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HUD rent and medical expenses
Last updated: 22 September 2026
If you live in HUD-assisted housing, higher out-of-pocket medical costs can sometimes lower the income HUD uses to calculate your rent. The rule is not automatic, and the answer can differ by housing program because HUD is still finishing the Housing Opportunity Through Modernization Act (HOTMA) transition.
Bottom Line
If you are in an elderly or disabled family under a covered HUD program, eligible unreimbursed health and medical expenses may reduce your adjusted income. That can reduce tenant rent or your voucher family share. Start by asking your housing office which rent rules it is using, then make a written request and submit proof of your costs.
Do not assume the new 10% HOTMA threshold already applies to you. In September 2026, some agencies and properties are still using pre-HOTMA calculations while others have started HOTMA. HUD’s HOTMA resources and your local written policy control the next step.
Need Help Right Now?
If you have a rent notice, a termination notice, or an eviction court date, do not wait for the next annual review. Give the housing office a written request now, keep a copy, and ask for every deadline in writing. If you also need emergency money or housing help, use the GFS emergency help guide.
Start Here
- Identify your program. Ask whether you have public housing, a Housing Choice Voucher, a project-based voucher, project-based Section 8, Section 202, Section 811, or another subsidy.
- Ask which rule applies. Say, “Is my rent calculation using HOTMA now, or the older rules?” Ask for the written policy or calculation sheet.
- Request a review in writing. Explain that your income fell, your unreimbursed medical costs increased, or both. Attach the strongest proof you already have.
Quick Reference
| Your housing | First contact | What to request | Important point |
|---|---|---|---|
| Public housing | Local public housing agency (PHA) | Interim reexamination | Ask whether HOTMA is already in use for your effective date. |
| Housing Choice Voucher | Voucher worker or PHA | Family-share recalculation | A deduction may change your share without changing the landlord’s contract rent. |
| Project-based voucher | PHA or property office | Interim reexamination | Ask which office actually processes income changes for your unit. |
| Project-based Section 8, Section 202, or Section 811 | Property manager or owner | Interim recertification | HUD Multifamily’s full HOTMA deadline is January 1, 2027. |
Not sure what program you have? Check your lease and rent notice, ask the manager for the subsidy name, or use the HUD Resource Locator. A tax-credit-only apartment may have income limits but may not use HUD’s medical-expense rent deduction.
What Has Changed
The biggest 2026 change is the approaching HOTMA compliance deadline. HUD’s May 2026 PHA notice says most non-Moving-to-Work PHAs and PHAs not using HUD’s Family Reporting Software must make transactions effective January 1, 2027, or later fully HOTMA-compliant. PHAs that begin annual reviews 120 days early may need to start using HOTMA policies in September 2026 for January 2027 effective dates.
HUD also issued an April 2026 interim notice requiring an interim reexamination when household members are added or removed, subject to a limited last-three-month policy exception. For this medical-cost guide, the practical lesson is simple: ask which rules apply to your effective date, not just what rules appear on a general HUD page.
Who Can Use This Guide
This guide is for older adults and helpers dealing with rent calculations in HUD-assisted housing. It is most relevant to public housing, Housing Choice Vouchers, project-based vouchers, and many HUD Multifamily programs, including project-based Section 8 and certain Section 202 and Section 811 properties.
The health and medical care expense deduction is tied to HUD’s definition of an elderly or disabled family. It is not a general deduction for every renter with a medical bill. If you are unsure whether your household is treated as an elderly or disabled family, ask the PHA or property manager to identify the rule used in your rent calculation.
If you are still searching for subsidized housing, this page is not the best first stop. Use the GFS income-based apartments guide or senior housing guide to compare housing types first.
How Medical Costs Can Lower HUD Rent
HUD rent formulas often use adjusted income, not only gross income. The current adjusted income rule allows an elderly or disabled family to deduct eligible unreimbursed health and medical care expenses, but only the amount above the applicable threshold.
Under full HOTMA rules, the normal threshold is 10% of annual income. A family that qualifies for phase-in relief can use 5% for the first 12 months of that relief, then 7.5% for the next 12 months, before reaching 10%. A separate general hardship rule can temporarily use a 5% threshold when the family meets HUD’s hardship conditions.
Some properties and PHAs are not yet using all HOTMA rules in September 2026. HUD’s Multifamily HOTMA page says Multifamily owners must be fully compliant for certifications effective January 1, 2027, or later, although earlier adoption is allowed. The PHA deadline also moves most covered PHA transactions to full HOTMA compliance on January 1, 2027.
For programs already applying HOTMA, HUD’s 2026 adjusted values set the mandatory elderly or disabled family deduction at $550. HUD warns that these inflation-adjusted values are not used by an agency or property that has not yet begun complying with HOTMA Sections 102 and 104.
| Rule example | Threshold on $16,000 income | $2,400 eligible costs | Rough rent effect |
|---|---|---|---|
| Older 3% rule | $480 | $1,920 above threshold | About $48 less monthly |
| 5% relief threshold | $800 | $1,600 above threshold | About $40 less monthly |
| 7.5% phase-in | $1,200 | $1,200 above threshold | About $30 less monthly |
| 10% HOTMA rule | $1,600 | $800 above threshold | About $20 less monthly |
Example only: The rough rent effect uses 30% of monthly adjusted income. Voucher and project formulas can produce a different result. Ask for the actual worksheet used in your case.
Hardship Relief Can Matter
Under HOTMA, a family may be able to request general hardship relief when health and medical expenses increase, or another qualifying change creates financial hardship but would not otherwise trigger an interim review. The HUD implementation guidance says eligible hardship relief uses expenses above 5% of annual income.
General hardship relief normally ends after 90 days or when the hardship ends, whichever comes first. The responsible PHA or owner may extend it for additional 90-day periods while the hardship continues. Ask for the property’s written hardship policy because the office must define how it decides whether a family cannot pay rent.
What Medical Costs May Count
Start with costs you paid or are expected to pay yourself. HUD defines health and medical care expenses broadly around diagnosis, cure, mitigation, treatment, or prevention of disease, and treatments affecting a body structure or function. Medical insurance premiums and long-term care premiums can be included when they meet HUD’s rules.
Common items older adults may submit include Medicare premiums, Part D premiums, Medigap or Medicare Advantage premiums, prescription costs, copays, coinsurance, deductibles, dental bills, vision bills, hearing expenses, hospital balances, and certain long-term care premiums. Only the unreimbursed part matters. If Medicare, Medicaid, the Department of Veterans Affairs, private insurance, a charity, or another payer covers a cost, that paid amount cannot also be deducted.
HUD’s rules are not identical to tax rules. The IRS medical guide can help identify records, but HUD specifically says a housing office should not simply use IRS Publication 502 as the final list of eligible HUD expenses. Ask the housing office to decide an unusual item under HUD’s rule.
| Expense | Strong proof | Common problem |
|---|---|---|
| Medicare or insurance premiums | Benefit letter, premium notice, or bank draft | Only sending an insurance card |
| Prescriptions | Pharmacy year-to-date printout | Using retail price instead of patient cost |
| Copays and coinsurance | Itemized bill plus explanation of benefits | Bill does not show insurance payment |
| Dental, vision, hearing | Provider bill and receipt | No proof that you paid or still owe it |
| Ongoing payment plan | Current balance, plan terms, and payment proof | Old bill with no current obligation shown |
If medical costs are creating problems beyond rent, the GFS medical bill help guide covers other places to ask for assistance.
How to Ask for an Interim Review
A mid-year rent review may be called an interim reexamination, interim recertification, or simply an interim. The office name and process depend on your program.
Under HOTMA, a family may report changes at any time, but a PHA or Multifamily owner may decline a full interim reexamination when it estimates the decrease in annual adjusted income is less than 10%, unless HUD or the local written policy sets a lower threshold. Higher medical deductions can count toward the decrease in adjusted income. If the change is too small for an interim, ask whether the hardship rule or a lower local threshold applies.
- Write the request. State that you want an interim rent review because your adjusted income may have fallen.
- Name the change. List higher unreimbursed medical costs, lower income, a household change, or each change that applies.
- Attach proof. Send the strongest documents you have now. Ask what else is required.
- Ask for the math. Request the medical threshold, adjusted-income calculation, and effective date in writing.
- Keep delivery proof. Save a date-stamped copy, upload receipt, fax report, email, or tracked-mail record.
- Read the decision. Check the effective date, rent amount, calculation, and appeal or grievance instructions.
Under the HOTMA final-rule framework, a timely reported decrease can generally take effect on the first day of the month after the change that caused the interim review. Late reporting can change how far back a decrease is applied, and local written policy matters. Do not rely on a verbal promise about the effective date.
Sample Written Request
“I am requesting an interim recertification or reexamination of my rent. My household’s adjusted income may have decreased because of higher unreimbursed medical costs, lower income, or both. Please tell me which rent rules and medical-expense threshold apply to my effective date. I am enclosing the documents I have now. Please give me any additional document list, the calculation, the effective date, and my appeal or grievance rights in writing.”
Documents to Gather
Use copies unless the office clearly requires an original. A well-organized packet can prevent repeat trips. The GFS documents checklist can help with a broader benefits file.
- Written interim request or agency form
- Current rent notice and last recertification papers
- Social Security, pension, wage, or benefit letters
- Proof of income loss or reduced hours, if relevant
- Medicare and other insurance premium proof
- Pharmacy year-to-date out-of-pocket report
- Medical, dental, hearing, vision, or hospital bills
- Explanations of benefits showing patient responsibility
- Receipts, bank records, canceled checks, or card statements
- Long-term care insurance premium notice, if relevant
- Payment-plan papers for continuing medical balances
- Signed release if a helper will speak for you
- A complete copy of everything submitted
Phone Scripts You Can Use
Housing office
“I need to request an interim rent review because my income went down, my unreimbursed medical costs went up, or both. Which rule set applies to me now, and what proof do you need? Please give me the answer and deadline in writing.”
Pharmacy
“I need proof of what I personally paid for prescriptions. Can you print a year-to-date report that shows my out-of-pocket cost rather than the retail price?”
Insurance plan
“I need proof of my premiums and the amounts I paid for copays, coinsurance, and deductibles. Can you send an itemized statement for the period my housing office is reviewing?”
Delayed request
“I submitted my written rent review request on [date]. Please tell me what is missing, who is handling it, when I should expect a written decision, and how I can appeal or file a grievance if it is denied or not processed.”
Reality Checks
- Medical bills do not automatically reduce rent. The household must be eligible for the deduction, the expense must qualify, and the amount must clear the applicable threshold.
- HOTMA timing is uneven. Two tenants in different programs can have different calculations during the 2026 transition.
- Small changes may not trigger an interim. Under HOTMA, the normal decrease threshold is 10% of annual adjusted income unless a lower rule or hardship path applies.
- Proof matters. A bill that does not show what you paid or still owe can slow the review.
- A voucher has two rent numbers. Ask about your family share, not only the landlord’s contract rent.
Common Mistakes to Avoid
- Calling but never making a written request
- Assuming every HUD property uses the same HOTMA date
- Using the full retail price of prescriptions instead of your out-of-pocket cost
- Forgetting Medicare premiums withheld from Social Security
- Submitting bills without proof of insurance payments or reimbursements
- Ignoring a written deadline because a worker said the case was “being reviewed”
- Stopping rent payments without getting housing or legal advice first
Denied, Delayed, or Overwhelmed
First, ask for the decision and calculation in writing. A denial may be caused by missing proof, a cost the office says is not eligible, a threshold that was not met, or a disagreement about which rules apply.
For public housing or voucher questions, use HUD’s PHA contact directory or call the PIH Information Resource Center at 1-800-955-2232. For HUD-assisted Multifamily housing, the Multifamily complaint line is 1-800-685-8470.
If you believe disability discrimination, retaliation, or another fair-housing issue is involved, use HUD’s fair housing complaint route or call 1-800-669-9777. A fair-housing complaint is separate from an ordinary disagreement about rent math.
Backup Help if Rent Is Still Too High
A corrected HUD rent calculation may help, but it may not solve every housing problem. If the rent is still unaffordable, check other routes at the same time. If home care is also a separate budget problem, readers in Kentucky can use the GFS Kentucky home care guide, readers in Arkansas can use the Arkansas home care guide, and readers in Delaware can use the Delaware home care guide.
- Broader rent help: Use the GFS rent assistance guide for other subsidy and emergency paths.
- Housing navigation: The GFS rent help finder can point you toward options based on your problem.
- Voucher delays: See Section 8 wait times if you are also trying to get a voucher or move to another program.
- Voucher preparation: Use these Section 8 strategies to avoid common paperwork problems.
- Local aging help: Find aging-network contacts with the GFS Area Agencies guide or the federal Eldercare Locator.
- Housing counseling: HUD’s housing counseling program can help renters find a participating counselor. HUD lists 1-800-569-4287 for locating an agency.
Resumen en Español
Si una persona mayor vive en una vivienda asistida por HUD, algunos gastos médicos no reembolsados pueden reducir el ingreso ajustado usado para calcular el alquiler. Esto no ocurre automáticamente. Primero pregunte qué reglas usa su oficina: HOTMA o las reglas anteriores.
Con HOTMA, el límite normal es 10% del ingreso anual antes de que ciertos gastos médicos sean deducibles. Algunas familias pueden tener una transición de 5% y 7.5%, o ayuda temporal por dificultad económica. Entregue la solicitud por escrito y guarde una copia.
Prepare comprobantes de primas de Medicare, recetas, copagos, facturas médicas y pagos no reembolsados. Si la oficina niega o demora el cambio, pida la razón, el cálculo y las instrucciones de apelación por escrito.
Frequently Asked Questions
Can medical costs really lower HUD rent?
Yes, for an eligible elderly or disabled family in a covered HUD program. Eligible unreimbursed health and medical expenses can reduce adjusted income once they exceed the threshold that applies to the household. A lower adjusted income can reduce tenant rent or a voucher family’s share.
Is the medical threshold 3% or 10%?
It depends on which rules your housing program is using. Full HOTMA uses a 10% threshold, with 5% and 7.5% phase-in relief for some families and a 5% general hardship threshold when the household qualifies. Some agencies and properties may still be using older rules during the 2026 transition.
Do Medicare premiums count?
They can. HUD includes medical insurance premiums among health and medical care expenses when the household qualifies for the deduction and the cost is not reimbursed. Submit proof of the premium amount, including amounts withheld from Social Security when applicable.
Do all medical bills count?
No. The expense must meet HUD’s definition, be unreimbursed, and be documented. Ask for an item-by-item decision if the housing office questions an unusual cost.
What if my change is too small?
Ask for the adjusted-income calculation in writing. Under HOTMA, a full interim review generally uses a 10% decrease threshold unless HUD or the local policy sets a lower threshold. Also ask whether the health and medical hardship rule applies.
Can a caregiver handle the paperwork?
Often yes, but the housing office may require the tenant’s signed release, an approved representative form, or another document before discussing private case information. Ask what form the office accepts.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 22 September 2026 · Next review: 22 January 2027
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