Washington’s “Medically Needy” Spenddown Program Helps Elderly Adults Cover Medical Expenses
To be eligible for Medicaid — known in Washington as Apple Health — an applicant must have income and assets below a certain amount. Many older people have income or assets that exceed Apple Health’s limits, but they also have high medical expenses that they can’t afford. What remedies are available in this predicament?
Washington residents aged 65 or older and certain younger people with disabilities may be able qualify for Medicaid with help from the Medically Needy Spenddown Program. It allows Medicaid applicants to spend excess income (income over the eligibility limit) to pay for certain medical expenses. Once the excess is spent and the person’s income is down to the Medicaid eligibility limit, they will qualify for Medicaid for the rest of the “spenddown period.” In Washington, the applicant can choose between a three-month or six month period, depending on the amount of spenddown and amount of medical bills her or she expects.
Though it’s not a perfect analogy, you can think of the spenddown as being similar to an insurance deductible, in that once you have spent a sufficient amount, the rest of your expenses are covered by the plan. Once you spend enough to get yourself down to the Medicaid eligibility limit, Medicaid covers the rest.
For 2021, the eligibility limits in Washington for regular Medicaid are:
- Single person — $794 monthly income and $2,000 in assets
- Couple — $1,191 monthly income and $3,000 assets
To spend down excess income or assets, you can spend money on items such as:
- Prepaying funeral expenses
- Paying off a mortgage, credit card or other debt
- Repairing or renovating a home
- Medical supplies and prescription drugs
- Health insurance deductibles
- Hospital visits
You should not attempt to spend down assets by giving them away as gifts. Medicaid has strict rules about how to properly transfer assets, so you should speak with an elder law attorney before transferring any assets for the purpose of qualifying for Medicaid.
If you have questions about Medicaid/Apple Health for yourself or an aging loved one, the attorneys at Bottimore & Associates, P.L.L.C. would be happy to speak with you. Please call our Tacoma office at 253-272-5653 or contact us online to arrange a consultation.