What is Spend Down/Provisional Medicaid?

In New York State, if you spend a lot on doctor’s visits, prescriptions, insurance premiums or other healthcare services, but have income over the Medicaid limits, you may still qualify under the Medicaid Spend Down Program (also called the Medicaid Excess Income Program). In other words, you will need to show that you spend enough on health care that it puts your income down below the Medicaid limits.

When you meet your spend down on a monthly basis, you can receive outpatient services within the month you meet it. You can also receive inpatient services if you meet your spend down for six (6) months at a time. You do not need to meet your spend down each month, only the months that you will need it.

There are a number of ways to meet your spend down, such as with unpaid or paid medical bills you have incurred or paying it directly to the Department of Social Services. Any specific questions should be directed to a Medicaid worker. For more information please call 315-366-2211.

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1. Who is eligible for medical assistance (Medicaid)?
2. What medical services are paid for by Medicaid in New York State?
3. Is Medicaid Managed Care available in Madison County?
4. How can I apply for Medicaid?
5. What do I need to apply?
6. Am I eligible for Medicaid?
7. What is Transitional Medical Assistance?
8. What is Spend Down/Provisional Medicaid?
9. Are there co-pays for this program?