Medicaid Spend-Down Calculator
Medicaid eligibility for many programs is limited by countable assets and, in medically needy states, by monthly income. If your resources exceed your state's limit, you may need to "spend down" the excess on allowable costs before you qualify. Because asset and income limits vary by state, program, and household size and change each year, this calculator takes those limits as editable inputs and shows you the excess assets and excess monthly income you would need to reduce. Always confirm your figures with your state Medicaid agency.
Medicaid spend-down formula
Excess assets = max(0, countable assets - asset limit)
Monthly income spend-down = max(0, monthly income - income limit)
Annual income spend-down = monthly income spend-down * 12
Total first-year spend-down = excess assets + annual income spend-down
The asset spend-down is a one-time reduction to reach the resource limit. The income spend-down (also called a share of cost) recurs each budget period in medically needy states. Both depend entirely on the limits your state publishes.
Medicaid spend-down context
- Asset and income limits are set by each state and differ by program: nursing-home Medicaid, Home and Community Based waivers, and Aged-Blind-Disabled all use different thresholds.
- Countable assets typically exclude a primary residence up to an equity cap, one vehicle, and personal property; enter only countable resources.
- Medically needy programs let applicants qualify by incurring medical expenses equal to their excess income each budget period.
- A look-back period (commonly 60 months for long-term care) can penalize asset transfers made for less than fair market value.
- This tool gives an estimate only; confirm limits and exemptions with your state Medicaid agency or Medicaid.gov.
Medicaid spend-down: frequently asked questions
What is a Medicaid spend-down?
A spend-down is the process of reducing countable assets or income to fall within your state's Medicaid eligibility limit. Applicants whose resources exceed the limit can spend the excess on allowable expenses (such as medical bills, debts, or exempt assets) to qualify. The specific limits are set by each state and program, so this calculator uses your own entered figures.
What assets count toward the Medicaid limit?
Countable assets generally include cash, bank accounts, stocks, bonds, and non-exempt property. A primary home (up to an equity cap), one vehicle, personal belongings, and certain burial funds are usually exempt. Exempt items vary by state, so enter only your countable assets, and check your state Medicaid agency for what is excluded.
How does the income spend-down work?
In medically needy states, if your monthly income exceeds the income limit, the difference is your monthly spend-down amount. You become eligible once you incur medical expenses equal to that excess during the budget period. This is sometimes called a Medicaid 'share of cost'. The income limit you enter should come from your state Medicaid office.
Why does this calculator ask me to enter the limits?
Medicaid asset and income limits differ by state, by program (such as nursing-home, waiver, or Aged-Blind-Disabled), and by household size, and they are updated each year. To avoid showing an inaccurate figure, this tool takes your state-specific limits as editable inputs. Find your current limits on your state Medicaid agency website or Medicaid.gov.
Does spending down assets affect future eligibility?
Medicaid uses a look-back period (commonly 60 months for long-term care) during which asset transfers for less than fair market value can trigger a penalty period. Spending down on legitimate expenses for yourself, like medical care or home repairs, generally does not cause a penalty, but gifting assets can. Consult an elder-law attorney before transferring assets.
Official sources
- Centers for Medicare and Medicaid Services: Medicaid.gov.
- Centers for Medicare and Medicaid Services: CMS.gov.
Reviewed by the CalculatorHub team, edited by James Graham, 17 June 2026. See our methodology.