SNAP Directors’ Conference September 23, 2013

1. SNAP Directors’ ConferenceSeptember 23, 2013 Medical Expense Deduction: A View from the Field By: Leslie Fried Director, National Center for Benefits Outreach & Enrollment

2. National Council on Aging (NCOA) NCOA is a nonprofit service and advocacy organization. Our mission is to improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged.

3. What is the National Council on Aging? (NCOA) • NCOA is a national voice for older Americans—especially those who are vulnerable and disadvantaged—and the community organizations that serve them. • NCOA brings together nonprofit organizations, businesses, and governmentto develop creative solutions that improve the lives of all older adults. • NCOA works with thousands of organizations across the country to help seniors find jobs and benefits, improve their health, live independently, and remain active in their communities. Over 2 million people visit NCOA websites every year

4. What is BenefitsCheckUp®? • BenefitsCheckUp® is a free, easy-to-use, confidential online service that screens individuals for thousands of public and private benefits and helps them take the steps to enroll. • A BenefitsCheckUp® screening can help identify hundreds or even thousands of dollars in potential benefits for older adults in need and often leads to a senior receiving a hot meal, saving on their medicine, or being able to pay rent.

5. 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

6. Overcoming barriers to participation • 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” • Others are more in need • 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

7. 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 the Part D Low Income Subsidy (LIS) and Medicare Savings Programs have unreimbursed out-of-pocket 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

8. “Fighting a Forest Fire with a Squirt Gun” • Quote is from a local DSS worker trying to do more with less • With increasing caseloads, reduced staff and state fiscal woes, case workers are extremely busy • Not as much time for robust interviews • Often take what clients present and move on to process application • May not have the time to provide as much assistance to maximize the medical deduction

9. Concern about Lack of Education or Training of Local “Boots on the Ground” • Many clients and case workers do not know or understand processes • Example: If you are over 60, you can deduct medical expenses • Workers may not ask about medical expenses, or do not know what is included in the deduction • Some workers will only accept premiums for medical deductions.

10. It’s All a Bit “Fuzzy” as to what is a deduction • In states where SNAP is county-administered, every county handles the medical deductions differently • Guidelines can be a bit “fuzzy” and open to interpretation • Each county interprets requirements somewhat differently • Case workers make their own judgment call too

11. Barriers and Hurdles Too High To Leap • Face to Face Interviews – pros and cons • Seniors & people with disabilities do not have access to basic technology (computers, internet, email, fax) • Documentation requirements • Difficult to provide especially with lack of copier and no assistance • Lack of transportation • Clients lack access to public transportation, especially in rural areas, or in large suburban communities

12. Medicaid & SNAP Medical Expense Deduction • Many medical bills can also be used for adult Medically Needy (MN) Medicaid also known as Spend Down Medicaid. • In some states…. • Once a bill is used for spend down, 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 the client apply for medically needy.

13. Online Application System • Revamped online application systems • Some questions have been removed and no longer includes questions on medical expenses • Removed because most applicants are under 60 • Caseworkers are supposed to ask questions about medical expenses in interviews but do not • Net result: Minimum $16 award or denied SNAP

14. Tools and Checklists: How NCOA can Help • Many seniors do not know what can be considered as Excess Medical Expenses. • Numerous programs have created worksheets to help advocates and seniors identify the type of expenses that should be considered. • On some forms, there is a place to ask the administering agency for help in verifying the medical expenses • Clients/advocates are encouraged to question a low benefit amount

15. 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

16. Other NCOA’s Resources Online • 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