How to meet a Medicaid spend-down in New York (excess income)

The DOH page says you must be under 21, 65 or older, certified blind or disabled, pregnant, or the parent of a child under 21. Your Medicaid notice gives your monthly excess income amount. It is the difference between your countable income and the Medicaid limit.

Spend-down cases stay with your local Department of Social Services (HRA in NYC). The state's modernization page lists the Excess Income program among the groups that keep working with their local office.

If you do none of these in a month, you have no Medicaid coverage that month.

• Doctor, dental, and clinic visits, eye exams, lab tests, and prescriptions. These providers do not have to take Medicaid for the bill to count.
• Rides to and from medical appointments (in most cases). Keep receipts.
• Therapists, nurses, personal care aides, and home health aides ordered by a doctor.
• Copays and deductibles for Medicare (including Part D), Medicaid, or other health insurance.
• Medical supplies, equipment, hearing aids, eyeglasses, and doctor-ordered over-the-counter drugs.
• What EPIC or ADAP paid for your drugs, not just your copay. Get a statement from EPIC at 1-800-332-3742 or ADAP at 1-800-542-2437.
• Bills for your spouse or your children under 21.

If Medicare or private insurance pays part of a bill, only the part you owe counts.

1. Find your excess income amount on your Medicaid notice.
2. Book appointments and fill prescriptions early in the month. DOH says this helps you reach the amount faster.
3. Collect the bills or receipts until they add up to your excess amount.
4. Send them to your local office. Bring, mail, or fax them. In NYC, fax to 917-639-0645.
5. On every fax, include your name, case number, CIN (Medicaid ID), your excess income amount, and the month or months you want covered.
6. After you meet it, use Medicaid providers. DOH warns that once the excess is met, Medicaid pays only providers enrolled in New York Medicaid.
7. Repeat each month you need care, or use the six-month option if you have big bills.

• Past paid bills: bills for care received and paid in the three calendar months before the month you applied can count toward up to six months.
• Past unpaid bills: can count even if they are years old, as long as the provider can still legally collect them. DOH says they can be used month after month until used up.
• A bill can only be used once.

If a spend-down every month is too much, a pooled income trust may help. See our guides on spend-down vs pooled trust and how to join a pooled trust in NYC.

• Paying the Pay-In amount in a month you don't need care.
• Throwing away old unpaid bills that could still count.
• Faxing bills without your case number, CIN, or the months you want.
• Seeing a non-Medicaid provider after you already met the amount that month.
• Forgetting EPIC or ADAP payments, which count in full.