What is Medically Needy Medi-Cal?
Medically Needy Medi-Cal provides full scope Medi-Cal services to aged, blind, or disabled people with income above the eligibility levels of no-cost Medi-Cal programs. The program usually requires that you incur a monthly share of cost, similar in principle to a monthly copayment.
This Medi-Cal eligibility category is often called “share of cost” Medi-Cal. A share of cost is usually more expensive than Medi-Cal’s Working Disabled Program, if you work
Medically Needy
States have the option to establish a “medically needy program” for individuals with significant health needs whose income is too high to otherwise qualify for Medicaid under other eligibility groups.
Medically needy individuals can still become eligible by “spending down” the amount of income that is above a state’s medically needy income standard. Individuals spend down by incurring expenses for medical and remedial care for which they do not have health insurance.
Once an individual’s incurred expenses exceed the difference between the individual’s income and the state’s medically needy income level (the “spenddown” amount), the person can be eligible for Medicaid. The Medicaid program then pays the cost of services that exceeds the expenses the individual had to incur to become eligible.
In addition to states with medically needy programs, 209(b) states also must allow a spenddown to the income eligibility levels eligibility groups based on blindness, disability, or age (65 and older), even if the state also has a medically needy program. Thirty-six states and the District of Columbia use spenddown programs, either as medically needy programs or as 209(b) states.
