Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Illinois program

Medicaid in a costly month (Family Health Spenddown)

A Medicaid route for a child over the All Kids income limit when medical bills are very high.

What it is

A Medicaid route for a child over the All Kids income limit when medical bills are very high.

Family Health Spenddown subtracts a low monthly standard from the income the state counts. Eligible medical bills can meet the resulting spend-down amount. Because the standard is low, this usually takes bills close to the family’s monthly income.

Eligibility rules
  • This route is for children under 19 whose income is above the All Kids limit.
  • The 2026 monthly standards are $375 for two, $508 for three, $558 for four, $650 for five and $733 for six. These are standards, not the amount of bills every family must have.
  • DHS calculates your actual spend-down using the income and household rules.
What you get
  • Medicaid coverage for the rest of a month after the spend-down is met.
  • Older unpaid bills can help meet the amount when the bill-date rules are met.
  • No savings test under Family Health Plans.
What the help includes
  • An unpaid bill can count regardless of when the care occurred if the bill is dated within the six months before the month used. Each charge counts only once.
  • The hospital can issue a current statement for older care. Insurance-paid charges cannot be treated as bills you still owe.
If you decide to apply
  1. Ask the hospital financial counselor to go through Family Health Spenddown with you and help with ABE.
  2. Have income records, insurance statements, unpaid bills and receipts ready.
  3. Ask the DHS caseworker for the monthly amount in writing and which charges can count.

DHS / All Kids: 866-255-5437 · Official page ↗

What happens next
  • The application standard is 45 days. DHS reviews bills for each month requested.
  • A written decision should show the spend-down amount and the date coverage starts after it is met.
Good to know

The bills used to meet your spend-down remain yours to pay. Each month starts again; this route does not give 12 months of continuous coverage.

Other details
  • Your insurance out-of-pocket maximum can limit the bills available to meet a large spend-down.
  • A child who gets SSI can have Medicaid through a separate disability route without counting parents' income; ask the caseworker for it by name (AABD Medical).

Federal background: Medicaid through a medically needy spend-down.

Official sources
Ask your social worker

“Would our unpaid bills meet a spend-down in any month? What bills would still be ours, and could you help us apply if this would reduce our costs?”

Why I’m asking: I want to know whether a particularly expensive month could qualify our child for Medicaid.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Apply on ABE, ask for the spend-down amount in writing, and send unpaid bills to the caseworker every month.

Your social worker

The financial counselor prints itemized bills dated within six months and separates what insurance did not pay.

The care team

Records and letters when the application asks for them.

Who decides
The Department of Human Services sets the spend-down amount and decides each month whether bills meet it.
Ask the agency
“What is our monthly spend-down amount, and which of these unpaid bills count toward it this month?”

How to apply

First step: Apply on ABE, ask for the spend-down amount in writing, and gather every unpaid bill dated in the last six months.

  1. Apply on ABE and ask for the spend-down amount in writing.
  2. Each month, send the caseworker every unpaid bill dated within the last six months.

Official application / program page ↗

Where it starts: Apply on ABE; then show unpaid bills or receipts to the DHS caseworker each month you want covered.

What to gather

  • Unpaid bills and receipts dated within the last six months
  • Insurance statements showing what was not paid
  • This month's income

How long: The application standard is 45 days; each month is decided when the bills are shown.

What a yes looks like

A spend-down amount in writing and, each month you meet it, Medicaid coverage for the rest of that month.

What a no looks like, and the next move

Ask which bills were rejected and why (date, insurance already paid, counted before). If income drops, ask for All Kids instead.

Watch out

  • The standard is tiny, so this works only in a month when unpaid bills come close to the whole income. With insurance the out-of-pocket maximum usually caps that first.
  • A bill counts if dated within the six months before the month you use it. Ask the hospital for a fresh bill on older care.
  • Spend-down months carry no 12-month continuous coverage; each month starts over.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 8, 2026.

What it is worth

Full Medicaid for any month in which medical bills above the standard equal or exceed the spend-down amount. 2026 standards: $375 for two, $508 for three, $558 for four, $650 for five, $733 for six.

  • $375/month — Family Health Spenddown monthly standard, family of 2
  • $508/month — Monthly standard, family of 3
  • $558/month — Monthly standard, family of 4
  • $650/month — Monthly standard, family of 5
  • $733/month — Monthly standard, family of 6

Covers: Full Medicaid for the month once spend-down is met

What it costs the family: The bills that count toward the spend-down stay yours to pay; Medicaid pays the rest of the month.

The eligibility facts, as published

Age
children (under 19) with income above the All Kids Assist limit
Budget period
monthly
Standard monthly usd
2: 375; 3: 508; 4: 558; 5: 650; 6: 733
Resource test
none (Family Health Plans)
Bills
unpaid bills count regardless of when the care happened if the bill is dated within the six months before the month used; ask for a new bill if older; each charge counts once
Aabd alternative
a child receiving SSI is placed in AABD Medical (household income and resources exempt); AABD's own standard is 100% FPL with a $17,500 resource limit for a one- or two-person unit

Decisions this site cannot make: Spend-down amount set by IDHS · Monthly spend-down met by bills shown to the caseworker

Expect friction on: Bills must be shown to the DHS caseworker every month

The trap: The standard is tiny: for four people you must owe $8,000 or more in a month to get coverage at a $9,000 income. With insurance, your out-of-pocket maximum caps what you can ever spend, so this fits an uninsured month, not an insured one.

Where I read this

← Back to your options