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.
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
- Federal Poverty Level figures use 2024 HHS guidelines for the 48 contiguous states and D.C. (Alaska and Hawaii have higher FPL thresholds).
- The standard earned income disregard for SSI-related Medicaid is $65 plus one-half of remaining earned income per 42 CFR § 435.831.
- Spend-down (also called "surplus income program") rules are governed by 42 CFR § 435.831 and vary by state; not all states operate a spend-down program.
- Qualifying medical expenses that count toward spend-down include: unpaid bills from prior periods, current-period medical costs, health insurance premiums, and certain remedial care costs.
- Spend-down periods are typically 1 or 6 months; some states use 3-month periods.
- This calculator does not account for asset/resource limits, which are a separate Medicaid eligibility criterion.
- MAGI-based Medicaid (ACA expansion, children, pregnant women) does not use a spend-down; this calculator applies to aged, blind, and disabled (ABD) Medicaid populations.
- Results are estimates only. Always verify with your state Medicaid agency or a qualified benefits counselor.
- References: Medicaid.gov Eligibility; HHS Poverty Guidelines; 42 CFR §§ 435.121, 435.831.