• Your mother’s spend-down amount will be the difference between her income and the Medicaid eligibility limit, as determined by her state over a given length of time (one to six months). Some states require Medicaid beneficiaries to submit receipts or bills to Medicaid to show their monthly expenses. Other states may let beneficiaries pay a monthly premium directly to Medicaid for the amount that their income is over their state’s Medicaid spend-down level. Spend-down income limits may be lower than the Medicaid income limits for people who do not have a spend-down.  

• Each period that your mother has enough medical expenses to meet her spend down, she will have Medicaid coverage. If she does not meet her spend-down amount for a certain period of time, she will not have Medicaid coverage for that time. She can still get Medicaid coverage later if she meets her spend-down amount during another period of the year. 

• Medicare will pay first for covered services, and Medicaid will pay second for qualifying costs, such as Medicare cost-sharing. 

• Your mother’s state may require her to qualify and apply for spend-down for multiple periods in order to qualify for Medicaid inpatient hospital coverage. 

• States with spend-down programs may allow people to use the spend-down program to qualify for Medicaid coverage of their nursing facility stays or home- and community-based waiver services. 

• Note: If your mother’s state does not have a spend-down program, it should have more generous Medicaid income guidelines for people who need nursing home care than for those who do not. 

• Your mother will automatically qualify for Extra Help the first month that she meets her Medicaid spend-down amount until the end of the calendar year (even if she does not meet her spend-down amount every period). 

• Trusts—such as Miller Trusts and Supplemental Needs Trusts or Special Needs Trusts—are available in some states to help people become Medicaid-eligible. Trusts allow people with disabilities and income or assets higher than Medicaid eligibility guidelines to place a portion of their income or assets into the trust, where it will not be counted. Rules about how these trusts work vary greatly by state. For more information, contact your mother’s local Medicaid office or an elder law attorney. 

• Some states offer the Medicaid Buy-In program, which allows people who are under age 65 and have a disability to work (as little as one hour per month) and still receive Medicaid benefits. 

• The program is designed to help people with disabilities who would otherwise not be eligible for Medicaid health coverage because their income or assets are too high. If your mother qualifies, she may be able to receive Medicaid by paying a premium to buy in to the program. Financial eligibility guidelines vary by state. Check with your local Medicaid office for eligibility information.  

• If your mother decides to work and is receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), check with her local Medicaid office to see how much earned income she is allowed to have without losing those benefits.