Utah program
Medicaid when qualifying bills meet a spenddown
A Medicaid route where qualifying medical bills or a payment can meet an income spenddown.
What it is
A Medicaid route where qualifying medical bills or a payment can meet an income spenddown.
Qualifying bills can open this route above the ordinary income limit. The worker calculates the required spenddown for the correct assistance unit and period. Your answers do not establish the eligible bills or the final amount.
Eligibility rules
- Children qualify under 18, or at 18 while in school and expected to graduate before 19.
- The income line for this route is very low: about $583 a month for three people and $682 for four. Medical bills above that are what count toward the spend-down.
- Resources are limited to $2,000 for one person, $3,000 for two, plus $25 for each further person.
What you get
- Medicaid for eligible periods once the spenddown is met.
- Qualifying unpaid older bills can count if they have not already been used.
What the help includes
- The family meets the calculated amount through eligible bills or payment to the state.
- Old unpaid balances must still be owed and qualify under the spenddown rules.
If you decide to apply
- Ask the MyCase eligibility worker about Child Medically Needy, also called spenddown.
- Bring paid and unpaid medical bills, this month’s income and account balances for the people assessed.
- Ask the hospital billing office for an itemized list of unpaid balances.
1-866-435-7414 · Official page ↗
After you ask
- The worker identifies the applicable assistance unit, spenddown amount and coverage period. A monthly maintenance standard alone does not establish the bill-submission deadline or covered dates.
- Could the eligibility worker give you the spenddown amount, the exact coverage period, the last dates for submitting qualifying bills or a payment, and the application decision deadline in writing? A monthly standard alone does not tell you those dates, and the same bill cannot be used twice.
Good to know
The same bill cannot meet a spenddown twice. Savings rules apply here even when they do not apply to ordinary child Medicaid.
Other details
- Spenddown, disability-based Medicaid and the children’s waivers use different financial and care rules. Could your social worker help the eligibility worker compare the routes that fit your child, rather than treating a high family income as a reason to stop checking?
Federal background: Medically needy Medicaid.
Official sources
- Child Medically Needy
- Medicaid Policy Manual, Table VII — Income Limits for Medical and Medicare Cost-Sharing Programs
- Medicaid policy 503, Household Size and Asset Limits
- Spenddown Program (Medically Needy)
- Medicaid policy 461, Spenddown Medicaid
- Medicaid policy 461-5, Spenddown with Medical Bills
- Medicaid Policy Manual, Table IX — Telephone Numbers
- Official source reviewed September 21, 2026
- Official source reviewed September 21, 2026
- Official source reviewed September 21, 2026
- Official source reviewed September 21, 2026
- Official source reviewed September 21, 2026
- Official source reviewed September 21, 2026
“Could any of our bills meet a spenddown, and how much would we have to pay ourselves? Could you compare this with the waiver routes and help us decide whether to apply?”
Why I’m asking: I want to know whether this route would save money after the spenddown and savings rules are considered.
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 for it by name and bring every bill, including old unpaid ones.
Your social worker
The hospital billing office can list unpaid balances in a form the worker accepts.
The care team
Records and letters when the application asks for them.
- Who decides
- The eligibility worker calculates the spenddown each month.
- Ask the agency
- “I want to apply for Child Medically Needy spenddown. Here are the unpaid medical bills; which of them count this month?”
How to apply
First step: Apply on MyCase or call 1-866-435-7414 and ask for Child Medically Needy by name.
- Ask for Child Medically Needy by name; it is not offered automatically.
- Keep every hospital bill, including older unpaid ones, and take them to the appointment.
- Ask what the assistance unit is for your family, because it is not always the household you live in.
Official application / program page ↗
Where it starts: Apply on MyCase or call 1-866-435-7414 and ask for Child Medically Needy, or spenddown, by name.
What to gather
- Every medical bill, paid and unpaid
- This month's income
- Account balances for the child and the unit
How long: Utah publishes no measured opening time for this route.
What a yes looks like
A spenddown figure for the month and cover once it is met.
What a no looks like, and the next move
If the no is about savings, ask which accounts were counted. If it is about the unit, ask who they counted in it.
Watch out
- Savings count here: $2,000 for one, $3,000 for two, plus $25 per further person in the unit.
- A bill can only be used once. Keep a note of which months you used which bill for.
- The posted rules date from 2020 and the budget period is not spelled out; ask the worker how many months they are working in.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Cover for the month once bills or payment eat the excess income. The monthly standards are $583 for three, $682 for four and $777 for five.
- $583/month — Basic Maintenance Standard, household of 3
- $682/month — Basic Maintenance Standard, household of 4
- $777/month — Basic Maintenance Standard, household of 5
- $2,000 — Countable resource limit, one person
- $3,000 — Countable resource limit, two people
Covers: Full Utah Medicaid for the months the spenddown is met
What it costs the family: The spenddown amount itself: the difference between income and the maintenance standard.
The eligibility facts, as published
- Age
- under 18, or 18 while at school and expected to graduate before 19
- Age max exclusive
- 19
- Income
- income above the maintenance standard is spent down each month; the standards are $583 for three, $682 for four and $777 for five
- Resources
- $2,000 for one person, $3,000 for two, plus $25 for each further person in the assistance unit
- Residency
- Utah
- Processing standard
- unknown
Decisions this site cannot make: Monthly spenddown calculation by the eligibility worker
Expect friction on: A savings test that ordinary child Medicaid does not have
The trap: Savings count here in a way they do not for ordinary child Medicaid: $2,000 for one person, $3,000 for two, and $25 for each extra person in the assistance unit. The assistance unit is the program's, not the household you told us about.
Where I read this
- Child Medically Needy — Utah Department of Health and Human Services, read September 10, 2026
- Medicaid Policy Manual, Table VII — Income Limits for Medical and Medicare Cost-Sharing Programs — Utah Department of Health and Human Services, read September 10, 2026
- Medicaid policy 503, Household Size and Asset Limits — Utah Department of Health and Human Services, read September 10, 2026
- Spenddown Program (Medically Needy) — Utah Department of Health and Human Services, read September 10, 2026
- Medicaid policy 461, Spenddown Medicaid — Utah Department of Health and Human Services, read September 10, 2026
- Medicaid policy 461-5, Spenddown with Medical Bills — Utah Department of Health and Human Services, read September 10, 2026
- Medicaid Policy Manual, Table IX — Telephone Numbers — Utah Department of Health and Human Services, read September 10, 2026