Do I qualify for New York State's Medicaid Excess Income Program?

The Medicaid Excess Income Program, also known as "Spenddown" or "Surplus Income" Program, is a Medicaid program designed to assist individuals who have income that exceeds the eligibility limits for regular Medicaid but still have high medical expenses. This program allows individuals to "spend down" their excess income on medical bills to qualify for Medicaid coverage. Under this program, individuals can use their excess income to pay for medical expenses such as doctor visits, prescriptions, hospital bills, and other healthcare costs.

To participate in the Medicaid Excess Income Program in New York State, you must meet certain eligibility criteria and follow specific guidelines:

1. Income Limits: You must have income that exceeds the regular Medicaid income limits in New York State. The excess income is then used to meet the "spenddown" requirement.

2. "Spenddown" Requirement: The "spenddown" is the amount of excess income you must "spend down" on medical bills before you become eligible for Medicaid coverage. The "spenddown" is determined based on a calculation that takes into account your income and certain allowable deductions.

3. Medical Expenses: You must provide documentation of their medical expenses to show that you have incurred eligible costs. This includes bills, receipts, and other relevant documentation. The medical expenses must be related to your health condition and meet the program's guidelines.

4. Monthly Reporting: You are required to report your medical expenses and any changes in income on a monthly basis to the local Medicaid office. It is important to keep track of all medical bills and expenses and report them accurately.

5. Retroactive Coverage: The Medicaid Excess Income Program may provide retroactive coverage for up to three months prior to the month of application if you had eligible medical expenses during that period.

It's important to note that the Medicaid Excess Income Program can be complex, and the eligibility rules and requirements may vary based on individual circumstances. To get detailed information and guidance specific to your situation, it is advisable to contact the local Medicaid office or speak with a Medicaid eligibility specialist in New York State.