Missouri's MO HealthNet Spend Down program gives elderly and disabled residents a path to Medicaid coverage even when their income exceeds the standard eligibility threshold. If you are 65 or older, blind, or disabled, and your monthly income is above the limit but you have ongoing medical costs, the spend down program may make you eligible for the remainder of each month after you meet your obligation. This guide covers the 2026 income and asset limits, which expenses count, how payments work, and how to apply.
What Is the Missouri Medicaid Spend Down Program?
Missouri's spend down program functions like a monthly medical deductible. The state sets a Medically Needy Income Limit (MNIL). If your income exceeds that limit, you are not automatically disqualified from MO HealthNet. Instead, the program requires you to pay or incur the difference between your income and the MNIL each month. Once you have met that obligation, full MO HealthNet coverage activates for the rest of that calendar month.
This is different from standard Medicaid, where you are either eligible or you are not. Spend down creates a middle path for people who earn too much to qualify outright but cannot afford private health insurance, often because they have high recurring medical costs.
The program is available to Missouri residents who are:
- Age 65 or older (Aged)
- Blind
- Disabled under Social Security or Social Security Disability definitions
- U.S. citizens or qualifying immigrants
- Missouri residents with countable assets below the limit
2026 Income Limits for MO HealthNet ABD
Missouri uses non-MAGI (Modified Adjusted Gross Income) rules for the Aged, Blind, and Disabled (ABD) Medicaid pathway. The income standards below are the Medically Needy Income Limits in effect from April 1, 2026 through March 31, 2027.
| Household Size | Monthly Income Limit | Program |
|---|
| Individual (Aged/Disabled) | $1,131 | Regular MO HealthNet ABD |
| Couple (Aged/Disabled) | $1,533 | Regular MO HealthNet ABD |
| Individual (Blind) | $1,330 | MO HealthNet for the Blind |
| Couple (Blind) | $1,804 | MO HealthNet for the Blind |
If your income is at or below these limits, you may qualify for standard MO HealthNet without a spend down obligation. If your income is above these limits, the spend down program calculates the difference you must pay or incur monthly.
Example: If you are a single individual receiving $1,500 per month in Social Security income, your income exceeds the $1,131 limit by $369. Your monthly spend down obligation is $369. Once you accumulate or pay $369 in qualifying medical expenses in a given month, MO HealthNet covers the remainder of that month.
2026 Asset Limits
To qualify for MO HealthNet ABD or the spend down program, you must also fall below the countable asset limits.
| Applicant Status | Countable Asset Limit |
|---|
| Individual | $6,068.80 |
| Married Couple | $12,137.55 |
Countable assets include bank accounts, stocks, bonds, and second real estate properties. Exempt assets typically include your primary home (if you intend to return), one vehicle, personal belongings, and pre-paid burial plans. If your assets exceed these limits, you must reduce them before qualifying for MO HealthNet.
For married couples where only one spouse is applying, Missouri provides spousal protections. The non-applicant spouse can retain a Community Spouse Resource Allowance. In 2026, if the non-applicant spouse's income falls below $2,644 per month, income can be transferred from the applicant spouse to bring their total up to that floor. The Maximum Monthly Maintenance Needs Allowance caps this at $4,066.50 per month.
How Missouri's Spend Down Works Month to Month
Missouri uses a one-month spend down period, which is shorter than the six-month period used by many other states. This means:
- Each calendar month is evaluated separately.
- Your spend down obligation resets every month.
- Coverage only applies to the months where you satisfy the obligation.
- Unused expenses from one month do not carry forward.
The monthly reset is important to understand. If you meet your $369 obligation in January, you have MO HealthNet coverage for January. In February, you start over and must meet the same obligation again to receive coverage. There is no accumulated credit.
Because of this structure, residents with consistent monthly medical expenses such as prescriptions, dialysis, or home health services often find it easier to regularly meet their spend down than those with unpredictable costs.
Qualifying Expenses for Spend Down
You can use a range of medical expenses to meet your monthly spend down obligation. Expenses do not need to be fully paid to count. Unpaid bills you are responsible for also qualify.
Expenses that count toward Missouri spend down:
- Prescription medications
- Doctor and specialist visits
- Hospital and emergency room bills
- Dental care (extractions, dentures, cleanings)
- Eye care (exams, glasses)
- Mental health and counseling services
- Durable medical equipment (wheelchairs, walkers, hearing aids, CPAP machines)
- Home health and nursing services
- Lab work and diagnostic tests
- Physical, occupational, and speech therapy
If you are married, your spouse's medical bills also count toward your spend down obligation, even if your spouse is not on the MO HealthNet application.
Expenses that do NOT count:
- Health insurance premiums (in most cases)
- Over-the-counter medications without a prescription
- Non-medical costs like transportation or meals
Ways to Meet Your Spend Down Obligation
Missouri gives participants four options for meeting their monthly obligation:
1. Pay the amount directly. You can pay your spend down amount as a monthly premium through mymohealthportal.com using a credit card or electronic check. This is the most straightforward option if you do not have enough medical bills in a given month.
2. Submit paid medical bills. If you paid for qualifying medical services out of pocket, you can submit those receipts and bills to count toward your obligation.
3. Submit unpaid medical bills. Bills you owe but have not yet paid also count. You need to document that you are responsible for the charges.
4. Set up automatic bank withdrawal. The MHD Premium Collections Unit will automatically withdraw your spend down payment from your bank account on the 10th of each month.
To submit medical bills, complete the MO HealthNet Spend Down Participant Form and send documentation through one of these channels:
- Upload: mydssupload.mo.gov/UploadPortal
- Fax: 855-600-3754
- Mail: Spend Down Unit, 16798 Oak Hill Drive, Suite 600, Houston, MO 65483
For payment questions, contact the Premium Collections Unit at 877-888-2811. For general spend down questions, call 855-600-4412.
Step-by-Step: How to Apply for MO HealthNet Spend Down
Step 1: Check your income and assets.
Compare your monthly income to the $1,131 individual or $1,533 couple limit. If you are above it, calculate the difference. That is your likely spend down amount. Verify your countable assets fall below $6,068.80 (individual) or $12,137.55 (couple).
Step 2: Gather required documents.
You will need:
- Proof of identity (driver's license, state ID, or passport)
- Proof of Missouri residency (utility bill, lease, or bank statement)
- Social Security card or number
- Proof of income (Social Security award letter, pension statements, pay stubs)
- Proof of assets (bank statements, investment account statements)
- Medicare card if applicable
- Documentation of disability if applicable (SSA award letter)
Step 3: Submit your MO HealthNet application.
You have three options:
- Online: Apply at myDSS, the Missouri Department of Social Services self-service portal at mydss.mo.gov
- Phone: Call 855-373-9994 to apply by phone
- Paper: Download the application from mydss.mo.gov, complete it, and mail or fax it to your local Family Support Division office
Step 4: Attend an interview if requested.
The Family Support Division may schedule a phone or in-person interview to verify your information.
Step 5: Receive your determination.
Missouri processes most applications within 45 days. If you are determined eligible for spend down rather than standard MO HealthNet, you will receive a notice explaining your monthly obligation amount.
Step 6: Meet your monthly obligation.
Each month, pay your spend down amount online, by mail, or through automatic withdrawal, or submit qualifying medical bills. Once the obligation is met, your MO HealthNet coverage activates for the rest of that month.
Step 7: Notify the Family Support Division of changes.
Report changes in income, household size, or address promptly. Changes can affect your eligibility and spend down amount.
MO HealthNet Spend Down vs. Other Missouri Medicaid Programs
| Program | For Whom | Income Approach | Spend Down? |
|---|
| MO HealthNet ABD (standard) | Elderly, blind, disabled at or below income limit | At or below $1,131/month | No |
| MO HealthNet Spend Down | Elderly, blind, disabled above income limit | Above $1,131/month | Yes, monthly obligation |
| Aged and Disabled Waiver (ADW) | Individuals needing nursing-level care at home | Up to $1,737/month | No (different threshold) |
| MO HealthNet for Families | Parents and caregivers | MAGI-based rules | No |
| MO HealthNet for Kids | Children under 19 | Up to 300% FPL | No |
If you need long-term care services such as home and community-based services, you may qualify for the Aged and Disabled Waiver, which has a higher income limit and does not require a spend down. Talk to a benefits counselor or your local Area Agency on Aging to determine which pathway is most appropriate.
Common Mistakes to Avoid
Not submitting bills promptly. Missouri's one-month period means you must document your expenses within the same calendar month. Bills from last month generally cannot be applied retroactively.
Assuming coverage is continuous. Each month starts fresh. If you forget to meet your obligation in March, you have no MO HealthNet coverage in March even if you met it in February.
Overlooking unpaid bills. Many applicants only count bills they have already paid. Unpaid bills you owe also count toward the spend down and can make it much easier to qualify.
Ignoring spousal medical bills. If your spouse has medical expenses, those count toward your spend down even if your spouse is not applying for MO HealthNet.
Not appealing a denial. If MO HealthNet denies your application or sets a spend down amount you believe is incorrect, you have the right to request a fair hearing. Deadlines for appeals are typically 90 days from the date of the notice.
Check Your Eligibility
Missouri's spend down rules can be complex, especially when factoring in multiple income sources, asset calculations, and the monthly reset. Use our free benefits screener to get an estimate of your eligibility before applying.
Check your MO HealthNet eligibility with the free Benefits Navigator screener
You can also find more information about all Missouri assistance programs at Missouri benefits overview.
Frequently Asked Questions
Who qualifies for Missouri's Medicaid spend down program?
Missouri's spend down program is available to residents who are age 65 or older, blind, or disabled and whose monthly income exceeds the Medically Needy Income Limit but who have enough medical expenses to reduce their effective income below that limit. You must also meet the asset limit of $6,068.80 for individuals or $12,137.55 for couples.
What is the spend down income limit in Missouri for 2026?
The 2026 MNIL for aged and disabled individuals is $1,131 per month for a single person and $1,533 per month for a couple, effective April 1, 2026 through March 31, 2027. For persons who are blind, the limit is $1,330 for an individual and $1,804 for a couple.
How long does MO HealthNet spend down coverage last?
Coverage lasts for the remainder of the calendar month in which you meet your spend down obligation. Missouri uses a one-month period, so you must meet the obligation again each month for continued coverage. Coverage does not carry over to the next month automatically.
Can I use unpaid medical bills to meet my spend down?
Yes. Missouri allows you to submit unpaid medical bills you are responsible for, not just bills you have already paid. This can significantly reduce the out-of-pocket cost of meeting your monthly obligation.
Can my spouse's medical bills count toward my spend down?
Yes. If you are married, medical bills incurred by your spouse can count toward your spend down obligation even if your spouse is not applying for MO HealthNet.
How do I pay my Missouri spend down?
You can pay online at mymohealthportal.com, set up automatic withdrawal from a bank account on the 10th of each month, mail a payment with your invoice to the Premium Collections Unit, or submit qualifying medical bills to meet the obligation. For payment questions, call 877-888-2811.
How do I apply for MO HealthNet spend down?
Apply online through myDSS at mydss.mo.gov, by phone at 855-373-9994, or by mailing a paper application to your local Family Support Division office. The state will determine whether you qualify for standard MO HealthNet or the spend down program after reviewing your income and assets.
What if I can't afford my spend down amount?
If you have qualifying medical expenses, you may be able to use those bills to meet the obligation instead of making a cash payment. If your spend down seems incorrect, you can request a fair hearing. A benefits counselor through Missouri's Area Agency on Aging (1-800-235-5503) can also help you review your options.
Does Missouri Medicaid spend down cover nursing home care?
Standard spend down Medicaid covers outpatient and community-based services. For nursing facility or long-term institutional care, a separate eligibility pathway applies with different income and asset rules. Contact your local Family Support Division for details on long-term care Medicaid in Missouri.
