Are Medical Expenses Tax Deductible in California?

Yes, medical expenses are tax deductible in California, but with two important limits: you can only deduct the portion of your unreimbursed medical and dental costs that exceeds 7.5% of your federal adjusted gross income, and you have to itemize on your California return instead of taking the standard deduction.¹ For most Californians, that combination means the deduction only pays off in a year with substantial medical spending or when other itemized deductions push the total above the standard deduction.

How the 7.5% Threshold Works

California uses your federal AGI, not your California-adjusted income, to calculate the floor.¹ The math is straightforward: add every qualifying medical expense you paid during the year, subtract any insurance reimbursements, then subtract 7.5% of your federal AGI. What’s left is your deduction.

Say your federal AGI is $60,000 and you paid $8,000 in unreimbursed medical costs. Your threshold is $4,500, and your deduction is $3,500. If your medical spending doesn’t clear the 7.5% floor, you get nothing. The threshold is the same regardless of age or filing status.

What Counts as a Qualifying Medical Expense

California incorporates the federal definition of deductible medical expenses through Revenue and Taxation Code Section 17201.² Any expense primarily aimed at diagnosing, treating, or preventing a physical or mental condition generally qualifies, and the scope is wider than most people assume.

Qualifying costs include payments to doctors, dentists, surgeons, chiropractors, psychiatrists, and psychologists; prescription medications and insulin; diagnostic tests, lab work, and X-rays; and medical equipment like eyeglasses, contact lenses, hearing aids, wheelchairs, and prosthetic limbs.³ Inpatient hospital and residential treatment costs, including meals and lodging during the stay, also count. These deductions extend to expenses you pay for a spouse or qualifying dependent.

A few less obvious categories worth knowing:

Service animals trained to assist with a disability: buying, training, feeding, grooming, and veterinary care are all deductible. Emotional support animals without specific disability-related training don’t qualify.⁴
Home modifications for a medical condition, such as entrance ramps, widened doorways, and grab bars. If the modification doesn’t increase home value, you deduct the full cost; if it does (an elevator, for example), you deduct only the amount by which the cost exceeds the added value.³
Nursing home costs, fully deductible when the person is there primarily for medical care. When the stay is mainly custodial, only the medical portion of the bill qualifies. Qualified long-term care insurance premiums are also deductible up to an age-based annual cap.⁵
Weight-loss programs, nutritional counseling, and even gym memberships, but only when a physician has diagnosed a specific condition (obesity, diabetes, hypertension, heart disease) and prescribed the program as treatment.⁶
Medical travel, including mileage on your personal vehicle, parking, tolls, bus fare, and ambulance costs. The 2026 IRS standard mileage rate for medical travel is 20.5 cents per mile. Lodging while traveling for medical care is deductible up to $50 per night per person, but meals during travel are not.⁷

Every expense has to be paid during the tax year you’re claiming it, regardless of when the treatment happened.

What Doesn’t Count

The line between medical treatment and general health maintenance is firm. Vitamins, supplements, and hygiene products like toothpaste are not deductible, even on a doctor’s recommendation. Over-the-counter medications don’t qualify unless a physician specifically prescribes them for a diagnosed condition.³

Cosmetic surgery is excluded unless it corrects a deformity from a congenital abnormality, an accidental injury, or a disfiguring disease. Teeth whitening, cosmetic liposuction, and facelifts all fail that test. General-fitness gym memberships are nondeductible.

You also can’t deduct any expense that an insurer, employer health plan, or legal settlement reimbursed. Only your actual out-of-pocket spending counts.⁸ If you receive a reimbursement in a later year for an expense you already deducted, you may need to report that reimbursement as income.

Two California Differences From the Federal Rules

HSAs Are Not Tax-Favored in California

California does not conform to the federal Health Savings Account rules. Contributions to an HSA are not deductible on your state return, employer contributions must be added back to your California taxable income, and investment earnings inside the account are taxable by the state.⁹

There is one benefit to that mismatch for itemizers. Because California treats HSA distributions as coming from after-tax dollars, medical expenses paid with HSA funds are not considered “reimbursed” for California purposes. You can include those expenses in your California medical deduction on Schedule CA (540) even though you couldn’t include them federally.¹⁰ The Schedule CA instructions direct you to enter qualified HSA-paid expenses exceeding 7.5% of federal AGI as an addition on Line 4, Column C.

Self-Employed Health Insurance Treatment

Federally, self-employed individuals get an above-the-line deduction for health insurance premiums covering themselves, a spouse, dependents, and children under 27, with no itemizing required.¹¹ California generally allows the same treatment, but workers classified as independent contractors federally and as employees under California law can’t claim the above-the-line deduction on their state return. They instead include those premiums as medical expenses on Schedule CA (540), subject to the 7.5% floor.¹⁰ It’s a worse deal than the federal treatment, but better than losing the deduction entirely.

Will Itemizing Actually Help You?

The medical deduction only matters if your total California itemized deductions beat the state’s standard deduction. For the 2025 tax year, California’s standard deduction is $5,706 for single filers and those married filing separately, and $11,412 for married couples filing jointly, heads of household, and qualifying surviving spouses.¹ The 2026 amounts will likely rise slightly with inflation adjustments.

Medical expenses alone rarely clear the standard deduction once the 7.5% floor takes its bite. The deduction usually pays off when you combine it with meaningful state and local tax deductions, mortgage interest, or charitable contributions. Because California doesn’t conform to all federal itemized deduction rules, your California itemized total may differ from your federal total. You might take the standard deduction federally and still benefit from itemizing in California, or the reverse. Run the numbers both ways before committing.

Claiming the Deduction on Your California Return

The deduction flows through Schedule CA (540), where California adjusts your federal itemized deductions for state purposes.¹² In Part II, report your total medical and dental expenses on Line 1, your federal AGI on Line 2, 7.5% of that AGI on Line 3, and the difference on Line 4. If your California-allowed deduction differs from the federal amount because of HSA-paid expenses or reclassified self-employed health insurance premiums, enter the difference in Column B or Column C.¹⁰

The completed Schedule CA attaches to your Form 540, and the final itemized deduction amount carries to Line 18 of Form 540.¹² The California filing deadline for 2025 returns is April 15, 2026, with an automatic extension to October 15 for filing, though any tax owed is still due by April 15.¹³

Records to Keep

Hold on to every receipt, explanation of benefits statement, and reimbursement record. If you’re deducting medical travel at the standard mileage rate, keep a log. The IRS requires records supporting a deduction for at least three years from the filing date, and six years if you underreported income by more than 25% of gross income.¹⁴ The Franchise Tax Board can audit returns within similar timeframes, so four years from filing is a safe retention period.

Grouping expenses by category and tracking a running total through the year has a practical benefit. If you can see by October that you’re going to clear the 7.5% floor, you can time elective procedures or major equipment purchases into the same tax year and get more of your spending above the threshold.

1
Franchise Tax Board. Deductions
2
California Legislative Information. California Revenue and Taxation Code 17201
3
Internal Revenue Service. Publication 502, Medical and Dental Expenses
4
Internal Revenue Service. Fact Sheet for Service Animals for Taxpayers with Disabilities
5
Internal Revenue Service. Medical, Nursing Home, Special Care Expenses
6
Internal Revenue Service. Frequently Asked Questions About Medical Expenses Related to Nutrition, Wellness and General Health
7
Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents
8
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
9
Franchise Tax Board. Bill Analysis, AB 781 – Health Savings Account Deduction Conformity
10
State of California Franchise Tax Board. 2025 Instructions for Schedule CA (540)
11
Internal Revenue Service. Instructions for Form 7206
12
Franchise Tax Board. 2025 Schedule CA (540) California Adjustments – Residents
13
Franchise Tax Board. Due Dates: Personal
14
Internal Revenue Service. Topic No. 305, Recordkeeping