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Are You Eligible For Medicaid?

October 2019

What is Medicaid?

Medicaid is health insurance that helps people pay some or all of their medical bills. Call 1-855-805-HEALTH (4325) to apply.

Medicaid may be free for

  • families with children (monthly income of less than about $2,256 for a family of 2);
  • pregnant women (monthly income of less than about $3,709 for a family of 2); and
  • adults without children at home (monthly income less than about $1,946 for a family of 2).

Medicaid may have a copay or monthly cost for

  • families with children (monthly income of between about $3,582 and $4,517 for a family of 2 – the premium is $30 per month for families with one child and is capped at $50 per month for families with 2 or more children); and
  • people with certain medical conditions.

Call 1-855-805-HEALTH (4325) for more information.

Medicaid with a spend-down

If your income is too high to qualify for free Medicaid, you may be able to get Medicaid after you spend down some of your money if you are

  • disabled,
  • on Medicare,
  • over the age of 65, or
  • meet other criteria.

You will get a notice from DSS that tells you

  • the amount you must spend down,
  • when your spend-down period starts and ends, and
  • where to send the proof about your spend-down.

Spend-down periods are 6 months long.

Remember: Keep copies of everything you give DSS. Keep all notices and envelopes that DSS sends you.

How can I meet my spend-down amount?

One way to meet your spend-down amount is to have medical bills.

Example 1:

Bob applied for Medicaid on January 1.

Bob’s 6-month spend-down period is from January 1 to June 30. 

Bob’s spend-down amount is $600. 

On January 1st, Bob starts his spend-down period with no Medicaid coverage. By March 15, his medical bills have totaled $600. Because Bob met his spend-down amount, Medicaid covers any new medical bills from March 15 to the end of his spend-down period (June 30 in this example).

On July 1, Bob has a new 6-month spend-down period and amount. 

Bob applies for Medicaid

Spend-down period
(6 months)

Spend-down amount

Bob’s new medical bills are covered

January 1

January 1 – June 30

$600

 

Between January 1 and March 15, Bob's medical bills add up to $600. 

He has met the spend-down amount by March 15 (which is within the 6-month spend-down period).

March 15 to June 30

  • Bob’s next 6-month spend-down period is from July 1 to December 31.
  • A spend-down period can be any six-month period.

Note: As soon as your medical bills reach your spend-down amount, you can get Medicaid. You don’t have to pay the medical bills. You can use unpaid bills to meet your spend-down.

Example 2:

Luz’s spend-down period is from March 1 to August 31.

Luz’s spend-down amount is $500.

By August 20, Luz has $500 in medical bills. If these bills are unpaid, she can give them to DSS at the start of her next period, which September 1 in this example.

Luz will be covered by Medicaid for all medical bills during the next spend-down period, which is September 1 to February 28.

Luz's 6-month spend-down period

Spend-down amount

Next spend-down period

March 1 to August 31

$500

September 1 to February 28

Between March 1 and August 20, Luz’s medical bills added up to $500. 

If her $500 in medical bills are unpaid, she can give these to DSS at the start of her next spend-down period, which begins on September 1.

   

Luz will be covered by Medicaid for all medical bills during the next spend-down period, which is September 1 through February 28.

You can use unpaid medical bills from a previous period to meet your spend-down amount in the current period.

Sometimes it takes almost the whole 6 months to meet your spend-down. If you plan ahead, you can get longer coverage.

What bills can I use toward my spend-down?

  • Doctor, hospital, and ambulance services.
  • Prescription drugs, over-the-counter drugs, and vitamins prescribed by your doctor.
  • Medical supplies such as bandages and gauze.
  • Health insurance premiums, co-payments, and deductibles.

Remember!

  • If your income or living situation changes, your spend-down amount may change. Tell DSS about changes within 10 days.
  • Save your medical bills. Keep track of the date and amount of each bill and the date you pay the bill.
  • If your medical bills are less than the spend-down amount in one period, you can use those bills toward the spend-down amount for the next period.
  • If you don’t pay medical bills, you may be charged late fees and penalties. Ask your doctor or pharmacist if you can pay over a period of time. If bill collectors are harassing you or taking legal action against you, call Statewide Legal Services at 800-453-3320 or 860-344-0380. See the legal aid booklet: Debt Collection: Know Your Rights.

Other programs that can help with medical bills

MED-Connect lets you work and keep your Medicaid, often without a spend-down. You’re eligible if you

  • are disabled, even if you don’t get SSI/SSDI;
  • earn income, even if you are self-employed or only work a few hours a week;
  • have assets worth less than about $10,000 for 1 person or $15,000 for a married couple.

Enrollees can earn up to $75,000 per year and qualify for full Medicaid/HUSKY Health coverage. (Some people with higher income may pay a monthly premium for this coverage).

Apply online at www.connect.ct.gov or download an application at https://portal.ct.gov/-/media/Departments-and-Agencies/DSS/Common-Applications/W-1E.pdf?la=en.

The Breast and Cervical Cancer Program covers all medical needs (not just cancer treatment) during the time you need cancer treatment.

  • You can get this if you don’t have insurance and you aren’t eligible for Medicaid or Medicare.
  • Get screened at an early detection site. Call 860-509-7804 or visit www.ct.gov/dph/earlydetection.

Home Care Program for Elders pays for home health aides, skilled nursing, emergency response alert, Meals on Wheels, adult day care, and more.

  • You’re eligible if you are 65 or older and need help with daily living activities like bathing, shopping, or taking medications.
  • The income limits are higher than for regular Medicaid.
  • To apply, call 1-800-445-5394 (toll-free) or 860-424-4904 (in the Hartford area) and select option 4.

Personal Care Assistance Program pays for assistants to help with your daily living activities.

  • You’re eligible if you have a disability and need help with daily living activities like bathing, shopping, or taking medications.
  • Income limits are higher than for regular Medicaid.
  • To apply, call DSS at 1-855-626-6632 or download the application at www.ct.gov/dss/lib/dss/pdfs/W-982.pdf.

Acquired Brain Injury Program offers home and community-based services to help you live at home instead of in a nursing home.

Tips

  • If DSS won’t pay for something your doctor ordered, ask for the reason in writing. Call Statewide Legal Services for help at 800-453-3320 or 860-453-3320.
  • Be careful not to go above your income limit. Even a few cents over from interest on a bank account can cause your Medicaid coverage to stop as of the day you went over the limit. You could pay for some medical bills to keep your income below the limit.

Get Help From Legal Aid

Age 60+: Get help from legal aid.
Under age 60: Find legal help or apply online.
Not from Connecticut? Find help in another state.