July 2013 Maximizing SNAP Benefits Through the Medical Expense Deduction Audio Portion: 1-866-740-1260 Web Portion: www.readytalk.com Code: 4796976 A nonprofit service and advocacy organization 2013 National Council on Aging 1
What we ll talk about today Speaker introductions The importance of the Medical Expense Deduction Promising Practices: Georgia Legal Services Program Policy Options: Center on Budget and Policy Priorities Resources for your next steps Q & A A nonprofit service and advocacy organization 2013 National Council on Aging 2
Speaker introductions Vicky Kimbrell Lura Barber Ty Jones A nonprofit service and advocacy organization 2013 National Council on Aging 3
Discussing two kinds of deductions Excess Medical Expense Deduction Vicky Kimbrell Federal regulation Available in every state your state may allow additional deductions Requires itemized documentation of unreimbursed medical expenses to calculate the deduction amount Some details in Vicky s presentation may be specific to Georgia, so check your state s rules Standard Medical Expense Deduction Ty Jones Policy option that states can apply for to streamline the deduction process Not available yet in every state check your state s SNAP handbook Requires only documentation of unreimbursed medical expenses in excess of $35 to get a standardized deduction (amount varies by state!) Any senior or disabled adult applying for SNAP in any state has the right to apply for the Excess Medical Expense Deduction. In some states, seniors and disabled adults also have a streamlined option called the Standard Medical Expense Deduction. A nonprofit service and advocacy organization 2013 National Council on Aging 4
Georgia Legal Services Program
*Legal assistance with civil cases for persons with incomes under 200% of poverty in 154 counties outside metro Atlanta. *10 regional offices across the state. *
*Benefits Hotline Project started in February of 2012 *Originally funded by NCOA *Seniors and people with disabilities apply for or keep Medicaid, Medicare Savings Programs, Food Stamps (SNAP), and Energy Assistance. *In 2013, began also helping families with Peach Care and TANF in addition to the other programs. *
Callan Wells Benefits Hotline Paralegal * Linda Lowe Health Policy Specialist Vicky O. Kimbrell Health Law Attorney
*In Georgia, there have been significant cuts to the Department of Family and Children s Services (DFCS), which oversees Medicaid and food stamps. *DFCS is moving to a technology heavy model to compensate. *Many seniors and people with disabilities do not have access to basic technology, such as phones, internet, email, and fax. *Hotline also contacts DFCS staff who rely heavily on email for communication. *
*Using robust follow up method, Hotline has been able to assist 1,124 individuals in getting or maintaining core benefits. * 91% of our clients live below 150% of poverty, and 58% live alone. *We have also developed long-lasting relationships with clients who continue to call us for help with renewals and maintaining excess medical expense deductions *
February 2012-June 2013 1124 Individuals assisted in getting or maintaining a core health benefit. About 80% of clients were missing at least one core benefit. 91% were living below 150% of the federal poverty guidelines. About 60% of clients served were women. Conducted 614 Follow ups to help clients solve problems with applications, renewals, or understand their benefits Helped individuals apply for about $900,324 in core benefits alone. 58% were living alone. About 57% had a self reported disability.
*Only Aged, Blind, Disabled households are considered. *Clients must still owe on the bill they are presenting (30 days). *Bills owed and ongoing medical expenses are considered. *Many clients and caseworkers, are not familiar with EMED. *The first $35 worth of medical expenses is not considered. * Can include: * Medical and dental services * Hospital bills * Prescriptions * Medical equipment * Transportation to and from medical services or treatment (at federal rate) * Attendant or home health aide * Medical insurance premiums or Medicare supplemental insurance policies *
* From Hotline Evaluation Surveys: * Clients are forced to choose between food and prescriptions. * About 23% of clients surveyed indicated they were skipping meals or medications before receiving assistance from the Benefits Hotline. * Only 6% surveyed indicated they were skipping meals or medications after receiving services from the Benefits Hotline. *
*Medical bills are considered on a onetime or ongoing basis. *For example, prescriptions are ongoing because seniors pay for them each month, while a hospital bill is a one time expense. *Ongoing expenses are factored into the monthly budget. *One-time bills are either factored into one-month s budget or pro-rated over the period of eligibility. *
*Prescriptions *Transportation *Monthly insurance premiums *Part-B Medicare premium *Hospital bills *Doctor bills *Eyeglasses *Dental services *Medical equipment costs *
Step 1 Have client complete worksheet documenting all of their medical expenses. Step 2 Collect medical bills, document mileage to and from the doctor or hospital, call the pharmacy for a list of all medications taken. Step 3 Submit these documents to the SNAP administering agency. In some states you can submit them at any time but some only take bills at renewals.
* Sometimes, a one time bill is pro-rated over the period of eligibility, and sometimes it is only used for one month, depending on what is better for the client. * The administering agency will not pro-rate for less time than the period of eligibility. * This means a client could have $1000 in bills but only get a one time maximum of $200 rather than $20 per month if the bill was pro-rated. * If the client has multiple bills totaling $1000, you can withhold bills and turn them in each month in order to receive the maximum for several months in a row. * Example: $1,000 in bills sent in February could mean $200 in March. $500 sent in February and $500 sent in March could mean $200 in March and April. *
*Many medical bills can also be used for Adult Medically Needy (AMN) Medicaid also known as Spend Down Medicaid. *Once a bill is used for AMN, it cannot be used as an Excess Medical Expense Deduction. *However, the reverse is not true. Use a bill towards the food stamps budget and then help your client apply for AMN. *
*Many seniors do not know what can be considered as Excess Medical Expenses. *GLSP s Food Stamps Action Committee created a worksheet to help advocates and seniors identify the type of expenses that should be considered. *There is a place on the form to ask the administering agency for help in verifying the medical expenses. *
* A client called the hotline because she was having a hard time affording food. * She had just started chemotherapy for a rare form of Leukemia, and the doctor told her a proper diet could aid her recovery. * She was not able to afford the nutrient-rich foods suggested with only $16 per month in SNAP benefits. * Using the bills she had incurred over the past few years, the GLSP Benefits Hotline was able to help her get $200/month in SNAP Benefits. That s $2,400 worth of SNAP Benefits per year! * She is now better able to afford the balanced diet suggested by her doctors. *
* * A couple in central Georgia called our office for help with Medicaid. The husband had dementia, and the wife was his sole caregiver so she does not work. * We screened the couple and saw the wife was eligible for QMB. * The husband has Medicare, but his social security check is too high to qualify for a Medicare Savings Program. * We helped her submit a QMB application which was approved. This also automatically enrolls her in LIS. * She indicated that with so much going on, they did not feel their $16 SNAP benefit was worth the trouble. * They were still responsible for his Medicare Part B premium and 20% of the rest of the bills incurred.
* *Using medical bills the couple had incurred over the past several years, the GLSP Benefits Hotline was able to get their SNAP benefits increased from $16 to $337 on an ongoing basis. *The couple recently called for help with a renewal and reported how much easier it was to afford medications since they had gotten the food stamps increase. *They will be submitting more bills to continue getting the increased benefit, and to help the husband possibly qualify for Spend Down Medicaid.
*Even though the clients initially only called for help with Medicaid, The Benefits Hotline helped them get QMB, LIS, an increase in food stamps, and hopefully, Spend Down Medicaid. *QMB is valued as a savings of about $3,500 per year. *LIS is valued as a savings of about $4,000 per year. *Their food stamps increase helped them get an extra $3,825 per year. *As of this date, the Benefits Hotline has saved the couple $11,352 this year. *The Benefits Hotline s goal is to provide low-income persons with a pathway out of poverty. *Using the robust follow up model, the Benefits Hotline can help ensure clients get every benefit to which they are entitled. *
*Legal Services Programs are especially equipped to handle SNAP and other public benefits cases. *GLSP s Benefits Hotline has helped clients request fair hearings and write letters requesting Reasonable Accommodations under the Americans with Disabilities Act. *Reasonable Accommodations Requests have proven especially helpful in asking the administering agency for help verifying medical bills for Excess Medical Expense Deductions claims. *Having an attorney on staff has helped the hotline claim Good Cause Exemptions for the child support mandate of Medicaid when a client was a victim of domestic violence. *We have also helped clients who were over resources due to a second vehicle prove the vehicle was in their name, but not in their possession. *These issues needed attorney involvement. *
*Several attorneys in Georgia Legal Services Program work closely with the Department of Family and Children s Services (DFCS) to create systemic changes which they believe will make the process of getting and maintaining SNAP benefits easier for all recipients. *For example *Due to a lawsuit in 1980s, GLSP s number is now on all DFCS notices. *DFCS and Senior SNAP have created fliers in conjunction with the Senior SNAP subcommittee about Excess Medical Expense Deductions to send to seniors all over the state. *
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Standard Medical Expense Deduction Ty Jones 28
What is the Center on Budget and Policy Priorities? The Center on Budget and Policy Priorities (CBPP) is a public policy think tank that works at the federal and state levels on fiscal policy and public programs that affect low- and moderate- income families and individuals. One mission of CBPP is to help make low-income programs more accessible and effective for eligible participants, as well as, simpler to administer for federal and state governments. 29
Comparison of SNAP Household Characteristics SNAP Participants: 44,708,726 U.S. 2011 Source: FY 2011 USDA Household Characteristics Data 30
Average Monthly SNAP Benefit Source: U.S. Department of Agriculture, Office of Research and Analysis, Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2011. 31
Who Claims the Deduction? Individuals With Medical Deduction No Medical Deduction Total Elderly 483,622 2,637,876 3,121,498 15.5% % Receiving Medical Deduction Non-elderly Disabled 380,245 4,422,878 4,803,123 8% SSI 115,148 4,065,486 4,180,634 2.8% Veteran s Compensation 17,579 133,379 150,958 11.6% Total 996,594 11,259,619 12,256,213 8% 32
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Why Are These Deductions Important? Household Size Gross Income Medical Expenses SNAP Benefits w/o Excess Medical Deduction SNAP Benefits w/excess Medical Deduction SNAP Benefits w/smd 1 person $710 $100 $32 $51 $74 2 people $1066 $100 $92 $111 $134 34
Why Aren t More Households Claiming the Deduction? Verifications Confusion Policy Constraints 35
Standard Medical Deduction A waiver from USDA Currently 14 State agencies are operating with these waivers Designed to: Test the impact of increasing access to SNAP by the elderly and disabled Increase administrative efficiency Reduce the risk of quality control errors. 36
14 States Have the Standard Medical Deduction
How Does it Work? Allows elderly or disabled households to claim medical expenses up to the standard without having to verify all costs At application: Household verifies that they have medical expenses in excess of $35 per month. If household has and can verify medical expenses in excess of the standard, they can claim actual. 38
How Does it Work? Cont. At recertification, The household must declare that it still has medical expense in excess of $35 month. Documentation is not required. Documentation 39
Barriers to Implementation of a SMD Confusion about Cost- Neutrality Determination Offset Dilemma Gathering Data Constraints on Staff Time 40
What is Cost Neutrality? Cost of Standard Medical Deduction Federal Government Cost Standard Medical Deduction Offset (SUA, income) Increased Benefits to Participants Benefits to Participants 41
Possible Downsides To Standard Medical Deduction Cost of Standard Medical Deduction Federal Government Cost Standard Medical Deduction Increased Benefits to Participants 42
What are the Elements of a Successful Standard Medical Deduction Increases elderly/disabled use of medical expense deduction. Offset to rest of SNAP population is minimum. Increases administrative efficiency since caseworkers do not have to spend as much time verifying medical expenses. More money for food for seniors. 43
States Gather Data What Can You Do? Multi-Dimensional Solution How many claim the deduction now? Increase the Utilization Rate Upfront Set Clear Policy Verifications Outreach, Outreach, Outreach Advocates Engage clients Outreach Application assistance and more Engage the state Provide real stories Help doesn t end at application assistance 44
RESOURCES CBPP Online Benefits Papers Online Services for Key Low-Income Benefit Programs http://www.cbpp.org/cms/index.cfm?fa=view&id=1414 SNAP Online: A Review of State Government SNAP Websites http://www.cbpp.org/cms/index.cfm?fa=view&id=618 CBPP Eligibility Paper A Quick Guide to SNAP Eligibility and Benefits http://www.cbpp.org/cms/index.cfm?fa=view&id=1269 45
Senior hunger and SNAP participation About 5 million seniors will experience hunger this year Food banks are seeing more seniors become repeat clients Only 1 in 3 eligible older adults participates in SNAP, i.e., 65% are missing out on a benefit for which they are eligible Aging network has the knowledge and experience to help close the gap A nonprofit service and advocacy organization 2013 National Council on Aging 46
Overcoming barriers to participation Three key barriers: The $16 Myth: Many believe they are only eligible for the minimum benefit of $16/month, although the national average is $122/month Application process considered not worth it 55% of SNAP-eligible seniors could take the deduction, but only 14% do! The medical expense deduction helps overcome these barriers Increases benefit amount, often dramatically Although deductions may require paperwork, the increased benefit amount is worth it Policy options simplify the deduction process A nonprofit service and advocacy organization 2013 National Council on Aging 47
Seniors are missing out on medical deductions About 14% of seniors take the medical deduction, but 55% of SNAP-eligible seniors would qualify Deductions increase SNAP benefit amount by reducing net income Even seniors with LIS and MSP have unreimbursed out-ofpocket costs in excess of $35 that would be eligible, including: Medical and dental care, prescription drugs, health policy premiums Costs of dentures, hearing aids, prosthetics Vet bills, food, and other costs associated with owning a service dog Eye glasses prescribed by an optometrist or specialist Transportation and lodging costs incurred to obtain medical treatment, including mileage (calculated at federal rate = 55.5 /mile in FY 12) Attendant, home health aide, homemaker, or child care services A nonprofit service and advocacy organization 2013 National Council on Aging 48
NCOA s resources for community organizations Economic Security Group : www.ncoa.org/enhance-economic-security National network of aging services providers Benefits Access, Economic Security Initiative, Mature Workers, Reverse Mortgage Counseling www.centerforbenefits.org Resource Library webinars, issue briefs, promising practices Fact sheets: Medicare, Medicaid, Prescriptions, Food and Nutrition, Energy National Institute of Senior Centers (NISC): www.ncoa.org/nisc Over 2,000 member centers across the country Economic Security Work Group focusing on benefits access NCOA s Center for Healthy Aging: www.ncoa.org/improve-health Chronic disease self management (CDSMP), falls prevention, community education, behavioral health A nonprofit service and advocacy organization 2013 National Council on Aging 49
Online resources to connect seniors to benefits BenefitsCheckUp.org - Free, online comprehensive benefits screening SNAP Maps and Application Form Center Online LIS/Extra Help application Medicaid Office Locator Senior Housing Locator A nonprofit service and advocacy organization 2013 National Council on Aging 50
Contact us Vicky Kimbrell, Georgia Legal Services Program vkimbrell@glsp.org Ty Jones, Center on Budget and Policy Priorities tjones@cbpp.org Lura Barber, National Council on Aging lura.barber@ncoa.org A nonprofit service and advocacy organization 2013 National Council on Aging 51