Spend Down

Medicaid Spend Down

What is a Medicaid spend-down?

Medicaid, also known as Title 19, is a medical assistance program for low-income people who are elderly (65 years and older), disabled, blind, or who meet some other category of eligibility. While some people have so little income that they automatically qualify for Medicaid, others who are slightly over the Medicaid income guidelines are placed on a spend down by the Department of Social Services

They qualify for Medicaid if within a six-month period they have medical expenses that add up to the amount their income exceeds the Medicaid limit.  When that occurs they will receive full Medicaid coverage — but only until the end of the six-month spend down period.

Who is eligible for a Medicaid spend-down?

  • A person must be disabled, blind or at least 65 years of age, have assets of no more than $1600 if single, or $2400 if married, and have income which exceeds the Medicaid limit in order to qualify for a Medicaid spend down.
  • Eligible people living in their own home, apartment, senior housing, congregate housing, etc. are eligible to be placed on a spend-down if they have income over the Medicaid limit.

How much is my spend-down amount?

The amount of your spend-down is the extra income that is over the limit to receive Medicaid automatically.  DSS figures out this amount for each person, taking into account the person’s income and living arrangements.

In Greater Hartford the income limit is $506.22 for a single person or $672.10 for a couple. Seniors and people with disabilities with unearned income such as Social Security do not have to count $278 which is the standard deduction.

How often do I have to meet the spend-down?

You will have to meet the spend-down every six months unless your income and living arrangements have changed so much that you qualify for Title 19 without a spend-down.  To get Medicaid in any six month period, you will have to meet the spend-down first.  Once you meet the spend-down, Title 19 will pay your medical bills for the rest of the six-month period.  Then Title 19 will stop until you run up enough medical bills to meet the spend-down again.

 

Here is how the spend-down works!

 Example #1: John is single and has monthly income of $700.Step #1: Take John’s monthly income – $700Step #2: Subtract the standard deduction for unearned income$700 minus $278 = $422

Step #3: If this amount ($422) is less than the Medicaid income limit of $506.22, John is eligible for Medicaid. And it is!

 

 Example#2: Maria is single and has monthly income of $600 from a part-time job.Step #1: Take Maria’s monthly income – $600Step #2: Subtract the standard deduction for unearned incomeMaria has no unearned income (Social Security).

So, $600 minus $0 = $600

Step #3: If this amount is over the Medicaid limit of $506.22, Maria would have to “spend-down” her income before she would qualify for Medicaid.  Maria would have to spend $562.68 ($600 minus $506.22 = $93.78 times 6 months = $562.68.  Then she would receive Medicaid for 6 months.

 

What medical bills can I use to meet the spend-down?

The bills must be ones which you owe for medical services or items for you (and your spouse, if your spouse’s income if counted ) which no other insurance or program is going to pay.

Your medical bills include not only the usual doctor, hospital and prescription bills, but also medical supplies, such as bandages, gauze, etc.); over the counter drugs and vitamins prescribed by your doctor; and health insurance premiums, co-payments and deductibles.

What are the problems with Spend Down?

There are several problems with the Spend Down system:

  1. The system is very confusing.  It is difficult for people to negotiate this process.
  2. After six months on Medicaid the process starts all over. People have been receiving care for illnesses then are forced to curtail treatment because they lack the money up front for the total cost of services.
  3. The amount of administrative work for the Department of Social Services is costly.

 

 

 

 

 

 

(This fact sheet was adapted from Connecticut Legal Services, Inc. for East Hartford Community Health Care, Inc. by UCAN. For more info, call 860-524-0502.