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You may be eligible for help with medical costs under "spend-down Medicaid."

Medicaid helps those who are aged, blind or disabled and who have low income and resources. If you have high health care costs, you may have little monthly income left after paying for doctors and medicine. Spend-down Medicaid may help.

The spend-down amount is what you must "spend" on medical expenses to become eligible for a Medicaid card. The amount is set by the Department of Job and Family Services. After that amount is incurred in a month, a Medicaid card will be issued to cover the rest of your medical expenses for that month.

There are three types of spend-down:

1.) You are eligible for ‘on-going spend-down’ if you have health care expenses that are more than your spend-down amount every single month. You will receive a Medicaid card automatically every month.

2.) You will be eligible for ‘delayed spend-down’ if your expenses are different every month. You may meet the expenses one month but not the next. In this case, you only receive the Medicaid card after incurring medical expenses that are more than the spend-down amount. You will need to prove your expenses every month.

3.) You can meet your spend-down amount through ‘pay-in spend-down.’ You pay the amount of your spend-down to the DJFS every month. You are then issued a Medicaid card for the rest of the month.

The Department of Human Services needs to see current statements or bills (even from a collection agency). The bills can be ones that you have already paid or ones that you still need to pay. You can use older bills to meet the spend-down amount. Older bills are added up and then divided by the spend-down amount. The result is the number of months for which the spend-down is covered.

You may be able to use the medical bills of family members who are your dependents to meet your spend-down amount. The expenses must be for medically necessary services but can include medical insurance premiums and co-pays.

 

For more information see CLAS’ other fact sheets:

SPEND-DOWN ELIGIBILITY: Meeting your monthly spend-down

 

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-F179-CLAS

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