While Medicaid can be a literal life saver, the high cost of living in New York often directly interferes with an applicant's ability to make ends meet and still receive desperately-needed benefits. That leaves many disabled patients scrambling to rid themselves of assets simply to access the services and medications they require to live. The good news is that you can apply for a secondary "spend-down" program within Medicaid, which essentially acts as a deductible to pay before coverage is activated.
Using The Medicaid Excess Income Program to Protect Yourself Financially
Medicaid features extremely strict requirements on both your current assets in the bank and your normal yearly income. Under typical circumstances, making any amount over the income maximum excludes you from any coverage at all. That becomes a problem for many seniors because you can easily make over the maximum income through a part-time job—but still require Medicaid to cover medical bills for unexpected health problems.
In these cases, the spend-down program can prevent financial disaster for either seniors who need serious medical care or even younger disabled patients with qualifying conditions. Although it is actually called the Excess-Surplus Income Program in the state of New York, most beneficiaries simply refer to this process as "spending down."
If you are approved for the Excess Income Program, you can simply pay in the surplus amount you make each month over the asset limit, but then still utilize Medicaid to cover costs after that point. This crucial tool for retaining coverage comes in two varieties:
- Medical Bills Program – Under this program, each month, you personally pay your own medical bills up to the spend-down amount. After that point, Medicaid kicks in for full coverage for the rest of the month.
- Pay-In Program – Rather than paying bills and submitting proof to your local Medicaid office, with this option, you pay in the monthly spend-down amount ahead of time, just like with an insurance premium. If you have excess money available in any given month, you can also pay in for future months to avoid problems down the line.
Of course, when using the former option, you can't simply pay any bill and call it a day. For the Medical Bills Program to cover your costs, you will have to spend down on expenses like:
- New medical equipment or monthly supplies to refresh existing equipment
- Your own personal bills for past or present medical services
- Medical bills for your spouse under some conditions
- Prescription drug refill costs
- Other medical costs that weren't covered by insurance
- Qualifying transportation costs to reach your medical services
To use either the Medical Bills Program or the Pay-In Program, you first need to enroll in the spend-down option separately from your initial application for Medicaid. If approved, you remain within that particular program for 12 months, after which point you have to be recertified for another year's coverage. To qualify for either side of the spend-down program, an applicant must meet one of these basic health or age requirements:
- Child Under 21
- Senior Over 65
Finding a means of protecting yourself financially, such as the spend-down program, is why you need the help of an experienced Medicaid planning attorney as early in the process as possible. Depending on your circumstances, other options may be available, like utilizing a pooled income trust, to help protect your assets while still ensuring you receive the full benefits you deserve.
Your lawyer can also help you avoid common pitfalls many applicants may not see ahead of time, such as gifting assets to family members, which can accidentally prevent you from enjoying benefits you would have otherwise received.
Do You Need Help Applying for Medicaid Benefits in New York?
When you are suffering from a debilitating medical condition, there's no reason to leave benefits you deserve on the table. If you or a loved one need to apply for Medicaid but aren't sure what to do next, set up a consultation with the Alatsas Law Firm today.