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Spend-Down Eligibility: Meeting your monthly spend-downPrintE-mailPDF

You are on "delayed" spend-down Medicaid eligibility.  Your income is above the need standard.  Your medical expenses may be different each month.  To receive a Medicaid card, you must "meet your spend-down amount."  As soon as you meet your spend-down you can have a Medicaid card for the rest of the month.  So the earlier you meet your spend-down for the month, the better.

HOW DO YOU MEET YOUR SPEND-DOWN?
Spend-down is met by showing the Department of Job and Family Services that your medical expenses for a month are more than the ‘medically needy level.’  Your caseworker will tell you the exact amount.  There are many types of medical expenses.

  • Medical insurance premiums count as an expense.  Medicare Part A and B premiums or supplemental insurance count as expenses. 
  • Current doctor visits and prescription medicines also count.  Make sure you schedule doctor visits for the first part of the month so that you can use the bill toward your spend-down.  You don't need to pay these bills, you just need to "incur" them.
  • Past medical expenses count.  These are bills before you had Medicaid, in a month where you did not meet your spend-down, or non-Medicaid covered services.  You must, in most cases, still be held responsible for these expenses.

There are a few other types of past due medical bills that can be used but you may need special help to get them recognized. 

NOW THAT I HAVE THESE BILLS, WHAT DO I DO?

  1. Make sure your Medicare premiums and supplemental insurance were counted when figuring your spend-down;
  2. Take this month's bills to the spend-down unit as soon as possible; and
  3. Take current statements showing past due bills.  The date of service must be on the bill. 

Collection notices can also be used as proof of past medical expenses.  If you have past medical expenses that are more than one month's spend-down, your caseworker can help you establish an "ongoing spend-down" based on those past due bills.

 

This article is meant to give you general information and not to give you specific legal advice.
Prepared by Community Legal Aid Services, Inc. Updated April, 2012. CE-51-F178-CLAS

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