To qualify for Connecticut State
Medical Assistance (Medicaid or Title XIX), you
must meet program requirements, including income
and asset limits. Income and asset limits are
fixed, but if you have very high medical
expenses, you may still qualify for Medicaid.
This is because of a process called "spend-down"
that lets you reduce or "spend down" your excess
income to bring it under the "medically needy
income limit." The spend-down process uses
medical bills as income deductions. Medical
bills are subtracted from income, and if medical
bills exceed the income above the medically
needy income limit, you are eligible for
Medicaid and any further medical expenses are
covered by Medicaid.
Income and medical expenses are
reviewed every six months, and once medical
expenses in a six month period bring income
below the medically needy income limit, the
client is deemed eligible for Medicaid.
WHO IS ELIGIBLE FOR MEDICAID
UNDER A SPEND-DOWN?
Anyone who meets all the
eligibility requirements for Medicaid, except
the income limit, is eligible for Medicaid if
the amount of medical expenses owed is greater
than the amount by which their income exceeds
the medically needy income limit. This limit is
set by DSS each year.
EXPENSES COUNT TOWARD THE MEDICAID
Any expense related to
medical or mental health care or treatment
counts toward the Medicaid spend-down. This
includes visits to medical professionals,
prescriptions, over the counter medicines,
bandages, insulin/test strips/syringes,
emergency transportation, (but not
non-emergency transportation), eyeglasses,
hearing aids, durable medical equipment,
psychiatrists, psychologists, and similar
expenses. There is no set list of expenses
that can be used for the spend-down, but generally
DSS will accept any expense that meets a
TO FIND PROVIDERS IN
CONNECTICUT'S COMMUNITY RESOURCES DATABASE:
Search by program
Expense Spend Down Policy
SOURCE: Connecticut Dept.
of Social Services, State Medical Assistance The
Spend-Down Process http://www.ct.gov/dss/lib/dss/PDFs/SPNDOWN.pdf
PREPARED BY: 211/rj
CONTENT LAST REVIEWED: January2012