C.M.R. 10, 144, ch. 332, app 144-332-B
To compute SGA earnings and costs of certain items and services needed to work and related to medical impairment will be deducted from the monthly average gross earnings. These costs are allowable even though the items and services are also used for daily living needs in addition to work, unless otherwise stated below. The costs for each item must be the responsibility of the disabled individual. Actual or potential reimbursements from another source will reduce the allowable deduction.
Example: | |
Individual purchases crutches for | $80.00 |
Reimbursement from another source | - $64.00 ____________ |
Allowable cost | $16.00 |
I. Allowable Expenses for Consideration
A. Attendant Care Services - Only that portion of cost associated with assistance:
1. traveling to and from work:
2. with personal functions while at work (such as eating and toileting):
3. with work related functions (such as reading, communicating): and
4. with personal functions at home for work (such as dressing, administering medications).
Note: Attendant care services may be paid to a family member only if that person suffered an economic loss by ending this job or other employment in order to perform these services. The family member can be related by blood, marriage, or adoption, and need not live with the disabled person.
B. Medical Devices - This item includes durable equipment (such as canes, wheelchairs, crutches).
C. Prosthetic Devices (such as artificial limbs).
D. Work Related Equipment specifically designed to accommodate an impairment (such as typewriters and telecommunication devices for deafness).
E. Residential Modifications :
1. Outside - For individuals employed away from home, changes may be made to the outside of the home to permit transportation to work (such as the installation of an exterior ramp for a wheelchair confined person or special railing or pathways for a person requiring crutches).
2. Inside - If an individual is employed at home, costs of modifying the inside of the home is allowed to create a work space to accommodate the individual's impairment. Only those expenses associated directly with the work area will be allowed, (such as the enlargement of the doorway leading to the work area).
Note: If the cost can be deducted as a business expense for the IRS, then it cannot be deducted in this calculation.
F. Non-medical Appliances and Equipment - Appliances and equipment specifically prescribed by a physician as essential for control of the impairment. Essential means the item must be one that if not available would cause immediate adverse impact on the individual's ability to function in work activity. (such as the need for an electric air cleaner for an individual who has severe respiratory disease and must work in a purified air environment).
G. Drugs and Medical Services - including diagnostic procedures to control medical impairments. These items must be prescribed or utilized to reduce or eliminate symptoms of the impairment or to slow down its progression. The diagnostic procedures must be performed to ascertain how the impairment is progressing or to determine what type of treatment is needed (such as anticonsulsant drugs for epilepsy, antidepressant drugs for mental disorders, radiation treatments or chemotherapy for cancer patients). Items or services not directly related to the impairment are not allowable deductions (such as routine annual physical exams, optician services when the impairment is not visual and dental checkups).
H. Medical Supplies - Medical items utilized for work and directly related to the impairment. (such as catheters, bandages, irrigating kits and face masks).
I. Transportation - Payments for transportation are limited to the following:
1. Own Vehicle
a. If the individual's impairment necessitates a modified vehicle needed for travel to work, modifications must be critical to the individual's operation or use of the vehicle and directly related to the impairment. The cost of the modifications is deductible but not the cost of the vehicle.
b. If the impairment prevents use of public transportation to and from work, a physician must verify that the need to drive is caused by the impairment and not the lack of public transportation.
c. The standard IRS mileage rate will be given for the trip to and from work and also, if needed, the cost to hire a driver.
2. Hired Transportation - Actual payments made to hire a driver will be allowed but not a mileage allowance.
Exception:
Except for mileage and modifications, costs for the operation of any vehicle are not allowable.
J. Installation, Maintenance and Repairs - Costs directly associated with these services for all appliances or devices, which qualify as a deduction in this appendix.
II. Limits on Deductions
Payments for allowable expenses must be made during a month when the individual was working. An individual is considered working even if absent from work temporarily to receive medical treatment.
In addition, a portion of payments for certain items made in any of the eleven (11) months preceding a month of work can be used.
Note: Allowable deductions in anticipation of work are limited to durable items such as medical devices, prosthesis, work related equipment, residential modifications, non-medical appliances and vehicle modifications, as defined in Section A above. Payments for services and expendable items such as drugs, oxygen, diagnostic procedures, medical supplies, and vehicle operating costs are not deductible for purposes of determining payments in anticipation of work.
For recurring expenses, payments made on a regular periodic basis, on credit and paid in installments, or rental, may be used.
For non-recurring expenses the one time payment may be deducted in one month or over a twelve consecutive month period beginning with the month of payment.
For down payments a separate deduction process is possible which may be prorated for up to a year. The proration may be for a shorter time period if the regular monthly payments are extended over a period of less than twelve months. When this happens, the proration time period for the down payment and duration of the regular monthly payments will be the same.
Example:
Individual begins to work on 3/1/07 and at the same time purchases special equipment which costs $4800, giving $1200 down. The balance of $3600, plus interest of $540.00, is to be repaid in thirty-six installments of $115 per month beginning 4/1/07
$ 1200.00 Down payment 3/07 |
+ $ 1265.00 Monthly payments _____________ |
$ 2465.00 |
÷12 Months |
= $ 205.42 Monthly deduction |
A monthly deduction of $205.42 would be allowed. Beginning 3/08, the deduction changes to the regular monthly payment of $115.00 per month.
Before any payments are used as deductions against SGA, the amounts must be determined reasonable.
Amounts up to the prevailing charges for durable medical equipment, prosthetic devices, medical services, and similar medically-related items and services as set by Medicare will be allowed. If the individual pays more than the prevailing charge allowed under Medicare it will be allowed if he or she can establish that the average is consistent with normal charges within their community.
Example:
Mr. Adams applies for Medicaid based on his disability. His assets are below $2000. His income consists of Social Security benefits of $132.90 gross and part time earnings of $530.00 gross a month.
After determining that the job was not created out of sympathy, a hobby, or part of therapy or Vocational Rehabilitation training, the presence and value of impairment related work expenses must be considered.
Mr. Adams is currently paying for a special shoe made from a mold and which costs $682.00. He has been making $50.00 payments monthly after an initial $100.00 down payment in 3/08 when he also found employment.
Using the policy under down payments, the calculation for the pretest is:
$ 100.00 Down payment + |
$582.00 |
$ 682.00 |
÷ 12Months _______________ |
$ 56.83 Monthly payments over one year |
As an allowable Impairment Related-Work Expense:
$ 530.00 Gross wages |
- $ 56.83 IRWE _______________ |
$ 473.17 Compare to earnings allowable standard. |
(see example to calculate eligibility). |
C.M.R. 10, 144, ch. 332, app 144-332-B