What Is the Ohio Medicaid Spend-down Program?

In Ohio, individuals must meet the residency, citizenship and income requirements to receive coverage through the Medicaid program. Exceeding the income limit is not an automatic disqualification. Ohio Medicaid offers applicants the opportunity to reduce their income by contributing toward their own medical expenses. If the deductions bring your income down enough to fall within the income guidelines, you will qualify for Medicaid.

How it Works

• A spend-down is similar to an insurance deductible. In a Medicaid spend-down, Ohioans are required to submit proof of medical expenses to bring their income below the threshold for eligibility. For example, if you are eligible for Medicaid, but your income is $150 more than the limit, you must submit $150 worth of acceptable medical bills you pay out of pocket, as of 2011. The excess income is equal to the spend-down amount. Once you reach the spend-down amount, you are eligible for Medicaid for the remainder of the month.

Who is Eligible?

• To be eligible, you must be a U.S. citizen or legal immigrant currently living in the state of Ohio. You must be age 65 or older, blind or disabled, as defined by the Social Security Administration. Disabled or blind individuals qualify for the spend-down program regardless of age. If you receive SSI, you will automatically qualify for Medicaid. Applicants' resources are limited to no more than $1,500 in countable assets per person or $2,250 for a couple, as of 2011. Your home, vehicle and personal possessions are exempt.

Countable Expenses

• Expenses that can be deducted from your income include: medical bills from a doctor's office or dentist, eye exams, prescriptions, medical equipment, lab work, disposable medical supplies, such as gauze or adult diapers, insurance premiums or co-pays, Medicare premiums and transportation costs for treatment. A copy of the bill for services can be mailed, faxed or hand-delivered to the local County Department of Job and Family Services, CDJFS. Maintain the original bills for your records.

Spending Options

• There are various ways for an applicant to meet the spend-down requirement through the program. The ongoing spend-down method offers individuals with consistent medical expenses reoccurring insurance coverage. Consumers without consistent medical debt can utilize the delayed method. Through this method, applicants submit copies of their bills to the case workers each month. Coverage begins the date the spend-down amount is met and ends on the last day of the month. For those who do not incur a steady amount of medical expenses, the buy-in program allows you to pay the spend-down amount directly to the CDJFS each month.