Spend Down FAQs

What is Spend Down?

If your income is above the limit to qualify for Missouri Medicaid (MO HealthNet) for the Aged, Blind, and Disabled, you may still be able to get MO HealthNet coverage under this category if you agree to pay, or “spend down,” a certain amount each month.

Some people have so little income that they automatically qualify for MO HealthNet; however, seniors and people with disabilities whose income exceed the income limit may qualify for MO HealthNet if they have incurred medical bills that are equal to or are greater than their “excess” income.  The process of subtracting those medical bills from your income is called spend down.

Once you spend or are charged this amount, and report it to the Family Support Division, 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.

Who is eligible for the Spend Down Program?

If your income is above the limit to qualify for Missouri Medicaid (MO HealthNet) and you are age 65 or older, disabled, or blind, you may qualify for help through the Spend Down Program.

Once you apply for MO HealthNet, the Family Support Division (FSD) will check to see what type of coverage you qualify for and will notify you. 

What services qualify for spend down?

You can submit bills for services you or your spouse get from a medical provider, even if you have not paid them yet. They must be bills you are responsible for paying and include services such as:

  • Prescriptions
  • Eye care services or eyeglasses
  • Chiropractic services
  • Hospital and emergency services
  • Labs and tests
  • Dental care
  • Mental health services and counseling
  • Doctor prescribed oxygen, nebulizer, hearing aids, prosthetic devices, wheelchair, crutches, or walker
  • Certain home medical services such as personal care or adult day care
How do I know if I have to pay or meet spend down?

You will receive a letter from the Family Support Division (FSD) 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 (MHD) regarding your spend down amount.

How do I pay spend down?

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

  1. 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
     
  2. MAIL: Send the bottom of the invoice that lists the month you are paying for along with your payment. Only include the invoice for the month you are paying for. 

    If you do not have an invoice, or do not have the month’s invoice you are paying for, write which month and case number on the check or money order (DO NOT SEND CASH). 

    Mail payments to: 
    MO HealthNet Division
    Premium Collections Unit
    P.O. Box 808001
    Kansas City, MO 64180-8001
     
  3. 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 for auto withdrawal, 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 listed 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. If you have questions about automatic withdrawal, call the Premium Collections Unit at (877) 888-2811.
     
  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 (FSD) office. Send copies by email to sesd@ip.sp.mo.gov, fax to 855-600-3754, or mail to:
    Spend Down Unit
    16798 Oak Hill Drive, Suite 600
    Houston, MO 65483 

    FSD will review your submitted bills and if your spend down is met, 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 you submitted to reach your spend down amount. Contact your provider (doctor) to make arrangements to pay the submitted bills. 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. To use a debit or credit card, visit mymohealthportal.com and create an account to manage your coverage and pay your spend down.

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, the Family Support Division (FSD) 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 have a spend down, contact the FSD 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 an FSD office and request a hearing within 90 days after you are approved for coverage or your spend down amount changes. 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 four payment options above.

How do I find out 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 (877) 888-2811.

There is also a DSS Chat on the Family Support Division website. If you mention spend down on the DSS Chat, you will be provided general information. You may also contact the live chat option in the mymohealthportal.com where you can chat live with an agent from 7:00 am to 6:00 pm. You do not have to have an account on the portal to use the Chat.

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, providing you MO HealthNet coverage for May.

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 (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 the Family Support Division will automatically stop your automatic withdrawal. If you become eligible again you will need to complete another Automatic Withdrawal Authorization 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 pay online through mymohealthportal.com or send either a money order or cashier’s check to cover your payment. A personal check cannot be accepted to cover an insufficient fund notice. If you have questions, call the Premium Collections Unit at (877) 888-2811.

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. If MO HealthNet covers the medical services you paid for, you should contact your medical provider to let them know you have MO HealthNet coverage. 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.

How should I pay my spend down if I need coverage right away?

If you need coverage right away, you should pay on the mymohealthportal.com. This captures your payment in real time and the payment will be sent overnight. This will provide you coverage the day following your payment. 

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).

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

If you cannot meet your spend down for a particular month, you can combine medical bills from different months. This is called carryover. 

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.

You may also pay the remaining amount left on your spend down by accessing mymohealthportal.com or by sending in a check or money order. 

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

You must provide the bills that show the amount that you owe after Medicare or other insurance has been billed. For example, you have Medicare and you go to the emergency room and they charge you $5000. Medicare pays a portion of that bill. You cannot use the $5000 bill to meet your spend down, you have to use the amount you still owe after Medicare pays. This would also be true with private insurance. 

Revised October 2024