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Medicaid Excess Income Program

New York State Department of Health Launches Medicaid Excess Income Program Website

New York State Department of Health has launched a new web page entitled “Medicaid Excess Income Program.” It provides consumers with information about this program, which is often referred to as the “Spend-down Program” or the “Surplus Income Program.”

The “Medicaid Excess Income Program” provides assistance with medical bills for those individuals whose monthly income is over the Medicaid level. Consumers are eligible for this program if they can demonstrate that they have medical bills equal to their excess income in any particular month. Medicaid will then pay their additional medical bills beyond that income level for the rest of that month.

The new web page was designed in collaboration with a working group of advocates. The group includes the three organizations that sponsor the New York Health Access website – Empire Justice Center, Legal Aid Society, and Self-help Community Services – along with the Center for Independence of Disabled of New York (CIDNY), the National Center for Law and Economic Justice, and the Medicare Rights Center.

This group was created in response to a report issued in May 2009 by the New York State Health Foundation titled Streamlining New York’s Excess Income Program, written by Manatt Health Solutions. The report outlined the complexity of the Excess Income Program. The report also indicated that 40 percent of those eligible for this program have great difficulty every month complying with the bureaucratic steps necessary to obtain Medicaid. The working group of advocates reacted to this report and urged changes. These changes were endorsed by 48 different organizations.

The goal was to affect  changes that would increase access to Medicaid for those allowed to “spend down”  excess income to qualify, specifically people age 65+, people with disabilities,  and children under 21 and their parents/caretaker relatives.

This new web page is the result of these efforts. It presented in a helpful Question and Answer format. The changes to the web site significantly improve public information about the Excess Income Program. Importantly, the web site explains the following facts:

  • Unpaid medical bill can be used to meet the spend-down.
  • Past unpaid medical bills as well as recent paid medical bills can be used to meet the current and future spend-down.
  • Bills paid by the EPIC and ADAP programs- in addition to co-payments paid by recipients for prescriptions paid by these programs – can be used to meet the current and future spend-down.
  • Bills of certain family members can be used to meet one’s spend-down.
  • People with disabilities who find it difficult to go into a DSS/Medicaid office have a right to submit by bills by fax as a reasonable accommodation for a disability, and that in some districts, including New York City, anyone can fax in bills. (For information about faxing bills in New York City, see this page for forms and instructions).

If you would like more information about this program, or if you would like training materials, sample notices, etc., please refer to the spend-down web page.