Medically Needy (also known as the "spenddown program")


If your income is too high for Medicaid but your medical costs are so high that it uses up most of your income, you may qualify for some payment help through the Medically Needy plan. If you qualify you are responsible for paying some of the costs of your medical expenses.

Who does Medically Needy cover?
 
Pregnant women if:
  • Family income is over 300% of the federal poverty limits (FPL) for a household of the same size. This includes the unborn baby.
  • Family resources are not more than $10,000. People under age 21 if family income is over the income limit for regular Medicaid.
People who are aged, blind or disabled who:
  • Would be eligible for SSI (Supplemental Security Income) except that income or resources (assets) are over the limit, and;
  • Are age 65 or older, or
  • Are legally blind as defined by Social Security, or
  • Are disabled as defined by Social Security.
Adults who care for dependent children under age 18 or age 19 and still in school, if:
  • They are the parent, aunt, uncle, grandparent or disabled stepparent of a dependent child, and
  • Their income is over the income limit for Medicaid for families, or their resources (assets) are over the resource limit for Medicaid for families.

Medically Needy Brochure

What services are covered by Medically Needy?
Once your spenddown is met, if you have one, then Medicaid will cover most services except for the following:
  • Care in nursing facilities, intermediate care facilities for the intellectually disabled or skilled nursing facilities.
  • Care in a facility licensed for psychiatric care
Where can I get medical care?
You will need to show your Medicaid Assistance Eligibility card to your health care providers before you receive medical care. You may receive services from any Iowa Medicaid provider. Tell your provider that you will have to pay the medical bills until your spenddown is met (if you have a spenddown.)
 
How can I apply for Medically Needy?
Apply for the Medically Needy program through the Iowa Department of Human Services Benefits Portal