Spend Down FAQs

What is Spend Down?

If your income is above the limit to qualify for Missouri Medicaid (MO HealthNet), you may still be able to get MO HealthNet coverage if you agree to pay, or “spend down,” a certain amount each month. Once you spend this amount, you will have MO HealthNet coverage for the month. If you do not spend this amount in a month, you will not have MO HealthNet coverage that month.

How do I know if I have to pay or meet spend down?

You will receive a letter from the Family Support Division when your application is approved or your coverage changes. This letter will tell you if you have to spend down your income to be eligible for coverage. You will also receive invoices from the MO HealthNet Division regarding your spend down amount.

How do I pay spend down?

There are three ways you can pay or meet your spend down:

  1. MAIL: To get coverage, send the bottom of the invoice that lists the month you want to pay for along with your payment and case number. If you do not have the correct invoice, write which month and case number on the check or money order (DO NOT SEND CASH). Only include the invoice for the month you want to pay for. Mail payments to:

    MO HealthNet Division
    Premium Collections Unit
    P.O. Box 808001
    Kansas City, MO 64180-8001

  2. AUTOMATIC WITHDRAWAL: You can have your payment taken directly out of your bank account on the 10th of each month and it will give you coverage for the next month. If you choose this option, you can submit medical bills you have paid to go towards your spend down.

    To sign up, submit the Spend Down Automatic Withdrawal Form. Make sure you mark the box that says “START,” complete and sign the form, attach a voided check, and return the form to the address on the form. When you start or change automatic withdrawal, please allow 30 days for processing. You will continue to receive monthly spend down invoices until the automatic withdrawal is in effect. Until it takes effect, you will need to mail in your spend down payment or meet your spend down with medical expenses. Once the automatic withdrawal takes effect, you will get a reminder each month that the payment was taken from your bank account.

  3. ONLINE: Visit mymohealthportal.com and create an account to manage your coverage and pay your spend down using either a credit card or electronic check.

  4. SUBMIT MEDICAL BILLS: You can use your medical bills to meet your spend down amount. When the cost of the services you are personally responsible for reaches your spend down amount, you may give copies of the medical bills along with your case number to your local Family Support Division office. Send copies to:

    Mail: Spend Down Unit, 16798 Oak Hill Drive, Suite 600, Houston, MO 65483
    Fax: 855-600-3754
    Email: sesd@ip.sp.mo.gov

The Family Support Division will review those bills and enter your coverage for that month. Your coverage will begin the day you reached your spend down amount. You are responsible to pay the bills used to reach your spend down amount. Contact your provider to make arrangements to pay. MO HealthNet will only pay for services over your spend down amount.

Do I have to pay or reach my spend down every month?

No, you do not have to pay or reach your spend down every month. You will not have MO HealthNet coverage for the months that you do not pay or reach your spend down.

Can I pay my spend down over the phone using my debit card or credit card?

No, the MO HealthNet Division cannot take payments over the phone. The only way to use the payment option is to mail your payment or submit a Spend Down Automatic Withdrawal Form. Do not take your payment to the Family Support Division office.

How do I know my spend down amount is correct?

Your spend down amount will depend on your individual circumstances. When you apply for MO HealthNet, our team will determine whether or not you are eligible for coverage and if you have to pay or reach a spend down. If you have questions about the amount of your spend down or about why you must pay the spend down, contact the Family Support Division Information Center at 855-373-4636.

If you disagree with your spend down amount, you have a right to a hearing. If you think you have been denied eligibility unfairly for any reason, call, write, or come in to the Family Support Division office and request a hearing within 90 days after the decision. During the hearing you can explain your situation and present evidence or be represented by an attorney, relative, or friend.

If I notify the Family Support Division that I met spend down using medical expenses, do I also have to mail a payment to the MO HealthNet Division?

No, you have a choice each month in how you want to pay your spend down by using one of the three payment options.

Where do I call or write to see if my spend down payment was received or if I have questions?

For questions about whether your payment was received, you should call the Premium Collections Unit at 1-877888-2811. You may also write to:

MO HealthNet Division
Premium Collections Unit
PO Box 6500
Jefferson City, MO 65102

If I sign up for automatic withdrawal, when is the spend down payment taken out?

Automatic withdrawals are done on the 10th of each month for the next month’s spend down. For example, on April 10, the automatic withdrawal will be done for May’s spend down payment.

If my payment is made by automatic withdrawal, what do I do if I change banks or accounts?

You will need to fill out a Spend Down Automatic Withdrawal Form and mark the box that says “CHANGE.” Once you complete and sign the form, attach a voided check for your new bank account and send it to the address on the form. You should allow 30 days for the change to take place. If you have questions about the automatic withdrawal, call the Premium Collections Unit at 1-877-888-2811.

If my payment is made by automatic withdrawal, do I need to complete the Automatic Withdrawal Authorization form each month?

No. Once you sign up for automatic withdrawal you only need to send an Automatic Withdrawal Authorization form to change your account or to stop the automatic withdrawal. If you stop automatic withdrawal you need to send a new form to start it again. If you lose eligibility we will automatically stop your automatic withdrawal. If you become eligible again you will need to complete another automatic withdrawal form.

What happens if I don't have sufficient funds in my bank account to cover the automatic withdrawal?

You will not have coverage until you make your payment. It is your responsibility to make sure you have enough money in your bank account to cover your automatic withdrawal. When your payment is insufficient, you will receive an insufficient funds notice explaining you must send either a money order or cashier’s check to cover your payment. A personal check cannot be accepted to cover an insufficient fund. You cannot submit bills for coverage in the same month you have an insufficient check.

What should I do if I sent a payment for my spend down and also paid for services that same month, or if I am getting a bill from a provider?

The MO HealthNet Division cannot refund your payment. You must go to the provider you got the services from. If MO HealthNet covers the medical services you paid for, you should contact the provider to let them know you have MO HealthNet. You can ask the provider if they will refund the payment to you and bill MO HealthNet for the services. It is the provider’s choice to refund the money to you and bill MO HealthNet. If you receive a bill from your provider and you were eligible for MO HealthNet during the dates of service on the bill, you must let the provider know that you were MO HealthNet eligible and ask them to bill MO HealthNet.

Can I overnight my payment if I need coverage right away?

No. Overnighting a check or money order will not speed up coverage.

How long do I have to send in bills to meet my spend down for a particular month?

Bills for medical services can be submitted for services you received up to one year (365 days) ago.

What if I don’t have enough bills to meet my spend down this month?

If you can’t meet spend down every month, you can combine medical bills from different months. This is called carryover. Here is an example of how it works:

Example: Tina’s spend down is $75. She has a medical bill of $25 each month in April, May, and June. She can submit all three bills and ask for carryover to cover July’s spend down.

You can carry over bills for medical services you or your spouse received in the current month or any of the three previous months. You can carry them over to help meet your spend down for the current month of any of the next three months.

What if I have other insurance and am using bills to meet my spend down?

Provide bills that show the amount that you owe after Medicare or other insurance has been billed.