Long-term care in a nursing home or other facility, or even in-home care, is very expensive, so expensive that it can put an elderly or ill Rochester resident in dire financial straits. It is therefore important for Rochester residents, in the course of their end-of-life and estate planning, to account for these expenses that many people in New York have to undertake since they need the medical care.

In this respect, one alternative for those of more modest means is to qualify for Medicaid. As a government-run program designed to benefit those of limited means, the Medicaid program has strict income and asset requirements along with additional regulations to prevent people from circumventing these requirements without a true tradeoff.

Fortunately, qualifying for Medicaid is not an all-or-nothing proposition, at least when it comes to a person’s income. A New Yorker who does not qualify for full Medicaid benefits can receive assistance through a program subject to what is called a “spend down.”

The way a spend down works is that the government will calculate a person’s overall income and then require that person to spend down their excess income by applying to qualified medical expenses. It works a lot like an insurance deductible in that a person will be directly responsible for a given amount of medical expenses, and then Medicaid will kick in and pay medical bills as it would with any other patient.

Not everyone qualifies for spend down treatment; specifically, the blind, the disabled, those over 65 and those under 21 can get Medicaid without being subject to a spend down. Those who are subject to a spend down should be aware of the many types of qualified medical expenses they can apply toward the spend down amount. Questions about what expenses would or would not count toward a spend down, as well as questions about how to plan accordingly, might best be directed to a qualified Rochester elder law attorney.