Spend Down

What is Spend Down?

MO HealthNet for the Elderly, Blind, and Disabled with a Spend Down allows consumers who have income above the income level for MO HealthNet for Disabled (Medicaid) to qualify for coverage. The Spend Down amount is the amount of income that is above the income maximum. For 2020 the income limit for the elderly and disabled is $885 for an individual and $1,198 for a couple.

MO HealthNet for the Elderly, Blind, and Disabled Income Deductions

The following income deductions are allowed:

  • The first $65 of earned income
  • One-half of remaining earned income
  • A $20 personal income exemption
  • All SSI payments
  • Health insurance premiums
Spend Down Calculator

This tool can be used to see how different earned income amounts impact the consumer's premium and eligibility for the Ticket to Work Health Assurance program.

Spend Down and Ticket to Work Health Assurance Calculator

By entering the amounts of income the individual has if not working and the anticipated amount of earned income, the calculator will show an estimated Spend Down or TWHA premium. 

Unlike a premium the Spend Down can be met in different ways:

Making a monthly payment to the MO HealthNet Division

The consumer may send a payment (check, money order, or cashiers check) to the MO HealthNet Division. The consumer will have coverage for the whole month that they pay for.

  • MO HealthNet Division

    PO Box 808001

    Kansas City, MO 64180-8001
  • You must put your MO HealthNet number (case number) on the check or money order. You should mail your payment along with the invoice stub for the month you want to pay. If you do not have the correct invoice stub to send you must write on the check or money order what month you are paying for.

The consumer may have the payment taken directly out of their bank account on the 10th of each month by the MO HealthNet Division to pay for their Spend Down for the following month.

Applying incurred medical expenses

The consumer or a provider can submit bills for medical services which the client is personally responsible for or which are billable to DMH. Coverage will begin the day the client reaches the Spend Down amount. MO HealthNet will not pay this amount to the providers who provided service. For the day Spend Down is met with bills MO HealthNet will only pay for services over the Spend Down amount. If meeting Spend Down with incurred medical expenses, send to the FSD Spend Down unit by fax, scan and email, or mail:

  • fax: 855-600-3754
  • email: sesd@ip.sp.mo.gov

    Family Support Division

    16798 Oakhill Drive

    Suite 600

    Houston, MO., 65483

Bills cannot be used if the Spend Down has been met with automatic withdrawal. 

If the Spend Down is not met for a month the consumer's MO HealthNet for Disabled case will remain open but they will not have coverage for that month. MO HealthNet allows up to a year to meet the spend down either through pay-in or bills.

What are the benefits Spend Down if the Spend Down is too expensive to be met?

Even if the consumer normally cannot meet spend down, by maintaining an open case the consumer is protected in the event of an unexpected medical expense. The spend down can be met at any time during the month either with bills or by payment, and previous months within the past year can also be met. There are no penalties for not meeting the Spend Down. For children who are on the wait list for the MOCDD waiver having an open case will speed up the process of getting them approved once they are given a waiver slot.