation/lodging for medical care—so long as they are unreimbursed and actually paid by the household [8] [5]. Some items commonly believed to help, such as special diets, are generally excluded from the medical deduction under federal guidance [8].
4. State variation and the role of the Standard Medical Deduction
Federal rules set the $35 threshold and the elderly/disabled eligibility, but states can simplify administration by offering a State Standard Medical Deduction (SMD) at a fixed monthly amount; about half of states have adopted an SMD or variations of it, and SMDs vary where they exist [2] [6]. FRAC and other advocates argue more states should adopt SMDs because they increase take‑up and reduce paperwork, while state administrators sometimes resist wider adoption citing verification burdens and cost [6].
5. Eligibility interactions and practical impacts for households
Because households with an elderly or disabled member often don’t have to pass the gross‑income test and only need to meet the net‑income limit, claiming medical deductions can be decisive—both for meeting eligibility and for materially increasing the benefit amount for households close to the thresholds [4] [1]. The excess shelter deduction rules are also more generous for elderly/disabled households, so medical deductions combine with other special rules to improve benefit adequacy for high‑expense, fixed‑income households [4] [5].
6. Caveats, verification, and policy debates
Claiming the deduction requires documentation and verification of unreimbursed payments; states may request proof of premiums, receipts, or billing statements [5]. Policy debates center on whether the $35 threshold and limited state uptake of SMDs undercount real medical burdens; advocacy groups assert SNAP’s medical deduction is underutilized and should be expanded or standardized, while administrators point to verification challenges and fiscal constraints [6].