What Counts as a Medical Expense for Housing?

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Art: Robin Mead

Every housing program sets its own rules on which medical expenses count and which do not. You can ask for a copy of the policy from your housing worker.

So far, all programs we have seen have used one of these documents as their policy:

The examples below come from the HUD policy of examples of medical expenses.


Health Care

🌸 Visits with a recognized health professional (doctor, nurse, dentist, optician, mental health, chiropractor, acupuncture, etc)

🌸 Medical services (surgeries, clinics, facilities, hospitals, etc)

🌸 Alcohol and drug treatment

🌸 Prescription medicine

🌸 Health insurance premiums

🌸 You can show your visits to health professionals in the last 12 months as a way to project anticipated expenses in the upcoming year. Or you can get a doctor’s letter estimating needed treatments in the upcoming year.

🌸 Warning; Medical marijuana is considered illegal by HUD Medical Marijuana in HUD Housing


Transportation

🌸 Transportation to doctors, treatments and pharmacies

🌸 Travel for treatment in other areas, including lodging

🌸 Actual cost of transportation and lodging or

🌸 IRS mileage rate for driving

🌸 Keep a log of your medical travel, number of trips and miles per trip.


Medical Equipment and Supplies

🌸 Eyeglasses and contact lenses

🌸 Hearing aid and batteries

🌸 Walkers and wheelchairs and other devices

🌸 Other needed equipment: Braille books and magazines, oxygen, artificial limbs, etc.


Emotional Support Animals and Service Animals

🌸 If you have a service animal, you can include their expenses as part of your medical expenses.

🌸 Some of our readers have also had success in making requests for expenses for emotional support animals. Sample Letter for Emotional Support Animal Medical Expense Deduction


Attendent Care

🌸 Includes salary for nursing care

🌸 Salary for attendant care – HUD does not specify what is included in this, but does specify “Do not include in medical expenses the cost of household help, even if such help is recommended by a doctor.”

🌸 Tip: If you you are having difficulty getting your attendant care covered under medical expense deductions, there may be a different way it can be deducted. If you or someone else in the household works: Disability Assistance Expenses Deductions. These rules are more flexible and the HUD occupancy handbook states that for this program: “Attendant care includes but is not limited to reasonable expenses for home medical care, nursing services, housekeeping and errand services, interpreters for hearing-impaired, and readers for persons with visual disabilities.”


Medical Bills

🌸 Scheduled payments (if you set up a payment plan). However, you may have better options. Take a look here: How to Deal with Debt & Disability


Vitamins, Herbs, Supplements, Over-the-Counter Items

These items should be “recommended in writing by a medical practitioner licensed in the locality where practicing. These items must be recommended as treatment for a specific medical condition diagnosed by a physician or other health care provider licensed to make a diagnosis in the locality where practicing. Otherwise, these items are taken to maintain ordinary good health, and are not for medical care.”

🌸 Over-the-counter medications (aspirin, anti-histamine, ear wash, eye drops, antacids, almost anything you buy at a pharmacy)

🌸 Supplements, herbs, vitamins, natural medicines


Personal Use Items

🌸 Personal use item that is used to “prevent or alleviate a physical or mental defect or illness”

🌸 There is not a specific description of what this means. The example HUD gives is: the cost of a wig purchased upon the advice of a physician for the mental health of a patient who has lost all of his or her hair from disease.


Stuff Needed By Other People You Live With

This rule is strange. But true.

If Head of Household, is elderly or disabled EVERYONE WHO LIVES THERE can deduct medical expenses.

On the other hand, if the Head of Household is not elderly or disabled, NO ONE WHO LIVES THERE can deduct medical expenses. Not even disabled kids!

Who Gets Medical Expense Deductions? (Tip: Not Who You Think!)


One Time Expenses that Won’t Happen Again

Some of our readers report that their housing worker rejected their medical expenses because they were one-time events – not ongoing or anticipated in upcoming year. HUD regulations disagree!

From https://www.hud.gov/sites/documents/DOC_35649.PDF:

“In addition to anticipated expenses, past one-time nonrecurring medical expenses that have been paid in full may be included in the calculation of the medical expense deduction **for current tenants at an initial, interim or annual recertification. Past one-time nonrecurring medical expenses that have been paid in full are not applicable when calculating anticipated medical expenses at move-in.** If the tenant is under a payment plan, the expense would be counted as anticipated.

“Maria and Gustav Crumpler had a total of $2,932 in medical expenses last year (Year 1). Of this amount, $932 covered Gustav’s gall bladder surgery; $2,000 was for routine costs that are expected to re-occur in the coming year. The entire amount may be included in the Crumpler’s medical costs for the coming year (Year 2) despite the fact that the gall bladder surgery is a past event that is not likely to re-occur.”


Other Types of Expenses

🌸 HUD Exhibit 5-3 also notes: “Any other medically necessary service, apparatus, or medication, as documented by third-party verification.”

🌸 That statement is broad and undefined. Make sure anything use submit comes with a doctor’s statement of “medically neccessary.”

🌸 Pansy had her air filters included as medical expenses after her doctor wrote them down on a prescription pad.

🌸 Other ideas from readers: waterless shampoo, adaptive clothing, bed pans, shower chairs, bed trays, weighted blankets, pressure vests, waterproof mattresses, therapeutic classes, noise canceling headphones, assistive technology (many different types of electronics are considered assistive technology with appropriate medical assessment).

🌸 More ideas! Here is a list of items and services that were approved as disability expenses for people in home care programs in Minnesota.  Examples of Disability Expenses. Examples include: Laundry reimbursement, Lawn Mowing and Snow Removal, Fences, Air purifiers, Water purification system, Air Conditioning Units, etc.

🌸 Yet more ideas! This list is for SNAP Food Stamps but includes some great ideas for housing too. Neroli’s Amazing Guide to Deducting Medical Expenses for SNAP.

🌸 The items above are only consider medical expenses if they are needed for disability-related reasons. For example, a fence can be an important health and safety item for a child with severe developmental disabilities who has a history of wandering away, along with a doctor’s letter verifying the need for a fence. A fence would not be a medical expense if you just want a fence for your house.


What Should I Request? 

🌸 There is no guarantee your Housing Authority will approve all your expenses, however it won’t hurt to submit the request for anything you want.

🌸 If your doctor writes that these things are medically recommended, they may get approved.

🌸 If some of your expenses are rejected, nothing bad happens, you simply don’t get a credit for those items.

🌸 We cannot guarantee which items will be approved and which will not. It depends how nice your housing program is, how flexible their policies are, and how clear your documentation is.

🌸 If your housing worker rejects your medical expense request, and you believe it should be covered according to the HUD documents, you have a right to appeal their decision, if you wish.


Learn More

🌸 Learn all about how medical expense deductions work and how to make the request: Epic Master List of Guides & Letters for Housing (Medical Expense Deductions)

🌸 How to Calculate (and sometimes lower) Rent in Section 8

🌸 Facebook Group: HUD and Section 8 for People with Disabilities

Updated February 2020. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working. If you found this page helpful, please share it with others by pressing one of these magic little buttons: 

37 thoughts on “What Counts as a Medical Expense for Housing?”

  1. Can you use food as an expense? My property manager says HUD does not allow it. But I have all the HUD manuals and HUD actually never addresses it in any manual that I saw. This includes a HUd manual that I have that is 794 pages long. They never said one word about whether its allowed or not. And I know IRS allows food as a deduction as long as it is in treatment of a disease and your doctor prescribes it. I am transferring to project based section 8 and property manager says HUD doesn’t allow it. But noone can show me anything where HUD says its against the rules? what i do see is exhibit 5-3 where it says we can use what the dr prescribes, such a “personal items used for living” or “natural medicines” which would be food. do you guys have any information about this? thank you Xyra

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    1. I’ve never seen food used as a medical expense. The closest I have seen sometimes people have used powders, like a protein powder. Since there are no rules, if you disagree with their decision, you can always appeal and try to make your case.

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    2. If the item is a powdered item, it can be seen as a supplement. Powdered beet juice, etc. Also if you have a medical food item designed to address a condition or deficiency, that would be a good try.
      Of course you have to have the doctors letter or prescription.

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  2. I am a 23 year resident in Public Housing in Oklahoma. Our housing worker is being nit picky about what can and can’t be used as medical deductions not covered by insurance. At first it was incontinence supplies, batteries for hearing aide/blood pressure machine/talking scales/lift chair/……I had to give her the 24 CFR Ex5.3…Then it was the cost of the internet needed for my Caption Call phone. She says I need to find out how much internet is used for the CC Phone because I use internet for other things. In my opion, If I only used the CC phone one time it wouldn’t matter what else the internet was used for. She says I will need to find out how much electricity is used to run my oxygen day and night….Then the BIGGY, I can’t use foods stamps to buy my protein supplement perscribed by my doctor (due to low protein levels) and count it as medical expense. She wants ME to see if I can fine that it can be. SOOOOO……Is there a site I can get this information? I know I can buy Glucerna Protein, and Plant based Nutritional Protein Power with food stamps, but can I use it as a medical expense? Thanks. Susie

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    1. I’m sorry to hear your worker is so difficult. I think the solution is to have a letter or statement from your doctor that this supplement is medically necessary. If your worker still wants to turn it down, let her know that you are requesting her denial in writing and that you intend to appeal her decision. Then go ahead and appeal.

      If you look online at the food stamps regulations, I believe that the classification has to do with the label on the product. If a label says “nutritional facts“ or “supplemental facts“ that might determine whether it is treated as food or supplement. You could try showing her this information plus a copy of the label.

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  3. I simply adore you and your hard work. What is your take on being able to write off the truck payments on a modified truck to haul the wheelchair when the sole purpose of the truck is to transport the disabled passenger? The family has other modes of transportation. Can this expense be written off as out-of-pocket-medical? Thank you in advance for you input.

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    1. Typically, you can write off the modification, but not the truck itself. You may need to research the value of the modification as a standalone. Then you could divide the value of that by the number of payments.

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  4. I’ve just filled out an app for sec8 and was told to send medical expenses, premiums and RX, but not to include the supplements and other things I buy monthly even with a Drs. note. Every state has own rules? These things are allowed for SNAP in Idaho.

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  5. Under the Section 8 program, the upkeep (vet bills, food) of assistance animals (service or email Suppprt animal) are considered a medical expenses when determining rent for an elderly/disabled households (meaning the head, co-head, or spouse of the head of the household is either elderly or is disabled)
    See page 5-49 , 8H.

    Click to access 43503C5HSGH.PDF

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  6. You say ESA medical supplies such asRX food and vet RXs can be written off as housing receipts our of pocket expenses but my housing says no under HUD here . Can you direct me to where my doctor or vet can list these with my over counter expenses too in their respective letter of our of pocket expenses listed for the year ? My ESA cat must have glucose control RX food and insulin I have to pay for now . It’s very common . He’s coming down and hopefully will go off Insulin , but needs the RX food . It’s prescribed by my vet .Thanks .so much SOS 🆘!

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    1. The rules are not set in stone on this one…. but there are some HUD regulations that may be helpful…. this page has info on ESA regs and also medical deduction regs…. hope it helps….

      howtogeton.wordpress.com/sample-disability-accommodation-letters-housing/

      Liked by 1 person

      1. It only makes sense that if my RX letter from doc was accepted because I need him , that the same RX s HE needs should be written . Just like service animals . I understand service animals are a difference in training etc .but BOTH ESA and Service are written as a medical necessity RX form your doctor . We need them to update these vet cost laws . They are both prescribed animals detrimental to your health . It has nothing to do with where they can go as trained service dogs . They need to stop being murky . An RX from your DOC is an RX ! I know you are frustrated with the murkiness too. If my doctor prescribed him , his medical receipts will be sent. DTA and housing need to understand that they are prescriptions not pets .

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          1. Under the Section 8 program, the upkeep (vet bills, food) of assistance animals (service or email Suppprt animal) are considered a medical expenses when determining rent for an elderly/disabled households (meaning the head, co-head, or spouse of the head of the household is either elderly or is disabled)
            See page 5-49 , 8H.

            Click to access 43503C5HSGH.PDF

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            1. My HA says no on emotional support animal deductions. I just spent $400 on my son’s ESA. Talk about a hit to the pocket. Our doctors have done reasonable accommodations for them.

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              1. You can appeal the decision if you wish. You need to first submit the request and ask for a written denial, then you can appeal. There are sample letters on this page that can be used for making requests or appealing. If you send them the right language they may just approve it without needing an appeal

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      1. I have the letter and accommodation also for HUD apt. I think the question is the same as mine , because tax forms address service animals and not ESAs from what I have read .

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        1. If you look at the page above there are also links to info on emotional support animals. HUD does recognize ESAs as assistance animals, and some people use this rule to also get them included as medical expense deductions… hope this helps.

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    1. For the section program, only the amount of the expenses the are in excess of 3% of household income are used as the allowable expense. The regulation regarding this requirement can be found at 24 CFR 5.611 (a)(3)

      https://www.law.cornell.edu/cfr/text/24/5.611

      It’s important to note that HUD has issued a Proposed Rule to implement provisions passed in the the Housing Opportunities through Modernization Act that will increase the percentage from 3% to 10%. If the proposed is made final this year, this change will go into effect 1/1/21. This change will result in an increase the rent for households claiming medical expenses.

      https://www.federalregister.gov/documents/2019/09/17/2019-19774/housing-opportunity-through-modernization-act-of-2016-implementation-of-sections-102-103-and-104

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  7. My local Housing Authority said that they are now using IRS 502 as a criteria for medical expenses. In the past, I have asked my physician to write a letter listing items and say they are prescribed to treat medical conditions, without listing any specific diagnosis or a diagnosis for each item. Elsewhere I have seem stated that specific diagnoses need to be used. Is this true?
    Also can I include essential oil diffusers if my doctor signs off? I bought them to remediate mold in my environment.

    Liked by 1 person

    1. Hi Sandra,

      different housing authorities handle medical expense deductions in different ways. Many of them are using the IRS regulations as their guide.

      My understanding is that both hud and the IRS include a statement that for supplements and vitamins it needs to be prescribed for a specific medical condition not for general health.

      It doesn’t say that your doctor needs to disclose what your diagnosis or condition is.

      Some Housing Authority’s are not requiring this specific language, but others may Require that the doctor has written that it is for a specific medical condition or diagnosis.

      I cannot guarantee if they will approve your essential oil’s diagnosis a diffuser, but if you’d like to submit it, it might be helpful if your doctor writes the words “medically necessary” and you can enclose a copy of the HUD examples policy that is linked to above and point out this line: “Or any other medically necessary service, apparatus, or medication, as documented by third-party verification.”

      Liked by 1 person

  8. I’m $97 short for being approved for a choice voucher , what would I be able to use to cover the $97 to be approved

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        1. Hi Kevin,

          The link below includes some information on excluded income. I do know whether you can use medical deductions to bring your income down for the purposes of eligibility, but there are some other types of income that do not count, so you can look to see if there’s anything you were counting that should not be counted or any other deductions.

          If your countable income truly is above the limit, in most cases section 8 may not be very helpful to you anyway, because the amount you pay is based on income.

          I hope it goes well for you.

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  9. You mentioned a form a doctor can fill out so I can try to deduct medical expenses while waiting for my SSI approval, do you know what search term I would use to find this? I’m in NV

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    1. Good question. Some housing authorities may have a form for verifying you are disabled.

      Or your doctor can simply write one and sign one sentence stating that you meet the HUD definition of disabled.

      Your doctor can also list any medically-necessary items (vitamins, herbs, supplements, supplies, equipment, etc)

      Like

    2. Hi, I love your blog. I live in housing and just got approved with my medical provider for an emotional support animal . I cannot find anywhere .. the literature to cover RX costs for hid special diet from vet etc . Plus RX vet expenses . Can you help with a link on ESA ? They all refer to “service animals . “ even tough I have been prescribed an ESA ???
      MC

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    1. From what I have seen, you can include the mileage for driving to doctors using the IRS mileage rate. Keep a log of how many miles you drive to each appointment.

      If your car has any modifications (like a wheelchair lift) the cost of the modification might also be a medical expenses.

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  10. I am always telling people that this blog has really incredible information that can be instrumental in helping you with disability, how to’s, and where to go for…. type stuff.

    Liked by 1 person

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