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• Be enrolled in Medicare Part A (hospital insurance) and/or Part B (medical insurance).
• Have income that exceeds Illinois Medicaid's income limits but still have high medical expenses.
• Be an Illinois resident and meet other Medicaid eligibility requirements such as citizenship or immigration status, and U.S. residency.  

2. The Spenddown Process
The process involves using your medical expenses to “spend down” your income to meet
Medicaid’s eligibility limits:  

• If your income exceeds the Medicaid income limit, you may still qualify for Medicaid if your medical expenses are high enough.
• Medical expenses (including co-pays, doctor bills, hospital stays, prescription drugs, and long-term care costs) can be counted toward the spenddown amount.  

3. How the Spenddown Works  

• Threshold: In Illinois, the Medicaid income limit is based on a "spenddown amount" that is the difference between your monthly income and the Medicaid income limit for your household size. For example, if your monthly income exceeds the limit by $500, you must incur $500 worth of medical expenses to meet the spenddown requirement and become eligible for Medicaid.
• Once you’ve spent enough on medical expenses to meet or go below the spenddown amount, you can receive Medicaid benefits for the remainder of the month. This includes services not covered by Medicare, like long-term care, home and community-based services, and Medicaid-covered medications.  

4. Services Covered by Medicaid  

• Medicaid will cover medical services that Medicare does not cover, such as:
  o Prescription drugs (if they are not covered by Medicare)
  o Dental services
  o Vision care
  o Hearing services
  o Long-term care (nursing home care, etc.)  
• Medicaid may also cover your Medicare premiums, co-pays, and deductibles if you qualify under the spenddown.  

5. The Application Process  

• How to Apply: You apply for the Medicaid Spenddown program through the Illinois Department of Healthcare and Family Services (HFS). Applications can be submitted online, by phone, or in person at your local HFS office.
• Medicaid Redetermination: Once enrolled in the spenddown program, you will need to complete annual redeterminations to verify continued eligibility.  

6. Spenddown Amount Calculation  

The spenddown amount is calculated based on your monthly income minus the Medicaid income limit. Once you have incurred medical expenses equal to the spenddown amount, you can receive Medicaid for the remainder of the month.  

7. Important Considerations  

• Limited Coverage: If you don’t meet the spenddown in a given month, you won’t receive Medicaid benefits for that month, but you can try again the next month.
• Record-Keeping: Keep detailed records of all your medical expenses, as you will need to submit them to prove you've met the spenddown amount.  

Example

• Let’s say your income exceeds the Medicaid limit by $300.
• If you spend at least $300 on eligible medical expenses, you will qualify for Medicaid for the rest of the month, covering services that Medicare doesn’t cover.  

For more detailed information, you can visit the Illinois Department of Healthcare and Family Services website or contact their office for assistance in navigating the process.