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Medicaid Spenddowns

What is a Medicaid Spenddown?

If you have certain qualifications for Medicaid for Children and Adults you may be able to get Medicaid through a spenddown. To get a spenddown, you must meet all Medicaid eligibility criteria except that your income is over the limit. Medicaid for the Aged Blind and Disabled may have different rules. You can also learn more about all Vermont Medicaid programs

If your income is over the limit, a spenddown is a way to lower your household income so you can get onto Medicaid. The difference between your household income and the Protected Income Level is calculated to create your spenddown amount.

You will have a six-month period to meet your spenddown. With a spenddown, you should keep track of certain medical expenses that can be used to reduce your income. Once you meet your spenddown, your Medicaid for Children and Adults will start.

As long as you meet the spenddown requirements, you can ask for a spenddown every time you apply for Medicaid for Children and Adults and are told your income is too high.

Who Can Get a Spenddown for Medicaid for Children and Adults?

  • An individual under 21
  • A pregnant person
  • A parent/caretaker of a child who is under 18 yrs old (or 19 if still in school)

How to Get a Spenddown

To get a spenddown, you must ask for one and be found eligible.

  • You can ask for a spenddown for just one person, or for every member of your household. You can decide who should meet a spend-down first.
  • One household member can have a different spenddown amount than other household members.

The Spenddown Period

You get six months to meet a spenddown. For example, if you apply for Medicaid in January, your spenddown period starts on January 1 and ends on June 30.

How to Meet a Spenddown

To meet a spenddown you must tell us about your medical expenses. These can include recurring medical expenses, bills for hospital visits or health insurance premiums. We may need to see proof of these expenses, like receipts for medications or copies of hospital bills. Eligible expenses are subtracted from your total spend-down amount. When your spenddown amount gets to zero, your Medicaid coverage begins.

Here are examples of expenses you should send us to meet a spend-down:

  • Health insurance premiums
  • Medical expenses your insurance does not cover
  • Over the counter drugs and medical supplies. For example—vitamins, band-aids and antacids
  • Travel costs to see a healthcare provider
  • Medical bills you owe before or during the spenddown period
  • Medical bills you paid during your spenddown period

Once Your Spenddown is Met

Medicaid will start on the date you meet your spenddown. Coverage will continue until the last day of the six-month spenddown period. At that point, your eligibility will be reviewed. You may be given another spenddown for the next six-month eligibility period.