The Medicaid Excess Income Program also known as the "Medicaid Spenddown Program" or the "Medicaid Surplus Income Program" offers Medicaid coverage to individuals whose net monthly income is above the Medicaid income limits and who meet all other Medicaid eligibility requirements.
Applicant must first apply for Medicaid. If applicant’s income is too high, the Human Resources Administration (HRA) will inform applicant of the amount of income that is over the allowable Medicaid levels. Applicants must belong to one of the following categories:
- Individuals over 65 years old;
- Children under 21 years old;
- Parents living with children under 21 years old; or
- Individuals receiving disability income or determined disabled by Medicaid
Applicants Must Meet Other Medicaid requirements:
- Residency: Must be a New York State resident;
- Citizenship/Immigration Status: Can be a U.S. citizen or fall under one of many immigration categories. Undocumented immigrants and people on short-term visas who are not in the process of applying for permanent status are not eligible.
- Assets: The resource (asset) test applies to applicants/recipients who are aged (65 or older), certified blind or certified disabled.
- Income: Applicant’s income is above the standard Medicaid income levels indicated below.
|This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.|
|For each additional person add:
NOTE: Chart effective January 1, 2013; subject to annual income updates.
|* The resource test applies to applicants/recipients who are aged (65 or older), certified blind or certified disabled.|
What Benefits are Covered by the Medicaid Excess Income Program?
This program provides the same medically necessary care generally covered by Medicaid including:
- Regular checkups;
- Hospital inpatient and outpatient services;
- Emergency room care;
- Prescription drugs;
- Specialist care;
- Home health care;
- Nursing home care;
- Dental care;
- Prenatal care;
- Smoking cessation agents;
- Medical supplies and equipment.
How to Obtain Services Using Medicaid Excess Income Program
Individuals can obtain services in one of two ways listed below:
- Present paid or unpaid medical bill equal to the monthly surplus amount to qualify for Medicaid coverage. An individual can present bills either in person or by mail. HRA will give specific instructions at the time of acceptance into the Medicaid Excess Income program; or
- Pay HRA the amount of surplus income. Once payment is made to HRA, applicant will be given coverage for the month he or she is paying for, and will not have to wait until a medical bill is incurred.
How to Enroll in the Medicaid Excess Income Program
Enrollment counselors will first screen applicants for Medicaid. Counselors are located at Medical Assistance Program Offices, community-based organizations, hospitals and health plans to assist individuals in filling out an application. It is important to see an enrollment counselor to assist you with the application process because many factors other than those noted above are considered to determine eligibility, including child and disabled care expenses as well as housing expenses. HRA makes the final determination for eligibility for this program.
Find out where you can enroll in your neighborhood.
Other Helpful Resources
For more information regarding this and other Medicaid programs, please contact an agency listed below:
Human Resources Administration at 1-718-557-1399
New York State Department of Health at 1-800-541-2831or visit its website at New York State Department of Health