Medicaid Spend-Down Calculator

Estimate your Medicaid spend-down amount for 2026 based on your income, medical expenses, and state's income limit.

If your income is too high for standard Medicaid, spend-down lets you qualify anyway by using medical expenses to reduce your countable income to your state's limit. That limit varies enormously, from a national median of about $563/month to over $1,300/month in some states, so check your exact figure before relying on this estimate.

Medicaid spend-down works like a deductible: once your medical expenses for a set period reach a certain amount, coverage kicks in for the rest of that period. Because the income threshold varies so much by state, start with your state's actual figure if you know it, or use the national median as a rough starting point.

Medically Needy Pathway (34 States)

Estimate Your Spend-Down Amount

⚠ This is a national median, not your state's actual limit. Using the wrong figure here can meaningfully change your result.

Thirty-four states offer this pathway, called medically needy, specifically for people whose income is above the standard Medicaid limit but who have significant medical expenses. The math works by comparing your income to your state's Medically Needy Income Level, or MNIL. Whatever you make above that level is your spend-down target for the period, and your qualifying medical expenses, doctor visits, hospital bills, prescriptions, insurance premiums, count against that target. Once your expenses meet or exceed the target, Medicaid coverage applies for the rest of that budget period, which is typically one, three, or six months depending on your state. The MNIL itself is where this gets genuinely variable. The national median is around $563 a month, but some states set it well over $1,300, more than double that. There's no substitute for knowing your specific state's number here, since using the wrong figure could significantly overstate or understate what you actually need to spend down.

Frequently Asked Questions

How does Medicaid spend-down work?

If your income is above your state's Medicaid limit, you can still qualify by using medical expenses to reduce your countable income down to your state's Medically Needy Income Level. Once your medical bills for a period equal the excess amount, Medicaid coverage applies for the rest of that period.

What is the Medically Needy Income Level (MNIL)?

The income threshold used in the spend-down pathway. It's set independently by each state and varies enormously, from a national median around $563/month to well over $1,300/month in some states.

What counts toward my Medicaid spend-down?

Medical and remedial care expenses, including doctor visits, hospital bills, prescriptions, and health insurance premiums, generally count. Specific rules on what qualifies vary by state.

How long is a Medicaid spend-down budget period?

It varies by state, commonly 1, 3, or 6 months. Once you meet your spend-down target within that period, coverage applies for the rest of it, then the process resets for the next period.

Do all states offer a Medicaid spend-down option?

No. As of 2026, 34 states offer a medically needy pathway with spend-down. States without this option may have other ways to qualify with high medical expenses, so check with your state Medicaid agency.

Is spend-down the same as a deductible?

The concept is similar: you're responsible for costs up to a certain amount before coverage kicks in, though the specific mechanics and timing differ from private insurance deductibles.

This calculator uses a national median Medically Needy Income Level as a default, which does not reflect your specific state's actual figure. Spend-down rules, budget periods, and what counts as a qualifying medical expense all vary by state. This is a general estimate only and does not constitute a determination of eligibility. For an official determination, contact your state Medicaid agency.