Medicaid Medically Needy Programs

Adults and children with limited incomes may be eligible for Medicaid benefits, which are managed and provided by each state’s own Medicaid program.  While the standards for eligibility vary from one state to the next, the general requirement is that you must have a low income and few assets.  Aside from income requirements, individuals who are blind, disabled, pregnant or over age 65 may also be eligible for Medicaid benefits.  However, for individuals in those categories whose income is too high, they may still be able to receive benefits through what are called Medicaid Medically Needy Programs. However, these programs are optional, and not all states have them.

How Do Medically Needy Programs Work?

Medical Needy Programs essentially effect how you “spend down” your income, in order to qualify for Medicaid.  In states that have a Medically Needy Program, you are allowed to use your medical expenses to reduce your income.  Each state will establish a spend-down period, in which they analyze your income and expenses to determine whether you qualify for Medicaid coverage.  So, if your state’s spend-down period is six months, for example, then you are required to show that you have sufficient medical expenses within that six month period, to satisfy the spend down requirement.  You are not required to show that the expenses were actually paid, only that they were incurred.

Who is eligible for Medicaid Medically Needy Programs?

Just as each state has the option to offer medically needy programs, they also have the right to choose the categories of individuals that may be eligible.  In other words, some states may choose to offer the program to disabled individuals, but not to the elderly.  However, if a state offers medical needy programs to anyone, they must offer them to most children and pregnant women.

Does My State Have Medically Needy Programs?

Thirty-two states, the District of Columbia and the Northern Mariana Islands have Medicaid Medically Needy Programs.  Those states include: Arkansas, California, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin.

Missouri, Ohio, and Oklahoma are three states that do not have medically needy programs.  However, individuals with disabilities and those who are 65 and over can still qualify for Medicaid by showing that their medical expenses reduce their income below the Medicaid eligibility level.

The Effect of the Affordable Care Act on Medically Needy Programs

The Affordable Care Act allowed states to expand Medicaid to low-income adults under the age of 65.  In those cases, individuals who might have qualified for Medicaid only under the medically needy program, may now qualify for Medicaid more easily under the new expansions.  But, these expansions do not affect the elderly (age 65 and older), so medically needy programs are still very important for them.

If you have questions regarding Medically Needy Programs, or any other Medicaid planning issues, please contact Sexton, Bailey Attorneys, PA online or by calling us at (470) 443-0062.