I am not eligible for Supplemental Security Income (SSI), but my medical bills are so large that I don’t have the income to pay them. Can I receive any assistance?

You may be able to receive Medicaid assistance. Medicaid is need-based, so you must meet an income and possibly an asset requirement to qualify. There are several different kinds of Medicaid, each with different eligibility requirements. The following information applies to people who are low-income and Medically needy. 

Income Requirement

In West Virginia, if you are eligible for SSI, you also meet the income requirement for Medicaid. However, you do not have to receive SSI to be eligible. If you are at least 65 years old, Medicaid allows you to spend down some of your income to meet the Medicaid income requirement. 

Spend down works very much like a deductible. Medicaid will calculate your spend down amount every six months. This six-month period is called the Period of Consideration (POC). Medicaid pays everything after the date the spend down amount has been met during the POC. You are responsible for the spend down amount. 

To calculate the spend down amount, Medicaid uses a Medically Needy Income Limit (MNIL). The MNIL for one person is $200 per month. The MNIL for a couple is $275 per month. The MNIL represents the amount of income needed for monthly living expenses. 

Next, Medicaid subtracts the MNIL, or $200, from your countable income. Medicaid then multiplies that number by six. This amount is your spend down amount. Medicaid will pay your medical bills that exceed this amount. You can also use your spouse’s or dependents’ medical bills to meet the spend down, provided that they live in your home. The idea is that you should spend, or incur and be responsible for paying, all of your income above the $200 MNIL on your medical bills before you receive Medicaid benefits. 

For example, say you have a countable income of $500 per month. This is $300 more than the $200 MNIL. Multiply the $300 by six months. This gives you a total of $1,800. This is your spend down amount for the POC. 

Let’s also say that you pay or incur $5,000 of medical bills during the POC. Medicaid will then pay your medical expenses after your $1,800 spend down amount has been met. That means that Medicaid will pay $3,200 of your medical bills. You are responsible for the spend down amount, or $1,800. In essence, you are responsible for the first $1,800 before Medicaid pays. This is why the spend down is like a deductible. 

However, spend down is unlike a deductible in that you do not have to actually pay the total spend down amount before Medicaid pays your medical bills, you only have to incur medical expenses equal to or greater than the spend down amount and be responsible for them. You may not use old medical bills twice to count toward your spend down amount. If you use an old medical bill toward your spend down amount you may not use it again, regardless of whether you actually pay it. 

Asset Requirement

Once you meet the income requirement, you must also meet the asset requirement. There is no asset test or Medically needy test for eligibility for the Medicaid expansion created under the Affordable Care Act, only income is considered. 

For more information, see: West Virginia Department of Health and Human Resources, Income Maintenance Manual, §§10.22(D)(11), 16.9, Chapter 10, Appendix A, http://www.wvdhhr.org/bcf/family_assistance/policy.asp (last visited May 26, 2015).