How Can You Use Medicaid Spend-Down in New York?

Medicaid is a vital safety net that helps millions access health care when private insurance or out‑of‑pocket costs would otherwise put treatment out of reach, from routine checkups to lifesaving care. To qualify for Medicaid coverage in New York, you must meet the income limits. In New York, the monthly income limit is about $1,800 per month for individuals and about $2,433 per month for a married couple.

If your income exceeds the income limits, the state allows you to attempt to meet them via Medicaid spend-down. 

How Medicaid spend-down works

In New York, you may qualify for Medicaid even if your income exceeds the limits if you pay or have medical expenses that effectively reduce your income to or below the monthly Medicaid eligibility limits. This is the Medicaid spend-down program, and it allows residents to deduct specific medical expenses from your income. 

For instance, if your income is $1,900 a month, but you can show you have $200 worth of medical expenses for the month of December, your income falls just below the limit. You must have enough medical expenses each month to reduce your income. Each month you cannot prove this is a month you must go without Medicaid benefits.

Medicare Rights Center explains in more detail how the Medicaid spend-down works in New York.

How to use Medicaid spend-down

To use Medicaid spend-down, first calculate the difference between your income and the qualifying limit. Then you must figure out how you plan to meet that limit. You can either accrue medical expenses that total that difference and show proof via paid or unpaid medical bills, or you can send a check to the Medicaid office for the remainder of the difference that you did not spend.

The Medicaid spend-down is an important tool in your arsenal when it comes to planning for your future and paying for medical expenses. For these reasons, it is important that you learn to use it effectively.