What is Medicaid spenddown?
"Spenddown is a way for someone with Medicare to qualify for Medicaid even if the person’s income is higher than the state’s Medicaid limit. Under spenddown, a state lets the person subtract their non-covered medical expenses and cost sharing (like premiums and deductibles) from their available income, so that their countable income is lowered to a level that qualifies them for Medicaid." (Source: CMS fact sheet)
The timeframe from private pay to spend down to Medicare is anywhere from one to five years. We usually see this when someone has been living in assisted living, for example, a few years and their care needs are increasing. The family's starting to get concerned about their parent's finances and paying for care.
If someone's within a couple years of spending all of their money, it's time to regroup and think about the strategy. Our Care Managers help families strategize, plan, and connect with resources to get this in order.
Sometimes a client will move to an adult family home even before they'd anticipated doing so because that's a supportive living option for a Medicaid spenddown. Spenddown is basically an advanced strategy to get someone in a facility where they can pay privately for that long-term care for one to five years. And then when their money is gone, they can stay there on Medicaid.
What you want to avoid is running out of money and then having to move. If you're already on Medicaid and you're trying to get into a facility, you have very few options. And that's where that private pay period helps to increase the availability of quality options.
Concerned about a parent's finances and care? Not sure how to anticipate and/or plan for a possible spenddown? We can help. Schedule a free, get-acquainted call today with one of our Certified Care Managers.
Resources
This podcast is part of a longer conversation between Nicole Amico Kane, Director of Care Management at Aging Wisdom, and Brenda Dodd, Director of Training and Special Projects at Áegis Living.
