The Medically Needy Pathway, more commonly known as the Spend-Down Program, allows individuals with high medical expenses and monthly income over the state Medicaid limit to achieve Medicaid eligibility. Income eligibility is generally based on the federal poverty level (FPL). In Missouri, the medically needy income limit (MNIL) is $1,109 for an individual and $1,499 for a couple. The medically needy asset limit is just over $6,000 for an individual and just over $12,000 for a couple. However, the income standard and financial eligibility criteria change from year to year.
When a person needing Regular Medicaid coverage or nursing home Medicaid coverage is over the income limit, their excess income can be spent on medical expenses as a sort of deductible paid towards the cost of care. The spend down period is one month, so they will then be eligible for Medicaid benefits for the remainder of the month. Countable income includes Social Security, Supplemental Security Income (SSI) and pensions. Countable medical expenses include health insurance premiums like Medicare, prescription drugs, durable medical equipment, medical services, and other medical bills, like hospital bills.
In Missouri, the Medically Needy Program is available to seniors, pregnant women, children under 18, and people with disabilities. It should be noted that Missouri does not permit the Medically Needy Pathway program to be used alongside home and community based services (HCBS) and other waiver programs.