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My client lives in a Rehab Center and unable to manage financial affairs - has a court appointed guardian. He receives a sizable pension from NYC plus Social Security. It appears he will be paying all of his income towards his medical care and housing. Is it necessary to file a tax return?
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If the pension and SS are enough income to create a filing requirement, yes.
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How would the government know that he pays so much for medical care? All they see are his pension 1099-R and SSA 1099.
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Patients are in a rehab center to be rehabilitated and then discharged. If they are permanently disabled, they go somewhere else. If they need help managing their financial affairs, that's not necessarily a medical expense. Way too little information here to figure out what's going on. But in any case, a return must be filed (unless, of course, that NYS pension is a form of workers compensation).