Recurring Medical Expenses

Recurring medical expenses not covered by insurance can be applied towards the SOC in the month the payment was made. The client must provide proof of the payment each month in order to apply the amount paid.

Important: A medical expense is not the same as an income deduction. A medical expense adjusts the share of cost (SOC) one month at a time (must be verified each month). An income deduction (e.g. health insurance premium) reduces the client’s countable income (must be verified at renewal).

Qualifying a Medical Expense

To determine if an expense qualifies as a bona fide medical expense, it must meet the following criteria:

  1. Prescribed by a physician as necessary to treat a medical condition and;
  2. Customarily considered by the medical profession as primarily for health care and medical treatment and;
  3. Intended, and will be used, solely for the health care and medical treatment of the individual.

All three criteria must be met. A letter from the healthcare provider attesting to each of the three criteria for the specific expense is acceptable proof.

There is no exhaustive list of what expenses may qualify, but a few of the most common are: prescription drugs, over-the-counter (OTC) items (e.g. incontinence supplies, vitamins/minerals, first aid items, etc.), medical equipment (e.g. oxygen tank, wheelchair, walker, etc.).

Note: SOC will be adjusted through MEDS only for medical expenses unrelated to Hunt v. Kizer

Adjustments through MEDS

Once the SOC adjustment has been completed in CalSAWS the information will automatically be sent to MEDS. If there is a system issue or the required months cannot be established in CalSAWS the EW may request that the MEDS Terminal Operator (MTO) enter the medical bill information on the [SOCR] screen.

Note: For recurring medical expenses (unrelated to Hunt v. Kizer), there are no CalSAWS entries needed and adjustment will be completed through MEDS only.

  • The MC 176 M must be completed for every month that an adjustment is made.
    • Enter adjustment amount in the Underpayment Adjustment Box (Column III, Line 15).
  • Manually generate Hunt v. Kizer approval NOA MC 352 HK (for Hunt v. Kizer cases only).
  • Request an on-line SOCO transaction via SCD 1296 SOCO.

Reminder: A 10-day NOA is always required to increase a SOC.

Related Topics

Share of Cost