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How do state variations affect which medical expenses are deductible for SNAP eligibility for seniors and disabled adults in 2025?
Executive summary
State rules change how easy it is for seniors and disabled adults to claim SNAP’s excess medical expense deduction — federal rules set the core test (only unreimbursed medical costs over $35/month for an elderly or disabled member are deductible), but states can shape verification, standard deductions, and administrative practices that affect who actually gets the benefit (see federal medical-expenses handbook and guidance) [1] [2]. Fifteen states have experimented with “standard medical deduction” waivers that simplify claiming; other state practices (application questions, data-sharing, averaging large bills) can either expand or reduce take‑up [3] [4].
1. Federal rule: the baseline everyone must follow
SNAP’s nationwide rule is straightforward: an elderly (60+) or disabled household member may deduct only unreimbursed medical expenses above $35 per month from gross income; that $35 threshold and the “unreimbursed” requirement are set in federal guidance and reiterated in the SNAP medical‑expenses handbook [2] [1]. This federal baseline determines the universe of deductible costs (prescription drugs, equipment, transportation for medical care, attendant care and many others listed in guidance) and requires verification of those expenses [1] [4].
2. How states create variation: policies that matter most
States cannot change the $35 federal floor, but they have discretion over administrative practices that produce major effects: whether they operate a standard medical deduction (SMD) that applies an averaged amount, what the SMD level is, how stringently they verify receipts, whether applications ask about transportation and other lesser‑known deductible items, and how they average or count one‑time bills [3] [4] [1]. The Center on Budget and Policy Priorities and USDA analyses show these operational choices — not changes to the underlying $35 rule — explain much state‑to‑state variation [5] [3].
3. Standard Medical Deduction waivers: a shortcut that raises benefits in some states
Fifteen states have received USDA waivers to implement SMD demonstration projects that let eligible households claim a standard deduction rather than document every out‑of‑pocket cost; CBPP documents these waivers and notes they can boost enrollment and benefits by lowering verification burdens [3]. FRAC and CBPP reporting explain that an SMD simplifies the process and can capture expenses households might otherwise miss, increasing the practical reach of the federal $35 threshold [6] [5].
4. Verification and application design: small choices, big effects
USDA memoranda flag that many state applications omit explicit questions about deductible items such as medical transportation, meaning households may not report them; Louisiana’s application is cited as a contrast because it asks detailed questions and documents costs during interviews [4]. CBPP and USDA materials also explain that states vary in how strictly they require documentation and whether they proactively match health‑program data to SNAP records — practices that influence whether eligible seniors actually receive the deduction [5] [4].
5. Examples of state‑level consequences and practical guidance
Massachusetts materials show that state-level calculation choices (e.g., using a standard deduction amount in practice) affect net income and SNAP benefit size for seniors and disabled people, and casework practices around averaging one‑time bills can alter monthly counting [7] [1]. National advocates (NCOA, AARP) emphasize that under‑use of the excess medical deduction is widespread and that more aggressive state outreach and better application forms raise take‑up [8] [9].
6. Where states still differ — and where sources do not say more
Reporting documents state flexibility in administrative rules, SMD waivers, application content and verification approaches as the main drivers of variation [5] [3]. Available sources do not mention a definitive, up‑to‑date list of which exact states use SMDs in 2025/26 or every state’s current SMD amount — interested readers should check their state SNAP office for precise local practice (not found in current reporting) [3].
7. Practical takeaway for seniors, caregivers and advocates
Ask your state SNAP office whether it uses an SMD waiver, whether their application/interview explicitly solicits transportation and attendant care costs, and how one‑time bills are averaged; document unreimbursed expenses and request that staff apply the medical expense deduction since it only requires that the household member be elderly or disabled and expenses exceed $35 [1] [4] [3]. Advocacy and better data‑sharing between state health and SNAP agencies are the two levers CBPP and USDA highlight that most reliably increase correct application of the deduction [3] [5].
Limitations: This summary relies on federal guidance, national analyses and advocacy reports in the provided search results; those sources describe mechanisms of state variation and identify SMD waivers but do not provide a current, state‑by‑state table of practices for 2025 — contact your state SNAP office for the exact local rule and SMD amounts (not found in current reporting). [2] [1] [3]