What Is Medicaid Spend Down?
Medicaid is a state-operated medical program designed to help ensure that certain low-income individuals--including the elderly, disabled, pregnant women, children and other qualifying groups--receive adequate medical coverage. In cases where an individual's income is too high, Medicaid may be obtained with a "spend down."
Identification
A Medicaid spend down is a portion of health coverage that an individual must pay for before Medicaid coverage begins. The exact amount of the spend down varies depending on the state in which one resides, medical bills that an individual has each month, and numerous other factors.
SSI
Individuals who receive any portion of their income from Supplemental Security Income (SSI) through Social Security are not required to pay a spend down for Medicaid.
Medicare
If you currently receive Medicare, you will still be required to pay a spend down for Medicaid services. However, your Medicare premiums, co-payments and coinsurance amounts will apply towards your spend down amount.
Social Security benefits
If you are receiving Social Security disability or retirement benefits, you may still have to pay a spend down. Your spend down will be calculated based on your income. For the state of Indiana, for instance, your spend down is $1 for every $1 over $690 you receive per month. For example, if you earn $800 per month in Social Security Disability Insurance benefits, you will have to pay the first $110 of your medical bills each month before Medicaid coverage begins.
Other Programs
Many states offer programs where, if an individual exceeds the income guidelines for Medicaid due to earnings earned while employed, the spend down may be be avoided by enrolling in a separate type of Medicaid in which a person can pay a premium for health coverage. In Indiana, this plan is called the MedWorks program; other states may call this program by different names.
