Medicaid Spend-Down Calculator

ANA›Life Services Authority›National Calculator Authority›Medicaid Spend-Down Calculator

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Medicaid Spend-Down Calculator

Determine how much you must spend on medical expenses before Medicaid coverage activates for the month. Enter your household income, allowable deductions, and your state's income limit to calculate your spend-down obligation.

Monthly Gross Income ($)

Household Size (persons)

State Medicaid Income Limit (% of FPL)

-- Select State Standard -- 100% FPL (e.g. many spend-down states) 133% FPL (ACA expansion states) 138% FPL (standard ACA expansion) 150% FPL 200% FPL Custom dollar amount

Custom Monthly Income Limit ($)

Earned Income Deduction ($) (Standard: $65 + 1/2 remaining earned income)

Other Allowable Deductions ($) (e.g. impairment-related work expenses, blind work expenses)

Spend-Down Period

1 Month 3 Months 6 Months

Existing Unpaid Medical Bills ($) (Bills already incurred that can be applied to spend-down)

Calculate Spend-Down

(function() {

// 2024 Federal Poverty Level monthly amounts by household size // Source: HHS 2024 FPL guidelines (48 contiguous states + DC) const FPL_MONTHLY = { 1: 1255, 2: 1704, 3: 2152, 4: 2601, 5: 3049, 6: 3498, 7: 3946, 8: 4395 }; // For households > 8, add $449 per additional person function getFPLMonthly(size) { if (size 20) errors.push("Household Size must be between 1 and 20."); if (!stateLimitSel) errors.push("Please select a State Medicaid Income Limit."); if (stateLimitSel === 'custom' && (isNaN(customLimit) || customLimit 0) { resultDiv.style.display = 'block'; resultDiv.className = 'calc-result calc-error'; resultDiv.innerHTML = 'Please fix the following errors:' + errors.map(function(e){ return ''; }).join('') + ''; return; }

// --- Core Calculations ---

// Step 1: Determine monthly income limit var monthlyIncomeLimit; var limitLabel; if (stateLimitSel === 'custom') { monthlyIncomeLimit = customLimit; limitLabel = '$' + customLimit.toFixed(2) + ' (custom)'; } else { var fplPct = parseInt(stateLimitSel); var fplBase = getFPLMonthly(householdSize); monthlyIncomeLimit = (fplBase * fplPct) / 100; limitLabel = fplPct + '% FPL = $' + monthlyIncomeLimit.toFixed(2); }

// Step 2: Calculate countable income // Standard Medicaid earned income disregard: first $65 earned + 1/2 of remainder // This calculator uses the user-supplied earned deduction (they may have already calculated it) // plus any other deductions var totalDeductions = earnedDeduction + otherDeductions; var countableIncome = Math.max(0, grossIncome - totalDeductions);

// Step 3: Monthly spend-down amount var monthlySpendDown = Math.max(0, countableIncome - monthlyIncomeLimit);

// Step 4: Period spend-down total var periodSpendDown = monthlySpendDown * period;

// Step 5: Remaining spend-down after applying existing bills var remainingSpendDown = Math.max(0, periodSpendDown - existingBills);

// Step 6: Determine coverage status var coverageStatus; var coverageClass; if (monthlySpendDown === 0) { coverageStatus = "✅ You likely qualify for Medicaid without a spend-down obligation."; coverageClass = "color:#1a7a1a;"; } else if (remainingSpendDown === 0) { coverageStatus = "✅ Your existing unpaid medical bills fully satisfy the spend-down. Medicaid coverage may begin now."; coverageClass = "color:#1a7a1a;"; } else { coverageStatus = "⚠️ You have a remaining spend-down obligation before Medicaid coverage activates."; coverageClass = "color:#b85c00;"; }

// Step 7: Effective income after spend-down (for informational purposes) var billsApplied = Math.min(existingBills, periodSpendDown);

// --- Output --- resultDiv.style.display = 'block'; resultDiv.className = 'calc-result'; resultDiv.innerHTML = '### Spend-Down Results ' + '' + coverageStatus + '

' + '' + 'Monthly Gross Income' + '$' + grossIncome.toFixed(2) + '' + 'Total Allowable Deductions' + '− $' + totalDeductions.toFixed(2) + '' + 'Countable Monthly Income' + '$' + countableIncome.toFixed(2) + '' + 'State Income Limit (' + limitLabel + ')' + '$' + monthlyIncomeLimit.toFixed(2) + '' + 'Monthly Spend-Down Amount' + '$' + monthlySpendDown.toFixed(2) + '' + 'Spend-Down Period' + '' + period + ' month(s)' + 'Total Period Spend-Down' + '$' + periodSpendDown.toFixed(2) + '' + 'Existing Bills Applied' + '− $' + billsApplied.toFixed(2) + '' + 'Remaining Spend-Down Obligation' + '$' + remainingSpendDown.toFixed(2) + '' + '' + (monthlySpendDown > 0 ? 'Once you incur and document $' + remainingSpendDown.toFixed(2) + ' in additional qualifying medical expenses during the ' + period + '-month period, Medicaid coverage activates for the remainder of that period.

'
'') + 'Results are estimates. Verify with your state Medicaid office.

'; };

})();

#### Formula

Step 1 — Countable Income: Countable Income = Gross Income − Earned Income Deduction − Other Allowable Deductions

Step 2 — Monthly Spend-Down: Monthly Spend-Down = max(0, Countable Income − State Monthly Income Limit)

Step 3 — Period Spend-Down: Period Spend-Down = Monthly Spend-Down × Number of Months in Period

Step 4 — Remaining Obligation: Remaining Spend-Down = max(0, Period Spend-Down − Existing Unpaid Medical Bills)

Standard Earned Income Disregard (SSI-related Medicaid): Earned Deduction = $65 + (Earned Income − $65) ÷ 2 Enter this pre-calculated value in the "Earned Income Deduction" field.

FPL-Based Income Limit: Monthly Limit = (2024 FPL for Household Size × State FPL%) ÷ 12

#### Assumptions & References

More Calculators

References

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