NAELA: Eye on Elder and Special Needs Issues

Eliminating the Medical Expense Deduction Will Harm People Who Are Chronically Ill

By Lauren S. Marinaro, Esq.

House Republicans have introduced their plan to reform the tax code. The legislation calls for ending the medical expense deduction (MED). NAELA anticipates this proposed change will cause major disruption to individuals and families trying to pay for the catastrophic costs of long-term services and supports (LTSS).

The MED has been in the tax code in one form or another since 1942. Elder law attorneys are intimately familiar with it because they have a front-row seat to their elderly clients’ chronic illnesses and long-term care expenditures as well as the special medical and remedial care expenses of individuals with disabilities. In my work as an elder law attorney, I deal with this tax deduction every single day, usually to reassure my clients that they will probably not have to worry about the tax consequences of paying for long-term care (LTC) themselves.

Right now, the MED is used for a variety of expenditures and situations. Taxpayers can deduct medical expenses in excess of 10 percent of their Adjusted Gross Income for the 2017 tax year. The MED can be used when people are:

- Trying to afford their health insurance premiums, co-pays, and deductibles
- Paying for the cost of childbirth and post-natal care
- Paying for their own LTC or the LTC of a dependent child, parent, or other relative
- Paying for assisted living
- Paying a Medicaid cost share to a facility
- Using pre-tax accounts for catastrophic medical expenses when they have no insurance or insufficient insurance coverage
- Paying for home accessibility for disabling conditions
- Paying for dental work, which is critical to long-term health
- Paying for toxic lead or mold remediation
- Paying for drug abuse rehabilitation for their dependent relative
- Paying for additional ABA for a child on the autism spectrum

Our current LTSS system is driven by Medicaid, a means-tested program, and it sometimes acts as a disincentive for the middle and working class to save. Perversely, many middle- and working-class individuals who develop a chronic illness would have been better off had they not saved at all, thereby allowing them to qualify immediately for Medicaid. Clients express this frustration to us all the time. The MED acts as a key counterweight to that disincentive by substantially expanding the length of time someone could pay privately before needing government assistance.

The Republican Tax Reform plan takes this important tax incentive away without any appropriate justification other than tax code simplification. Elder and special needs law attorneys are leading the way in educating and persuading stakeholders and the larger public to work as hard to fight back against removing the MED.

Here's how you can help:


- Call your representative - Look up the direct office number in the House of Representatives Directory.
- Post this or your own thoughts on social media.
- Warn others in your local community organizations.

Read more about the Medical Expense Deduction for the Chronically Ill.

About the Author

Lauren S. Marinaro, Esq., practices elder and special needs law in Clark, New Jersey. She is a member of NAELA’s Public Policy Steering Committee and Litigation Committee.

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