Missouri MO HealthNet Guidance
Missouri Medicaid Spend Down Explained
Learn how Missouri spend down eligibility works, how coverage becomes active and why the process may need to be completed again each month.
What Is a Medicaid Spend Down?
Missouri’s Spend Down Program applies to certain people seeking MO HealthNet for the Aged, Blind and Disabled whose countable income is above the applicable program limit.
The Family Support Division calculates a monthly spend-down amount based on the person’s individual eligibility information. The participant must meet or pay that amount before MO HealthNet coverage becomes active for the applicable period.
Who Is Missouri Spend Down Designed to Help?
The program may be available when a person’s income is above the regular MO HealthNet limit but the person otherwise qualifies under an aged, blind or disabled eligibility category.
Adults Age 65 or Older
Seniors whose income is above the regular MO HealthNet limit may be evaluated for Spend Down coverage.
People With Disabilities
People who satisfy Missouri’s disability and other eligibility requirements may qualify through the Spend Down pathway.
People Who Are Blind
People who meet the applicable blindness and financial requirements may also be evaluated for Spend Down coverage.
How a Spend Down Can Work
The following example uses hypothetical numbers only. It does not represent Missouri’s current income limit or determine anyone’s actual eligibility.
Example: $300 Monthly Spend Down
The participant receives an official approval letter and monthly invoice showing the amount.
The spend down has not yet been reached.
Total qualifying expenses are now $320, so the $300 spend down has been reached.
After FSD verifies the expenses, MO HealthNet coverage can be activated from that date through the end of the month.
How Can You Meet or Pay a Spend Down?
Missouri currently provides four primary ways to meet or pay the monthly amount.
Pay Online
You can create an account through the MO HealthNet Portal and pay using an accepted electronic payment method.
Missouri advises that an online payment is captured in real time and generally provides coverage beginning the day after payment.
Visit the MO HealthNet Portal →Pay by Mail
Send the applicable invoice section with a check or money order. Include the case number and the month being paid. Do not mail cash.
MO HealthNet DivisionPremium Collections Unit
P.O. Box 808001
Kansas City, MO 64180-8001
Automatic Withdrawal
Approved automatic withdrawals are taken on the 10th of the month for the following month’s coverage. Missouri advises allowing approximately 30 days for enrollment or account changes to process.
Automatic Withdrawal Information →Submit Medical Expenses
Submit qualifying bills or expenses for review. After FSD verifies that the required amount was reached, coverage generally begins on the date the spend down was met.
Open the Spend Down Participant Form →What Medical Bills Can Be Submitted?
Missouri states that bills for medical services received by you or your spouse may qualify when you are personally responsible for the expense. The bill may qualify even if it has not yet been paid.
Examples of Potentially Qualifying Expenses
- Prescription medications
- Doctor and specialist services
- Hospital and emergency services
- Laboratory work and medical testing
- Dental care
- Eye care services and eyeglasses
- Mental health services and counseling
- Certain chiropractic expenses
Equipment and Support Services
- Doctor-prescribed oxygen
- Nebulizers
- Hearing aids
- Prosthetic devices
- Wheelchairs
- Walkers or crutches
- Certain personal-care services
- Certain adult day-care services
When Does MO HealthNet Coverage Begin?
The effective date depends on how the spend down is met.
When Using Medical Bills
Coverage generally begins on the date the accumulated qualifying medical expenses reach the required spend-down amount. Coverage can then continue through the last day of that month.
Expenses incurred before the spend down was reached generally remain the participant’s responsibility.
When Paying the Amount
The effective date depends on the payment method and when Missouri receives or processes the payment. Online payment is generally the fastest option when coverage is needed quickly.
Automatic withdrawal on the 10th is intended to provide coverage for the following month.
Do You Have to Meet Spend Down Every Month?
No. You are not required to meet or pay the spend down every month. However, you generally will not have active MO HealthNet coverage for a month in which the spend down is not paid or met.
This can result in coverage being active during some months but not others. That distinction can affect:
- Whether MO HealthNet will consider claims for a particular date
- Medicare deductibles, copayments and coinsurance
- Access to Medicaid-covered services
- Prescription assistance and Extra Help records
- Eligibility for certain dual-eligible Medicare plans
What If You Do Not Have Enough Bills This Month?
Missouri allows certain medical expenses to be combined across months through a process called carryover.
According to Missouri’s current Spend Down FAQ, qualifying bills from the current month or any of the three previous months may potentially be carried forward and applied to the current month or one of the next three months.
How Does Spend Down Affect Someone With Medicare?
Medicare remains the primary payer for Medicare-covered services. MO HealthNet may consider eligible remaining expenses only when Medicaid coverage is active for the date of service and the service satisfies program rules.
If you have Medicare, submit bills showing what remains after Medicare, Medicare Advantage or other insurance has processed the claim.
Medicare Cost Sharing
Do not assume MO HealthNet will pay every Medicare deductible or copayment. Payment depends on active coverage, Medicaid eligibility category, provider billing and applicable state payment rules.
D-SNP Eligibility
A Spend Down case does not automatically guarantee continuous eligibility for every Dual Eligible Special Needs Plan. The plan must verify the Medicaid category and eligibility record it accepts.
Where Can You Send Spend Down Bills?
Missouri provides several ways to submit the participant form and supporting documentation.
Online participant form:
Submit the MO HealthNet Spend Down Participant Form
Document upload:
mydssupload.mo.gov/UploadPortal
Email:
FSD.IM.SPENDDOWNDOCS@DSS.MO.GOV
Fax:
855-600-3754
Spend Down Unit
16798 Oak Hill Drive, Suite 600
Houston, MO 65483
Common Spend Down Mistakes
Assuming Coverage Is Already Active
Approval for the program does not necessarily mean coverage is active for every date. Verify that the month’s spend down was met or paid.
Submitting the Full Provider Charge
When another insurer is involved, use documentation showing the amount you owe after that insurer processes the claim.
Expecting Medicaid to Pay the Spend-Down Portion
The bills used to meet the spend down remain your responsibility. MO HealthNet generally considers eligible expenses over the required amount.
Failing to Keep Proof
Missing bills, receipts, dates of service or insurance explanations can delay FSD’s review and activation of coverage.
Paying Twice
If you pay the monthly amount and also pay medical expenses, Missouri generally does not refund the spend-down payment. A provider may choose to refund an eligible payment and bill MO HealthNet, but is not required to do so.
Ignoring Eligibility Notices
Changes in income, household information, Medicare premiums or other circumstances can change the required amount. Read every FSD notice.
What If the Spend Down Amount Looks Wrong?
The Family Support Division calculates the official amount. If you believe income, medical deductions, household information or another eligibility factor was processed incorrectly, contact FSD and request an explanation.
Missouri states that applicants generally have the right to request a hearing within 90 days after approval or a change in the spend-down amount.
FSD Information Center:
855-373-4636
Spend Down questions:
855-600-4412
Payment receipt or automatic withdrawal questions:
877-888-2811
Missouri Spend Down Questions
Is a Medicaid spend down a penalty?
No. It is an eligibility pathway for certain people whose income is above the regular MO HealthNet limit. The required amount represents the income that must be offset by qualifying medical expenses or paid before coverage becomes active.
Do the medical bills have to be paid first?
Not always. Missouri permits certain medical bills that you or your spouse incurred and remain responsible for paying, even if those bills have not yet been paid.
Who pays the bills used to meet spend down?
You remain responsible for the portion used to meet the required amount. MO HealthNet generally considers eligible covered expenses above the spend down after coverage becomes active.
Does coverage begin on the first day of the month?
Not necessarily. When medical bills are used, coverage generally begins on the date the qualifying expenses reach the spend-down amount. Payment methods can produce a different effective date.
Do I have to meet spend down every month?
No. However, you generally will not have active MO HealthNet coverage for a month in which the required amount is not paid or met.
Can my spouse’s medical bills count?
Missouri states that qualifying bills for services received by you or your spouse may be submitted when you are responsible for paying them. FSD makes the final determination.
Can older medical bills be carried forward?
Certain bills from the current month or three previous months may potentially be carried forward and applied under Missouri’s carryover rules. Submit the documentation to FSD for review.
Can I pay my spend down by telephone?
No. Missouri does not accept spend-down debit or credit card payments by telephone. Electronic payment is available through the MO HealthNet Portal.
Does spend down automatically pay my Medicare Part B premium?
No. Medicare Savings Programs such as QMB or SLMB are separate eligibility determinations. Ask FSD whether you were also evaluated for assistance with the Part B premium.
Can a Medicare broker determine my Medicaid eligibility?
No. Medicaid eligibility and the official spend-down amount are determined by Missouri’s Family Support Division. A Medicare broker can help explain how an active Medicaid status may interact with Medicare coverage.
Continue Learning About Medicare and Medicaid
Need Help Understanding How Spend Down Affects Medicare?
Missouri’s Family Support Division controls Medicaid eligibility and spend-down processing. Benjamin Thompson can help you understand how an active or inactive MO HealthNet status may affect your Medicare plan, Medicare cost sharing, Extra Help or D-SNP eligibility.
I’m an expert problem solver, not a high-pressure salesman. Consultations are available at no cost and without obligation.
This page provides general educational information about Missouri’s MO HealthNet Spend Down Program. Thompson Medicare Brokerage does not determine Medicaid eligibility, activate Medicaid coverage, process Spend Down payments or provide legal advice. Program rules, covered services, eligibility amounts, forms, addresses and procedures may change. Confirm your individual status and responsibilities directly with the Missouri Family Support Division or MO HealthNet.