Medicaid Planning
Medicaid Spend-Down: How to Qualify When Income Is Too High (2026)
Medically needy spend-down pathways, excess income trusts, and state variations for nursing home and waiver Medicaid.
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Spend-down allows applicants whose income exceeds Medicaid limits to become eligible by incurring medical expenses that reduce countable income to the state threshold. This is common for nursing home Medicaid and some waiver programs.
How spend-down works
- State sets a monthly income limit (often ~$2,829 for LTC)
- Medical bills and care costs count toward reducing excess income
- Once spend-down amount is met, Medicaid coverage may begin for the month
- Rules vary — New York and California differ significantly from Texas or Florida
Check your state limits
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- District of Columbia
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