Who Qualifies

Spend-down is a method used to determine Medicaid eligibility for individuals with low income, a disability, or those aged 65 and older. Sometimes, individuals may have an income slightly above the Medicaid eligibility threshold. By spending the excess income on medical bills, they can qualify for Medicaid. The spend-down amount is the difference between the individual’s income and their medical expenses.

There are three ways to meet your spend-down requirement and obtain coverage. You must select one option:

Option 1:

• Send a payment (check, money order, or cashier’s check) to the MO HealthNet Division.
• Coverage will be provided for the entire month for which the payment is made.

Option 2:

• Have the payment automatically deducted from your bank account on the 10th of each month by the MO HealthNet Division for the following month’s spend-down.
• Complete the Spend Down Automatic Withdrawal Form to set up this service.
• Allow 30 days for processing the automatic withdrawal.

Option 3:

• Use medical services to reach the spend-down amount.
• When your personal responsibility for medical service costs reaches the spend-down amount, submit the bills to your eligibility specialist at the local Family Support Division office.
• The eligibility specialist will activate your coverage for that month.
• Coverage will begin the day you meet the spend-down amount.
• You are responsible for paying the amount to the service providers.
• For the day you reach the spend-down amount, MO HealthNet will cover only the services exceeding the spend-down amount.
• Bills cannot be used for the spend-down if you opt for automatic withdrawal payments.

You Can Still Qualify For Services

Did you know that waiver services are included in the Missouri Medicaid Program under the authority of a Home and Community-Based Waiver granted by the Centers for Medicare & Medicaid Services (CMS)? Under a waiver, certain services that otherwise wouldn’t be reimbursable under Title XIX can be provided to a select group of participants as an alternative to institutional care.

Adult Day Care Waiver

• Provides continuous care and supervision in a licensed adult day care setting for disabled adults ages 18 to 63 who meet nursing facility level of care.
• Services include assistance with activities of daily living, planned group activities, food services, observation, skilled nursing services as specified in the plan of care, and transportation to and from the adult daycare setting.

Aged & Disabled Waiver

• Offers in-home services to individuals aged 63 or over who have been assessed with certain impairments and unmet needs requiring nursing home care in the absence of these services.
• Services include homemaker, chore, respite, home-delivered meals, and adult day care.

AIDS Waiver

• Provides in-home services to participants diagnosed by a physician as having AIDS or an HIV-related illness and who meet a nursing home level of care.
• Services include personal care, private duty nursing, attendant care, and supplies such as diapers, underpads, and gloves.

Independent Living Waiver

• Similar to the Consumer-Directed State Plan Personal Care program, this waiver requires the same eligibility criteria and offers additional personal assistance services beyond the limitations of the state plan.
• Additional services include environmental accessibility adaptations, specialized medical equipment and supplies, financial management services, and case management.

Medically Fragile Adult Waiver

• Offers services to individuals with serious and complex medical needs who are no longer eligible for services under the Healthy Children and Youth program.
• To be eligible, individuals must be age 21 or older and assessed as requiring placement in an ICF/MR in the absence of these services.
• Services include attendant care, private duty nursing, and specialized medical supplies.