63-253     Determining Deductions for Change Reporting (CR) and SAR Households

 

Table of Content

 

Section

Deductible Expenses

253.1

Billed Expenses

253.2

Billed Medical Expenses

253.3

Averaging Expenses

253.4

Averaging Medical Expenses with no Specific Payment Schedule

253.5

Averaging Medical Expenses with a Written Plan of Payment

253.6

Averaging Fluctuating Medical Expenses

253.7

Averaging Medical Expenses Reported During the Certification Period

253.8

Anticipating/ Estimating Medical Expenses

253.9

Calculating Expenses for CR and SAR Households

253.10

Disallowed Expenses

253.11

Expenses Billed Weekly or Bi-Weekly

253.12

 

 

 

63- 253.1
Deductible Expenses

Deductible expenses include only certain medical, dependent care, and shelter costs. 

 

63- 253.2
Billed Expenses

Except for averaged expenses, a deduction will be allowed only for the month the expense is billed or otherwise comes due, regardless of when the household intends to pay the expense.

·      Rent which is due each month will be included in the household’s shelter expenses, even if the household has not yet paid the expense.

·      Amounts carried forward from past billing periods are not deductible, even if included with the most recent billing and actually paid by the household.

·      An allowable expense will be deducted only once.

 

63- 253.3
Billed Medical Expenses

A medical deduction is allowed for excess medical costs only if incurred by an elderly or disabled household member and when the cost is in excess of $35.  The portion of the medical expense in excess of $35 is the actual deduction allowed in the budget.

For reimbursable medical expenses or for those expenses in which the non-reimbursable portion is known or can be determined at the time of the billing, the period of deduction and past due expenses are established as follows:

If ...

Then ...

The billing period is specified on the bill

A deduction will be allowed until the final day in the month that the bill becomes due

No billing period is specified

The bill is considered to become due one month after the date of the bill.

 A deduction will be allowed until the final day in the month following the month the bill was issued.

When an eligible household member presents a medical bill, other than for hospital expenses, the amount of the household’s allowable medical cost will be determined in the following manner:

If ...

And If ...

Then ...

Insured (Reimbursable) Medical Expenses

The bill is submitted and Medicare, or Blue Cross/Blue Shield, or private insurance company covers the eligible household member

 

20 percent of the total bill will be the household’s medical cost.

The bill is submitted and the eligible household member is covered by Medi-Cal.

 

The share of cost or the doctor’s bill, whichever is less, will be the household’s medical cost.

 

Uninsured (Non-reimbursable) Medical Expenses

Verified

The total amount of the uninsured medical expenses incurred by an eligible household member is the household’s medical cost

 

A Medi-Cal bill is submitted for an allowable medical expense incurred, but not covered by Medi-Cal

 

The full amount billed will be the household’s medical cost regardless of the member’s share of cost.

 For hospital bills the total amount of the non-reimbursable portion of the medical expense shown on the final bill as due and payable by the eligible household member will be the household’s medical cost.

Eligible household members who have coverage by more than one health insurance policy (except for Medi-Cal/Medicare and Blue Cross/Blue Shield) will receive the medical deduction only after all reimbursements and/or payments have been received or verified.

 

63- 253.4
Averaging Expenses

All households may elect to have fluctuating expenses or payments averaged. 

Households may also elect to have expenses which are billed less often than monthly averaged forward over the interval between scheduled billings, or if there is no scheduled interval, averaged forward over the period the expenses are intended to cover (such as local property taxes and fire insurance).  The household may elect to have one-time only expenses averaged over the entire certification period in which they are billed.

 

63-253.5
Averaging Medical Expenses with no Specific Payment Schedule

Households reporting medical expenses during their certification period, with no specified payment schedule, may elect to have a one-time only deduction or to have the expense averaged over the remaining months of their certification period.   

·      Averaging would begin in the month the change becomes effective, and only the excess medical expense will be deducted each month.

·      Households reporting a one-time medical expense:

If the household is certified for 24 months and…

Then the household will be offered a choice of one of the following options:

Reports a one-time medical expense during the first 12 months of the certification period

·   Deduct the expense for one month; or

·   Average the expense over the remaining first 12 months of the certification period; or

·   Average the expense over the remaining months in the certification period.

Reports a one-time medical expense after the 12th month of the certification period

·   Deduct the expense for one month; or

·   Average the expense over the remaining months in the certification period.

 

63- 253.6
Averaging Medical Expenses with a Written Plan of Payment

When an eligible household member has a written agreement, contract, or other type of written plan for payment of billed medical expenses, the stipulated amount of monthly payment will be the base for determining the monthly excess medical expenses.

 

63- 253.7
Averaging Fluctuating Medical Expenses

Fluctuating medical expenses may be averaged over the certification period.  Households may elect to average medical expenses billed less often than monthly over the certification period or claim such expenses in the month received.

·      Medical expenses averaged over the certification period will not be determined by automatically averaging past months’ medical expenses.  Past expenses will be used only as an indicator of the expenses that are estimated or reasonably anticipated during the certification period.

·      Fluctuating medical expenses may be allowed as a deduction and averaged over the certification period only if regularly recurring, reasonably anticipated and verified to recur over the certification period.

·      Fluctuating medical expenses include, but are not limited to:

o  Medical service and treatments received regularly, but less often than monthly, and

o  Fluctuating monthly health expenses for prescription drugs.

 

63-253.8
Averaging Medical Expenses Reported During the Certification Period

Expenses that occur and are reported and verified during the certification period that were not anticipated and deducted will be considered one-time only expenses and may be deducted in the month billed, when the bill otherwise becomes due, or averaged over the remaining months of the certification period.

 

63-253.9
Anticipating/ Estimating Medical Expenses

APPLICATION AND RECERTIFICATION

The worker shall require the household to report and provide verification of all medical expenses at certification and recertification.  The household’s monthly medical deduction for the certification period will be based on the information reported and verified by the household.  This information will include any anticipated changes in the household’s medical expenses that can be reasonably expected to occur during the certification period, based on available information about the recipient’s medical condition, public or private insurance coverage, and current verified medical expenses.

DURING THE CERTIFICATION PERIOD

Reporting medical expenses during the certification period shall be on a voluntary basis.  If the household voluntarily reports a change in medical expenses the worker is required to request verification of the expense with the following exceptions:  The worker will not:

·      Verify medical expenses which are unchanged or have changed by $25 or less;

·      Take action on changes in medical expenses obtained from a source other than the household.  In order to take action the worker is required to contact the household for verification.  The worker will only act on changes received from another source if they are verified and do not require contact with the household.

The worker is required to verify changes to voluntarily reported medical expenses if the change is over $25 and/or would increase the household's allotment.

In the case of a reported change that would decrease the household's allotment, or make the household ineligible the worker shall act on the change without requiring verification.  However, if the reported change is over $25 the verification shall be obtained at the next recertification

Note:  The worker is required to verify questionable information which is incomplete, inaccurate, inconsistent or outdated.

Refer to 63-284.7, Changes in Medical, Dependent Care, and Shelter Expenses.

 

63-253.10
Calculating Expenses for CR and SAR Households

Expenses for Change Reporting (CR) and Semi-Annual Reporting (SAR) households will be calculated based on the expenses the household expects to be billed for.  Anticipation of the expenses will be based on the most recent month’s bills, unless the household is reasonably certain a change will occur.

 

63-253.11
Disallowed Expenses

The following expenses are not deductible for CR and SAR households:

·      An expense covered by an excluded reimbursement or vendor payment will not be deductible except for energy assistance vendor payments made under the LIHEAA of 1981.

·      That portion of an allowable medical expense (when the CalFresh household includes an elderly or disabled member) which is not reimbursable will be included as part of the household’s medical expenses.

If the household reports an allowable medical expense at the time of certification but cannot provide verification at that time, and if the amount of the expense cannot be reasonably anticipated based upon available information about the recipient’s medical condition, and public or private medical insurance coverage, the worker will not deduct the expense.  The household will have the non-reimbursable portion of the medical expense deducted at the time the amount of the expense or reimbursement is reported and verified.

·      An expense, which is covered by an excluded vendor payment that has been converted to a direct cash payment under the approval of a federally authorized demonstration project.

·      Expenses will only be deductible if someone outside the household provides the service and the household makes a money payment for the service.  For example:  a dependent care deduction will not be allowed if another household member or excluded member provides the care or compensation for the care is provided in the form of an in-kind benefit, such as food.

·      Past-due medical bills.

·      Medical bills paid prior to the month of initial application are not a deductible expense.  Medical bills received during the month of application are an allowable expense, even if the medical service was provided prior to the month of application, provided the household is otherwise eligible.

 

63-253.12
Expenses Billed Weekly or Bi-Weekly

Income conversion procedures also apply to expenses billed on a weekly or biweekly basis for CR and SAR households.