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

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New York program

Spend-down Medicaid for a month of huge bills (Excess Income Program)

The Excess Income Program can open Medicaid when medical bills use up income above its limit.

What it is

The Excess Income Program can open Medicaid when medical bills use up income above its limit.

High treatment bills can change the Medicaid discussion even when income is above the usual line. The district calculates an excess-income amount and reviews which medical bills can count. It confirms the coverage period and whether a bill has already been used.

Eligibility rules
  • Eligible categories include children under 21, pregnant people, parents of children under 21, and people who are 65 or older, blind or disabled.
  • Published 2026 monthly standards are $3,142 for three people, $3,795 for four and $4,449 for five. The district sets the actual budget unit.
  • The district first checks which Medicaid category and household budget apply to your child. The number of people living at home is not automatically the spend-down budget, and savings rules can differ by category. Ask for a written calculation showing the countable income, any applicable resource test, the monthly excess, which bills can be used and the coverage dates.
What you get
  • Medicaid for eligible care after bills meet the required excess-income amount.
  • Unpaid bills, including eligible earlier bills, can help meet that amount.
What the help includes
  • The district explains whether your bills could open outpatient coverage for individual months or a longer inpatient coverage period.
  • If a six-month inpatient period is considered, the district must confirm the required excess-income total and the covered dates.
  • The district checks paid and unpaid bills, earlier service dates and any previous use of those expenses.
If you decide to apply
  1. Ask your local Department of Social Services for an Excess Income worksheet if you want this reviewed.
  2. Have the hospital financial counselor organize itemized bills by month.
  3. Ask the district which bills it can count and which coverage period they would open.

Your local Department of Social Services; in New York City, HRA Health Assistance

After you ask
  • The district reviews the worksheet and bills to identify the covered months.
  • An itemized statement helps distinguish bills used for spend-down from bills Medicaid may pay.
Good to know

The district's household calculation matters. A family-of-four table is not necessarily your child's budget.

Other details
  • The local district can provide the current Excess Income instructions and identify any resource rule that actually applies to your child. A one- or two-person aged/blind/disabled resource table is not a general savings limit for every family with a child.
  • Hospital financial assistance is a separate way to address unpaid bills.

Federal background: medically needy Medicaid.

Official sources
Ask your social worker

“Could our child's bills meet a spend-down, and what would we still owe afterward? If this route helps, could you get the district's worksheet and help us sort the bills?”

Why I’m asking: We want to understand whether large treatment bills could open Medicaid for months when income is too high.

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

Ask the local Department of Social Services for the worksheet, keep every bill, and send the bills the month they reach the excess amount.

Your social worker

The hospital financial counselor prints itemized bills by month and helps you total them.

The care team

Records and letters when the application asks for them.

Who decides
The local Department of Social Services sets the excess-income amount and counts the bills.
Ask the agency
“I want to be in the Excess Income Program. What is our household's monthly excess-income amount, and can you send me the worksheet?”

How to apply

First step: Tell the local Department of Social Services you want the Excess Income Program and ask for the household worksheet. Bring or send bills when they at least equal the excess income.

  1. Ask the local DSS for the excess-income worksheet for your household.
  2. Collect every bill (paid and unpaid) for the months you want covered.

Official application / program page ↗

Where it starts: Tell the local DSS you want to be in the Excess Income Program, then bring or send bills when they at least equal the excess income.

What to gather

  • Itemized hospital and pharmacy bills by month (paid and unpaid)
  • This month's income for everyone the district counts
  • Insurance explanation-of-benefits statements

How long: Coverage is month by month once the bills are counted; inpatient coverage runs six months.

What a yes looks like

A notice of the excess-income amount and Medicaid for the month (or six months) the bills covered.

What a no looks like, and the next move

"Bills below the excess income": keep collecting. A later month with an admission can meet it. Ask about the six-month inpatient option.

Watch out

  • Ask the local Department of Social Services (DSS) for the worksheet. Whether your child is budgeted alone or with the household decides the excess amount.
  • A bill counts once. Keep itemized statements by month and do not pay them off before the district has counted them.
  • Savings limits for households of three to five were not published; ask the district before assuming you are over.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 9, 2026.

What it is worth

Medicaid for the rest of a month once bills at least equal the excess income. Published 2026 standards: $3,142 (three), $3,795 (four), $4,449 (five) a month. Six months of coverage after bills equal to six months of excess income.

  • $3,142/month — Published non-MAGI income standard, 3 people (138% FPL)
  • $3,795/month — Published non-MAGI income standard, 4 people (138% FPL)
  • $4,449/month — Published non-MAGI income standard, 5 people (138% FPL)
  • $6 (then six months of Medicaid) — Months of excess income in bills needed for inpatient coverage

Covers: Medicaid for the balance of the month (outpatient) or six months (inpatient)

What it costs the family: The excess-income amount each month, met with bills (paid or unpaid).

The eligibility facts, as published

Who
under 21, 65 or older, certified blind or disabled, pregnant, or a parent of a child under 21
Income standard
published 2026 non-MAGI standards $2,489 / $3,142 / $3,795 / $4,449 / $5,102 for two to six (138% FPL); the child's actual budget unit is decided by the local district
Resources
published for one ($33,038) and two ($44,796) only; sizes three to five NOT FOUND
Budget period
outpatient one month at a time; inpatient six months after bills equal to six months of excess income
Bills
paid or unpaid; unpaid bills from prior months count; a bill cannot be reused

Decisions this site cannot make: Local district excess-income budget

Expect friction on: Monthly bill submission · Budget unit decided case by case

The trap: A bill counts once. The published standards ($3,795 a month for four) are the state's budget lines. The local district decides whether your child is budgeted alone or with the household, so ask for the worksheet.

Where I read this

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