Medically Needy

If your income is too high for Medicaid but your medical costs are so high that it uses up most of your income, you may qualify for some payment help through the Medically Needy plan.  If you qualify you are responsible for paying some of the costs of your medical expenses.

You may be able to get Medically Needy if: 

• you have too much income or too many resources (assets) to get regular Medicaid, but
• not enough to pay your medical bills. 

Medically Needy may not pay all of your medical bills. You may still have to pay some of your medical bills.

For more information, download the Medically Needy brochure.

Eligibility

You may be eligible for Medically Needy plan with these circumstances:

Pregnant women if:

• Family income is over 300% of the federal poverty limits (FPL) for a household of the same size. This includes the unborn baby.
• Family resources are not more than $10,000. People under age 21 if family income is over the income limit for regular Medicaid.

People who are aged, blind or disabled who:

• Would be eligible for SSI (Supplemental Security Income) except that income or resources (assets) are over the limit, and;
• Are age 65 or older, or
• Are legally blind as defined by Social Security, or
• Are disabled as defined by Social Security.

Adults who care for dependent children under age 18 or age 19 and still in school, if:

• They are the parent, aunt, uncle, grandparent or disabled stepparent of a dependent child, and
• Their income is over the income limit for Medicaid for families, or their resources (assets) are over the resource limit for Medicaid for families.

Income Guidelines

Earned and unearned income of all persons who might be eligible for Medically Needy and persons who are considered responsible relatives are counted.

• The MNIL is the Medically Needy Income Level. If your total net countable income is equal to or less than the MNIL, all eligible members of your family will get Medicaid without a spend-down.
• Note: Net countable income is your gross income after deductions that DHS allows.

If your total net countable income is more than the MNIL, you will need to meet a spend-down before you get Medicaid. If you pay health insurance premiums or have medical bills, these may be used to help meet your spend-down.

Covered Services

Once your spend-down is met, if you have one, then Medicaid will cover most services except for the following:

• Care in nursing facilities, intermediate care facilities for the intellectually disabled or skilled nursing facilities.
• Care in a facility licensed for psychiatric care

Getting Care

• You will need to show your Medicaid Assistance Eligibility card to your health care providers before you receive medical care.
• You may receive services from any Iowa Medicaid provider.
• Tell your provider that you will have to pay the medical bills until your spenddown is met (if you have a spend-down.)

How to Apply

Apply for the Medically Needy program through the Iowa HHS Benefits Portal.