What is a Spend Down?

Medicaid eligibility is granted when spend down is met. Spend down means you spend your remaining money on qualified expenses to meet the Medicaid income guidelines. 

Iowa Spend Down Policy

In Iowa, the spend down is calcluated for a two-month period. Once one has met the required "spend down," they may be Medicaid eligible. 

Learn more about income limits and eligibility.

You may also explore Medical Assistance Income Trusts (MAITs) that help if moving to a nursing home or long-term care facility.

Income You Can Spend Down

Income is money you get on a regular basis. If you need to spend down, talk to your local HHS office about qualifications and rules.

In addition to your salary or pay you get for work, Medicaid can consider the following as sources of income:

• Social security retirement payments
• Social security disability payments
• Veterans benefits
• Pensions / retirement
• Interest from bank accounts and certificates of deposit
• Dividends from stocks and bonds

Examples of Accepted Spend Down

You may spend down on:

• Medications
• Paid or unpaid medical bills
• Nursing home care
• Health-related home renovations, such as ramps or chair lifts
• Transportation to medical appointments

Always keep copies of your medical bills and receipts for any health care-related spending. You may need to show this during your Medicaid approval process.

What if I don't spend down enough?

If you can't spend down your income during the spend down period, you may lose coverage or not be accepted to Medicaid. A case worker can answer questions you have about coverage and next steps.