Through Medicaid, the government seeks to provide assistance to those in need. The unfortunate reality is that Medicaid’s general eligibility criteria can be so strict that higher income families in need won’t qualify for benefits. And that’s why Medicaid Spend Down exists. If you’ve heard about Medicaid Spend Down and want to learn more, this is the article for you. In it, we’ll share everything you need to know in layman’s terms, since the concept has the tendency to be confusing.
What is Medicaid Spend Down?
Louisiana’s Spend-Down Medically Needy Home and Community-Based Services (also called the SD MNP HCBS) program is a safety net that allows aged, blind, or disabled individuals who wouldn’t otherwise have qualified for Medicaid to gain access to services.
Those who qualify for the program will make too much income to qualify for Medicaid. That excess income is the amount you must pay in medical bills before your Medicaid benefits kick in. Once you meet your spend-down and show evidence of it with paid or unpaid medical bills, you can receive Medicaid benefits.
To truly understand Medicaid spend down, think of it sort of like a deductible, where you have to pay a certain amount of money before your insurance company will pay anything.
Note: You may not be eligible to spend-down every month. There may be times when you don’t incur enough medical bills to surpass your excess income. In those instances, you’ll be ineligible for Medicaid services for that period.
Could You Be Eligible?
Not everyone who makes too much money for LA Medicaid will qualify for the spend down program. Here are the requirements you must meet:
1.You must meet the income eligibility requirements for LA Home and Community Based Services (HCBS)
2.You must meet the eligibility requirements for ONE of the following programs:
- Community Choices
- New Opportunities Waiver
- Residential Options Waiver
- Adult Day Health Care
- Supports
3.Your income must surpass the special income limit (SIL).
Note: Just because you meet all of these requirements doesn’t mean that you’ll qualify for benefits every month. As mentioned earlier, you must pay enough of your own expenses before your benefits will apply.
You Must Use Medicaid Providers
Whenever you will be getting assistance from Medicaid after having met your spend-down amount, you’ll need to go to a Medicaid-contracted provider. It’s crucial to know this beforehand, because if you go to a provider that doesn’t accept Medicaid, your services will not be covered.
How to Apply
Do you think that Medicaid spend down could be your ticket to Medicaid? You can take action starting today. To apply for this program, speak with a Medicaid agent or go to your local Medicaid office and speak to the staff there. They will direct you to the right forms and help you through the process.
We hope this article has helped you to understand Medicaid Spend Down a little better, and we wish you the best as you work to secure the benefits you’re entitled to.
