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The Ohio Department of Aging

Ohio Department of Aging Boomerang: It all comes back to you!

Boomerang: It all comes back to you!

My Future - August 2011

What to do when you aren't poor enough to get help
Medicaid spenddown program helps Ohioans qualify for valuable assistance

These days many of us struggle to make ends meet, but we manage to pay our bills and take care of life's necessities through hard work and sacrificing what we don't need. Unfortunately, things happen in life that we can't predict or plan for that can throw everything out of whack - an accident, an emergency, something out of the blue. Ohio's Medicaid program provides medical benefits for qualified individuals who may have no medical insurance to help with expenses, but many people who were meeting expenses before becoming ill or injured find that their incomes and asset levels are too high to qualify for Medicaid.

Ohio Medicaid's spenddown program helps older Ohioans and people who are blind or who have a disability to qualify for Medicaid even if their income is too high. Individuals may deduct medical expenses from their incomes so that they fall within Medicaid guidelines. A caseworker from the county department of job and family services works with interested consumers to determine their spenddown amounts, which is generally monthly income minus the Medicaid limit.

Individuals in the spenddown program must pay any medical bill that is used to meet eligibility, Medicaid will then pay for services that are needed for the remainder of the month after the spenddown is met. Spenddown applies only to out-of-pocket expenses, and costs that are covered by other insurance cannot be counted. Medicaid eligibility begins on the day the spenddown amount is met, and ends on the last day of that month.

You can meet your Medicaid spenddown in three ways:

  1. Ongoing - You provide proof of monthly medical expenses (e.g, medical premiums or unpaid past medical bills) that consistently meet or exceed your monthly spenddown amount.
  2. Delayed - If you don't have monthly medical expenses, you can submit other medical expenses that meet or exceed your spenddown amount each month.
  3. Pay-in - You can pay the spenddown amount directly to the county office each month.

Your county office will determine if your expenses can be applied to the spenddown. Some eligible expenses include:

  • Medical bills (e.g., doctor and dentist visits, eye exams, prescriptions, physical therapy, medical equipment, lab work);
  • Medical insurance premiums (e.g., health, vision, dental, long-term care);
  • Medical insurance co-pays and deductibles;
  • Medicare premiums;
  • Transportation costs to get to medical appointments; and
  • Disposable medical supplies, that are prescribed and medically necessary, such as gauze or sterile water.

You also can apply unpaid past medical bills to your spenddown amount. For example, if your monthly spenddown is $100 and you have an unpaid past medical bill of $800, that medical bill can be used to meet the spenddown for eight months. You still have to pay the bill, and you have to give the unpaid past medical bills to the caseworker for documentation. Depending upon your situation, medical bills of certain family members also may be used to help meet spenddown.

Contact your local job and family services office or call the Medicaid Consumer Hotline at 1-800-324-8680 for more information about Medicaid spenddown.

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