In a very exciting move New York State recently provided a new web page that explains in very good detail what happens with surplus income for the Medicaid program, often known as a "spenddown." This program is for certain people whose monthly income exceeds the income threshold for a Medicaid recipient, but who have medical expenses on an ongoing basis that could be covered through the Medicaid program. By using their medical expenses to offset their excess income they can qualify for community Medicaid or a number of waiver programs available to individuals outside a nursing home setting. New York Medicaid applicants and recipients can learn a lot in this one-stop shop.
Applicants and recipients need to know that they only need to incur a medical expense equal to or greater than their spenddown amount. The expense does NOT need to be paid prior to submission to the Medicaid caseworker. However, Medicaid will only pay qualified providers of care - debts owed for care provided your neighbor, church friend or the kid down the street do NOT count for Medicaid reimbursement. Also, home care expenses incurred through a licensed home care agency instead of a certified home health agency ("CHHA") will not be reimbursed either, unless there is a special contract between the agency and the particular County, so check your agency's licensing BEFORE incurring care expenses. (Monroe County has 3 CHHAs - Visiting Nurse Service, Lifetime Care and HCR.) There are many companion agencies out there providing wonderful services, but they cannot bill the Medicaid program.
Education and implementation are two different things...so please contact us if you are interested in exploring this possible Medicaid option in the Rochester area or if you are seeking options for meeting your spenddown such as using a pooled supplemental needs trust.