An Experienced Medicaid Application Lawyer Explains What You Need to Know About Medicaid Spend-Down in NY

Serving Families Throughout Melville

Are you worried about how you’ll pay for long-term care if your financial situation changes? You’re not alone; by 2050, Medicaid spending is expected to triple. Increasingly, New York residents have been researching the Medicaid rules to understand how to qualify for long-term care. However, applying for Medicaid and understanding the Medicaid spend-down in NY without the help of an experienced Medicaid application lawyer can leave you with more questions than answers.

An individual or household cannot earn money above a relatively low-income threshold to be eligible for Medicaid benefits. However, New York’s Medicaid “spend-down program” opens up eligibility to higher income levels by allowing beneficiaries to deduct some medical services to reduce the income calculation for Medicaid eligibility.

This article will share what you need to know about Medicaid spend-down in NY. Contact Schneider, Garrastegui & Fedele PLLC at (631) 519-9831 to schedule a consultation to discuss Medicaid eligibility and the Medicaid spend-down program.

What Is the Medicaid Spend-Down Program?

Also called the “Medicaid Excess Income Program,” the Medicaid spend-down program allows New Yorkers to receive Medicaid benefits even if their earnings exceed the maximum income for Medicaid eligibility.

To reduce reported income levels that the government uses to calculate eligibility, potential Medicaid beneficiaries can deduct the following medical expenses from their income:

  • Visits to the doctor
  • Prescription drugs
  • Medical supplies
  • Inpatient and hospital care services
  • Insurance premiums

The New York Department of Health refers to this excess income as a “deductible.” Therefore, when you spend a specific amount of your income on medical bills, this amount is deducted from your income. If your modified income after this deductible meets Medicaid eligibility requirements, you can receive Medicaid benefits for the month.

You do not necessarily have to pay these medical bills before being eligible for the spend-down program. You can send or fax your medical invoices and billing statements to your local department of social services once they are equal to or higher than your excess income.

How Medicaid Spend-Down in NY Works

Eligibility for Medicaid under New York’s spend-down program is determined monthly. You can have Medicaid coverage if your medical bills are substantial enough to reduce the rest of your income to the maximum eligibility limits.

Medicaid recipients utilizing the spend-down program will have Medicare coverage for covered medical services. Medicaid benefits will then cover additional qualifying costs.

It’s also possible that Medicaid will cover the cost of treatments from a medical provider that Medicare doesn’t traditionally cover, such as visits and care from an eye doctor, dentist, or audiologist.

If you do not meet Medicaid spend-down eligibility requirements in a given month, you can still be eligible the next month.

Qualifying for Medicaid Spend-Down in NY

To be eligible for Medicaid, and specifically Medicaid spend-down in NY, you must meet the following requirements:

  1. Be at least 65 years of age (or have a Medicaid-eligible disability)
  2. Spend a relatively high portion of your income on medical care
  3. Have assets valued not in excess of $30,182 or $40,821 for individuals and couples, respectively

The Medicaid spend-down program is also available to pregnant women or parents who have a child under 21 years old.

In general, the Medicaid application process can be complex and arduous. It involves submitting a significant amount of paperwork, including:

  • Financial and income statements
  • Income verification letter
  • Tax returns
  • Letter from the Social Security Administration
  • Canceled checks (in some circumstances)

Further, acceptance into the Medicaid spend-down or excess income program requires you to contact your local department of social services. You can find out which department is local by checking out this map. Inform the department that you want to be in the “Excess Income Program.”

What to Do If You Are Denied When Applying for Medicaid in New York

If your Medicaid application is denied, you might think that you’re not eligible for Medicaid. However, there’s still a chance you can get approved for Medicaid, especially under the Medicaid spend-down program.

A Medicaid application lawyer will first find out the reason for the denial and request that the decision be reversed through an appeal if the denial was in error. Even if you were rejected eligibility for legitimate reasons based on your application, an attorney could guide you on becoming eligible for Medicaid.

Sometimes, this can involve deducting the cost of medical services to put your income in the range of the income limit for Medicaid qualification, which is the spend-down eligibility discussed in this article. Another option is joining the Medicaid Pay-In Program, another NY health assistance program.

Contact Elder Law Firm Schneider, Garrastegui & Fedele, PLLC, to Learn More About Medicaid Spend-Down in NY

Applying for Medicaid in New York can be tricky, and it's easy to get confused about eligibility requirements. However, consulting an experienced Medicaid application lawyer can simplify the process. Your lawyer can help you understand the nuances of spend-down rules, walk you through the application process, and ensure the proper completion of your application. At Scheider, Garrastegui & Fedele, we hyperfocus on elder law and real estate law and provide hands-on guidance to our clients. Although we’re a smaller firm, we’re fully staffed with Class A office space, with two conference rooms and two paralegals ready to assist you in the office at all times.

If you have further questions about the Medicaid spend-down program in New York or general Medicaid eligibility questions, contact Schneider, Garrastegui & Fedele PLLC at (631) 519-9831 to schedule a consultation.

Copyright © 2023. SCHNEIDER, GARRASTEGUI & FEDELE PLLC. All rights reserved.

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.

135 Pinelawn Rd #250s
Melville, NY 11747
(631) 519-9831

Share To: