Medicaid Spend-Down
benefitsAlso known as: Medicaid spend down, medically needy program
Updated · Written and reviewed by Konstantin Iakovlev
Detailed explanation
Process: state subtracts your medical bills (paid + incurred) from your monthly income; if the remainder falls below the Medically Needy Income Level (varies by state, typically 100% of cash assistance levels), you qualify for Medicaid for that month. Common use: nursing home residents whose Social Security exceeds Medicaid limits but medical/care costs are higher. Requires extensive documentation of medical expenses each month. Some states use "share of cost" or "surplus income" terminology. States WITHOUT spend-down: TX, FL, AZ, NV, NM, AL, CO, ID, OK, OR, MO, MS, SD, WY (must use other Medicaid pathways like LTSS or 209(b)).
Use these calculators to apply this concept
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