Spend Down

What is Spend Down?

MO HealthNet for the Elderly, Blind, and Disabled with a Spend Down allows consumers who have income above the income level for MO HealthNet for Disabled (Medicaid) to qualify for coverage. The Spend Down amount is the amount of income that is above the income maximum. For 2020 the income limit for the elderly and disabled is $885 for an individual and $1,198 for a couple.

MO HealthNet for the Elderly, Blind, and Disabled Income Deductions

The following income deductions are allowed:

  • The first $65 of earned income
  • One-half of remaining earned income
  • A $20 personal income exemption
  • All SSI payments
  • Health insurance premiums
Spend Down Calculator

This tool can be used to see how different earned income amounts impact the consumer's premium and eligibility for the Ticket to Work Health Assurance program.
Spend Down and Ticket to Work Health Assurance Calculator

By entering the amounts of income the individual has if not working and the anticipated amount of earned income, the calculator will show an estimated Spend Down or TWHA premium. 

Unlike a premium the Spend Down can be met in different ways:

Making a monthly payment to the MO HealthNet Division

The consumer may pay online or send a payment (check, money order, or cashiers check) to the MO HealthNet Division. The consumer will have coverage for the whole month that they pay for.

  • ONLINE
  • MAIL
    • MO HealthNet Division
      PO Box 808001
      Kansas City, MO 64180-8001
    • You must put your MO HealthNet number (case number) on the check or money order. You should mail your payment along with the invoice stub for the month you want to pay. If you do not have the correct invoice stub to send you must write on the check or money order what month you are paying for.
  • AUTOMATIC WITHDRAWAL
    • The consumer may have the payment taken directly out of their bank account on the 10th of each month by the MO HealthNet Division to meet the Spend Down for the following month. If the consumer is wanting automatic withdrawal, the Spend Down Automatic Withdrawal Form should be submitted along with a voided check to the address listed on the form. 
Applying incurred medical expenses

The consumer or a provider can submit bills for medical services which the client is personally responsible for, or which are billable to DMH. MO HealthNet coverage will begin on the date the incurred expenses equal the spend down amount. 

The online MO HealthNet Spend Down Provider form allows providers to verify qualified expenses to meet a participant's spend down. The form should be completed when the provider has a MO HealthNet participant who has qualified for spend down and an actual bill is not yet available. By completing the online form, providers verify that the participant has incurred and personally owes payment for services they provided. If a provider needs a paper form, they should access the MO HealthNet Spend Down Provider form (IM-29PROV).

Participants should access the online MO HealthNet Spend Down Participant form to provide proof of qualifying expenses and identify which months the expenses should be applied to. If participants are not able to complete the form online, they can also access and print the MO HealthNet Spend Down Participant form (IM-29SDP).

Upon receipt of verification that spend down has been met with incurred and/or paid expenses for a month, FSD sends a Notification of Spend Down Coverage letter to inform the participant spend down was met with the incurred and/or paid expenses. The letter informs the participant of the MO HealthNet start date and the amount of spend down met on the start date.

If the Spend Down is not met for a month the consumer's MO HealthNet for Disabled case will remain open but they will not have coverage for that month. MO HealthNet allows up to a year to meet the spend down either through pay-in or bills.

What are the benefits Spend Down if the Spend Down is too expensive to be met?

Even if the consumer normally cannot meet spend down, by maintaining an open case the consumer is protected in the event of an unexpected medical expense. The spend down can be met at any time during the month either with bills or by payment, and previous months within the past year can also be met. There are no penalties for not meeting the Spend Down. For children who are on the wait list for the MOCDD waiver having an open case will speed up the process of getting them approved once they are given a waiver slot.