Glossary
Spend-down
A route to Medicaid for people whose income is above the limit, by subtracting medical costs they have already incurred.
Spend-down is the route to Medicaid for someone whose income sits above the eligibility limit but who has heavy medical costs. States may run what is called a medically needy program, and in those states you can subtract medical and remedial expenses you have incurred from your income. Once those expenses exceed the difference between your income and the state's medically needy income level, Medicaid coverage can begin. The comparison is made over a set budget period, which states choose within a range of one to six months, so the arithmetic starts fresh each period rather than running continuously. This matters to you, or to someone you are helping, because the expenses generally need to be incurred rather than already paid, and because not every state runs such a program. Rules, income levels, and budget periods differ from state to state, so the state Medicaid agency is the source of record for how it works where you live.