Public Assistance Division 

Medicaid Spend-down Overview

What is a Medicaid spend-down? A spend-down is a dollar amount that is figured to help you qualify for Medicaid. If your income is more than the amount the government allows in order to receive Medicaid, you can “spend down” to that level and qualify for assistance. A spend-down amount can either be paid directly to Holmes County Job and Family Services, or you can use certain expenses to meet the spend-down.

Who is eligible for spend-down? You may qualify for spend-down if you meet Medicaid eligibility guidelines (other than your income is too high) and you are an adult who is either 65 years old or older, disabled, or legally blind.

How is a spend-down amount determined? Spend-down amounts are based on a formula that considers your monthly income and medical expenses, and compares the income to pre-determined amounts called income disregard and the Medicaid Need Standard. Your case worker will explain these in greater detail.  

Here’s an example: Sarah is 65 years old and applies for Medicaid. She receives Social Security of $600 per month, and has medical expenses of $200 per month. Her spend-down would be figured like this:

$ 600 Social Security income

-$ 20 Income disregard

-$ 556 Medicaid Need Standard

$ 24 is Sarah’s monthly spend-down

How does a spend-down work? Think of it like a deductible for car insurance. If you pay the spend-down amount yourself via Pay-In, or you accumulate enough medical bills that – added together - meet your spend-down amount, you can be eligible for Medicaid for that month. You must incur the expense during the month in which you are requesting a Medicaid spend-down. Medicaid will be effective the date you meet the spend-down.  

Can a spend-down amount change?    Yes. There are circumstances that can affect the amount of a spend-down such as:      

• Any change in income      
• Health insurance coverage and premiums

Talk with your caseworker if you think something might affect your spend-down amount. You must tell your case worker within 10 days of any change. If you don’t, you could lose your Medicaid coverage.

What bills or expenses are counted toward spend-down? With some exceptions, all medically necessary services can be used for a spend-down.

Examples include:
• Medical bills for you or family members (such as doctor and dentist, eye exams, prescriptions, physical   therapy, medical equipment, or lab work)
 • Medical insurance premiums      
 • Medical insurance co-pays and deductibles      
 • Medicare premiums      
 • Transportation cost to get to medical appointments (such as miles traveled in your car, on bus fares, or  on taxi fares)

Always check with your caseworker if you are unsure whether an expense qualifies.  

What proof do I need to show that I have met my spend-down amount?

Copies of your bills are needed to prove that you have met any spend-down amount that’s been determined for you. Those bills need to show

      • Date of service

      • Amount that is owed or was paid

      • The name of the person receiving the service

How do I turn in copies of the bills?