Medicaid Spend-Down Calculator

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

Reviewed by the SGB Team · Last updated October 2026

If your income is too high for regular Medicaid, a spend-down lets you qualify by counting medical expenses against the income above your state's limit. The limit differs widely by state, from a national median of about $563 a month to more than $1,300 in some states. Find your state's figure before you rely on this estimate.

A spend-down works like a deductible. Once your medical expenses in a set period reach a certain amount, Medicaid covers the rest of that period. Enter your state's income limit if you know it, or start with the national median.

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.

Who can use it. Thirty-four states have a "medically needy" pathway for people whose income is above the regular Medicaid limit and who have large medical expenses.

The calculation. Your income above the state's Medically Needy Income Level (MNIL) is your spend-down amount for the budget period. Qualifying medical expenses count against it: doctor visits, hospital bills, prescriptions and health insurance premiums, including Medicare premiums. When your expenses reach the amount, Medicaid covers the rest of the period.

Example. Your countable income is $1,400 a month and your state's MNIL is $563. The excess is $837 a month. If your state uses a three-month budget period, you need $2,511 in medical expenses before Medicaid starts paying for the rest of those three months.

It repeats. Budget periods are one, three or six months depending on the state. Meeting the amount in one period does not carry over, so you meet it again in the next.

Unpaid bills can count. In many states a medical bill you owe counts toward the spend-down even if you have not paid it. Keep every bill and ask your state agency what it accepts.

The MNIL varies a great deal. The national median is about $563 a month, and some states set it above $1,300. Using the wrong figure will give a misleading result, so get your state's number from the state Medicaid agency.

States without a medically needy pathway generally use a Qualified Income Trust for long-term care. See Medicaid spend-down: what it means and common myths.

Frequently Asked Questions

How does Medicaid spend-down work?

If your income is above your state's Medicaid limit, you can still qualify by counting medical expenses against the income above your state's Medically Needy Income Level. Once your medical bills for a period equal that excess, Medicaid covers the rest of the period.

What is the Medically Needy Income Level (MNIL)?

It is the income threshold used for spend-down. Each state sets its own, and it ranges from a national median of about $563 a month to more than $1,300 in some states.

What counts toward my Medicaid spend-down?

Medical and remedial care expenses generally count, including doctor visits, hospital bills, prescriptions and health insurance premiums. The details differ by state.

How long is a Medicaid spend-down budget period?

It depends on the state and is commonly 1, 3 or 6 months. After you meet the spend-down amount in a period, coverage applies for the rest of it, and the count starts again in the next period.

Do all states offer a Medicaid spend-down option?

No. As of 2026, 34 states have a medically needy pathway with spend-down. Other states may have different ways to qualify with high medical expenses, so ask your state Medicaid agency.

Is spend-down the same as a deductible?

It is similar. You are responsible for costs up to a set amount before coverage begins. The timing and rules differ from a private insurance deductible.

This calculator uses a national median Medically Needy Income Level as its default, which is not your state's figure. Spend-down rules, budget periods and qualifying medical expenses differ by state. This is a general estimate, not a determination of eligibility. For an official decision, contact your state Medicaid agency.