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

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Washington program

Apple Health when medical bills are very high (spend-down)

A fallback for families over every other line, once bills they owe use up income above about $994 a month.

What it is

A fallback for families over every other line, once bills they owe use up income above about $994 a month.

In a three- or six-month period, once the medical bills you owe use up income above about $994 a month (for units of one to six), Apple Health covers the rest of the period. The bills used to reach that figure stay yours. Unlike the children’s coverage, this has a savings test.

Rules
  • Income, resources and household rules differ from ordinary Apple Health for Kids.
  • A new eligibility period requires another application.
  • Old unpaid bills may help meet the figure; bring them.
What you get
  • Coverage for the remainder of a chosen period after the spend-down is met.
What you still owe
  • Apple Health does not pay the bills used to meet the spend-down.
If you decide to apply
  1. If a very large bill arrives and no other route fits, ask a hospital Medicaid specialist for a written spend-down estimate and coverage dates, and compare hospital financial assistance first.

Hospital Medicaid specialist

If it becomes relevant
  • Ask for a written spend-down estimate and coverage dates, and compare hospital financial assistance first.
Good to know

Hospital financial assistance and the long-stay route usually help sooner than spend-down.

Other details
  • Children are included in the program.

Federal background: Apple Health when medical bills are high.

Official sources
Ask your social worker

“Is spend-down something we should ever need to think about?”

Why I’m asking: We want to know the fallbacks if our situation changes.

More background and detailed requirements

How this could help

You choose a three- or six-month period. The agency calculates a spenddown from the income it counts. Once eligible medical expenses reach that amount, coverage can begin for the remaining eligible part of the period. Ask for the calculation before deciding whether this will help.

This is not a discount that automatically erases existing bills. Bills used to meet spenddown are not paid by Apple Health. Older unpaid bills may help meet it, so bring them rather than assuming they are too old.

What to know before you apply

  • Income, resources and household rules differ from ordinary Apple Health for Kids. A simple household-income comparison is not enough.
  • The published 2026 medically needy income standard used in this guide is $994 monthly, but the agency must determine the correct assistance unit and countable income.
  • A new eligibility period requires another application.

Your next steps

  1. Ask a hospital Medicaid specialist for a written spenddown estimate and coverage dates.
  2. Gather unpaid bills, insurance statements, income information and savings/resource details.
  3. Compare this with charity care and the long-hospital-stay route before committing to a payment plan.

children are included

income above the effective medically needy income level must be spent down on incurred medical expenses

$2,000 for one person, $3,000 for a legally married couple, plus $50 for each additional family member

Additional program information and published rules

Who does what

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

You

Collect every unpaid medical bill and choose the period.

Your social worker

The hospital's financial counselor works out the spend-down figure and sends the bills in.

The care team

Nothing beyond the billing records.

Who decides
The Health Care Authority, on the bills you show for the period you chose.
Ask the billing office
“Could our medical bills help my child qualify through spenddown, and which bills would we still owe?”

How to apply

First step: Ask a hospital Medicaid specialist for a written spenddown estimate and coverage dates.

  1. Gather every unpaid medical bill, old ones included.
  2. Ask the counselor whether a three-month or six-month period fits the treatment better.
  3. Apply through Washington Connection or on form HCA 18-005.

Official application / program page ↗

Where it starts: Apply through Washington Connection, or send form HCA 18-005 to the Department of Social and Health Services. Ask the hospital's financial counselor to help work the figure out.

What to gather

  • Every unpaid medical bill, however old
  • This month's income
  • Bank balances on the first of the month

How long: The published standard for a decision needing a disability finding is 60 days.

What a yes looks like

A notice naming the spend-down figure and the period, and coverage from the day the figure is met.

What a no looks like, and the next move

If the no is about savings, ask which people the office put in the unit, because that changes the limit.

Watch out

  • The first slice of bills stays yours: Apple Health does not pay the part used to meet the spend-down.
  • There is a savings test here that the children's coverage does not have.
  • It restarts every period, so you apply again each time.

Dates that change this

2026-01-01: The $994 figure is the rule's own higher-of formula applied to Social Security's 2026 one-person rate, because the state's current worker table would not open. The office's own figure for your household size is the one that counts.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Once the bills you owe in a three- or six-month period use up income above $994 a month, Apple Health covers the rest of that period.

  • $994/month — Effective monthly medically needy income level in 2026
  • $2,000 — Savings limit, one person
  • $3,000 — Savings limit, a legally married couple
  • $50 — Added to the savings limit for each further family member

Covers: Full Apple Health coverage for the rest of the period once the spend-down is met

Legal protection: Unpaid bills of any age can count while you still owe them

What it costs the family: You carry the bills up to the spend-down figure yourself; Apple Health does not pay that slice.

The eligibility facts, as published

Age
children are included
Income
income above the effective medically needy income level must be spent down on incurred medical expenses
Resources
$2,000 for one person, $3,000 for a legally married couple, plus $50 for each additional family member
Base period
three or six months, chosen by the applicant
Residency
Washington
Renewal
a new application is needed for each period

Decisions this site cannot make: Spend-down calculation by the eligibility worker

Expect friction on: Collecting every unpaid bill for the period

The trap: Apple Health does not pay the part of the bill you used to meet the spend-down, so it is not a way out of the first slice of the bill. You must apply again for each period. There is a savings test here, unlike the children's coverage: $2,000 for one person, $3,000 for a married couple, plus $50 a person after that, and the office decides which people are in the unit first.

Where I read this

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