There is also another concept for what "spenddown" means. In my state, WA, it also refers to when you are on a type of Medicaid program that will pick up the balance of your medical bills during a 3 or 6 month period of time after you have met your "spenddown" responsibility. Think of it as a deductible on insurance. To show the state you have met your spenddown /deductible you do provide bills for the medical expenses you have incurred. Then the state picks up the rest of the medical costs during that period. Most of the time on this site people are talking about how to spend down their excess assets to qualify for a Medicaid program. This is a different issue. In both concepts the state is interested in some aspect of the financial circumstances before it uses taxpayers money for an individual 's private medical expenses, whether it's just some prescriptions and copays or huge hospital bills., or long term nursing home care.
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Reply to vegaslady

Yep. When I was Mom’s POA, I kept a separate envelope in my purse and irritated cashiers by asking for separate receipts for her things and mine. But her facility worked with me and let me know when I needed to lower her balances so she wouldn’t be disqualified. If in doubt, keep it!
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Reply to Ahmijoy

Pretty much, yes. Or some proof such as a cancelled check to verify it was something for the applicant and not given as a gift.
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Reply to jeannegibbs