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Ohio Department of Aging Aging Connection - April 2009

April 2009

The Basics of Medicaid Spend-Down

Some people who are 65 years and older or who have disabilities have so little income they automatically qualify for Medicaid. The spend-down program is an option available to everyone who meets all the eligibility requirements for Medicaid, except their income is too high. The program allows these people to deduct medical expenses, like the cost of prescription drugs, from their incomes in order to meet Ohio's Medicaid guidelines.

As of January 1, 2009, Ohio's monthly income limit for Medicaid is $609 for individuals and $1,031 for couples. The federal government sets the income standards and they change annually. In State Fiscal Year 2006, the Ohio spend-down program served more than 180,000 eligible consumers with an average monthly assistance of $1,845.20 per person, according to the Ohio Department of Job and Family Services.

The county caseworker determines a consumer's monthly spend-down amount by subtracting the monthly Medicaid income limit from an applicant's countable income. That spend-down amount is the monthly amount of medical expenses a consumer must pay before becoming eligible for Medicaid benefits.

There are three ways consumers can work with their county departments of job and family services (CDJFS) to meet the spend-down amount:

  1. On-going - Consumers provide proof of monthly medical expenses, such as medical premiums or unpaid past medical bills, that consistently meet or exceed the monthly spend-down amount.
  2. Delayed - Consumers who do not have monthly medical expenses can submit other medical expenses that meet or exceed their spend-down amount each month. Medicaid eligibility begins on the day the spend-down amount is met and ends the last day of that month.
  3. Pay-in - Consumers also can pay the spend-down amount directly to their CDJFS each month. The Medicaid card will cover the entire month and should be dated from the first day to the last day of the month.

Medical expenses and bills for medically necessary services that can be counted toward the spend-down amount are:

  • Medical bills including doctor and dentist visits, eye exams, prescriptions, physical therapy, medical equipment and lab work;
  • Medical insurance premiums;
  • Medical insurance co-pays and deductibles;
  • Medicare premiums;
  • Transportation costs to get to medical appointments, including miles traveled by car and bus or taxi fares; and
  • Disposable medical supplies that are prescribed and medically necessary, such as adult disposable diapers, gauze and sterile water.

The consumer must mail, fax or drop off copies of medical bills used to meet spend-down to the caseworker at the CDJFS. Original medical bills should be kept for the consumer's personal files. After spend-down is met and approved, a Medicaid card will be issued in approximately two business days.

Personal assets and spend-down is a complicated topic and every situation is unique. For more specific information, consumers should contact caseworkers at the CDJFS or call the Medicaid Consumer Hotline toll-free at 1-800-324-8680.

You can find more information about Medicaid-related topics on the Ohio Department of Job and Family Services Web site.