Medicaid Burn: Spend Down What?

Medicaid Burn: Spend Down What? March 11, 2013

They called it “Spend-Down.” The Department of Human Services said this is how it works: “Some people have too much income to qualify for Medicaid. This amount is called excess income. Some of these people may qualify for Medicaid if they spend the excess income on medical bills first. This is called Spend Down”

Disability is not a lot of money, there is no need for a savings account to hold excess income. Disability teaches humility and frugality. The Social Security Administration attorney put me on permanent disability and approved my Medicaid in the autumn of 2012. I received medical benefits for about 90 days. And then in January 2013 my world radically changed…the government changed the Medicaid rules.

I ran the numbers that the DHS indicated as my deductible amount: my Spend Down deductible for medical expenses must be 75% of my disability check (that’s right 75%) before I will be reimbursed.  If it’s, say, 72%…oops, so sorry, you’re not getting any medical reimbursement and you’re out that amount to pay for your living expenses.

So, let’s imagine my SSA monthly income is on the higher end at $1000 a month. This must pay for mortgage, utilities, food, clothing, laundry soap, and, well, all other personal hygiene stuff. And now imagine my medical and prescription expenses are at the low end at $720 for the month. That is only 72%, three points below my required 75% Spend Down deductible. Do the numbers ($1000 SSA income – $720 un-reimbursable medical). That leaves me with $280 per month to pay my mortgage, utilities, and groceries. Oh, and DHS added to my income my qualifying amount of $20 a month in food assistance. $20 a month for food?!

How do I manage financially? Where is the excess income on which my Medicaid Spend Down is based? How do I choose between paying the mortgage or buying prescriptions, seeing a doctor or keeping the lights on?

What am I to do? What are any of us on disability to do?

I had relied on the charity of others and their loans while I waited for the SSA determination of my disability. I’m a single person without a husband or family. I had to spend my back up plan in the economic crash of 2009.  I’ve worked hard since I was 14, paid my taxes, paid into Social Security.

Now I am set adrift with medical expenses eating into my excess (below poverty level) income, seeking a way to not become an indigent…it’s too cold in Michigan to live under a bridge.

I’m scared. Very scared.



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