A Spend Down:
What is a Spend Down?
For an individual receiving Supplemental Security Income (SSI) and/or Medicaid, a “Spend Down” literally refers to spending excess money that he/she receives within a calendar month to maintain eligibility for public benefits. This is allowable because SSI determines a lump sum of money to be considered income only in the month received if it is spent within that same calendar month (SI 01110.600). In most states, that means that on the last day of the same calendar month that the funds were received the recipient can have not a penny more than the resource limit, which is generally $2,000 for an unmarried individual and $3,000 for a married couple. For example, if John Doe, an unmarried individual, is on SSI and receives $28,000 dollars on September 12th, he must spend down his total resources to $2,000 dollars before October 1st.
What Can a Recipient Spend Their Funds On?
Florida Medicaid services are administered by the Agency for Health Care Administration. The Department of Children and Families or the Social Security Administration (for individuals who receive Supplemental Security Income (SSI) determines the eligibility for Medicaid in the state of Florida.
States known as “1634” states are states that have completed a “1634 agreement” with the Social Security Administration. This agreement determines eligibility for a specific state’s Medicaid program for Supplemental Security Income (SSI) recipients. This is known as categorical eligibility. The agreements are only with states that use Supplemental Security Income (SSI) criteria to determine Medicaid eligibility. In other words, individuals who receive Supplemental Security Income (SSI) in those states receive Medicaid automatically. Individuals do not need to apply for Medicaid benefits separately.
William E. Lindahl, MBA, CLPF