The 209(b) States use at least one eligibility criterion more restrictive than the
SSI program. States that elected this option may not use more restrictive standards
than those in effect in January 1, 1972, and must provide for deducting incurred medical
expenses from income through Medicaid spenddown so that individuals may reduce their income to the income eligibility level.
Medicaid spenddown is an important concept not only to the 209(b) States but also
to all States with medically needy programs. Spenddown applies to individuals who
have too much income to qualify under the State's income limits. When an individual
has too much countable income to qualify for Medicaid, the State Medicaid agency looks
at the individual's incurred medical expenses during a budget period (1 to 6 months).
In some cases, the State can also look at some anticipated expenses, such as the cost
of health insurance. The State then takes incurred costs for medical services covered
under the State's Medicaid plan during the budget period and deducts them from the
individual's countable income until the individual meets the State's income limit.
The amount of the excess over the State's income limit is the responsibility of the
individual, i.e., to qualify for Medicaid, the individual will have to spend down
income to the State's income limit.
At present, there are 8 209(b) States. They are:
Connecticut*
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New Hampshire*
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Hawaii
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North Dakota
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Illinois
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Minnesota
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Virginia
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Missouri*
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*These States do not include nonblind individuals under the age of 18 in their definition
of disability. Nonblind children qualify for Medicaid under the Temporary Assistance
for Needy Families (TANF) program-related eligibility standards or the special standard
described in SI 01715.005A.2.
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