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“Spend down” means that the applicant for Medicaid needs to get all their nonexempt (for Medicaid) assets to whatever the asset limit is for the type of Medicaid program they are applying to and they do this by spending their ier assets on their care, their needs or their property in advance of the application. The $ has to be able to be clearly documented as to where it was spent. No transfers of property or $ to family, siblings or others as it’s considered “gifting” & will likely lead to a transfer penalty by Medicaid.

Whether the spend down is straightforward or very complex really is going to be interdependent on the applicants situation.

Imo for a son or daughter who have been involved in their parents life & are already their parents DPOA, doing the Medicaid application for a widow or widower parent needing to go into a NH/Medicaid LTC program, it’s pretty straightforward..... they get to under 2k in non exempt assets (like $ in their bank account) and have their income under whatever the monthly income limit is for their state (for most states monthly income is abt $2100). And if it’s over the set by your states monthly income limit, you as DPOA see if they can get a Miller Trust done for the overage. Most elderly are on just SS so they will be easily under income limit. 
For assets, to me, a lot of this depends on how much $ in assets & what kinds of assets. 50k sitting in savings, can be an easy spend down. Like they buy a preneedfuneral & burial policy (within Medicaid limits), new hearing aid, couple of pair of eyeglasss, better quality walker or wheelchair, update their legal... and 50k pfft gone within medicaid guidelines. If dental work needed, that could easily be entire 50k.

But if their finances are complex - like they have to cash out life insurance policies or stocks, or sell property- working with a elder atty is very veryworthwhile.

For couples, where only 1 is going into a NH & the other staying in thier home as a “community spouse”, it is not simple and imho you really need a elder law atty to discuss options for the NH spouse and the CS and do this BEFORE ever submitting a Medicaid application.

So what’s your backstory? Folks will have suggestions if you let us know a bit more!
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There is a lot on the internet about this subject, and many posts on this site. A search will bring up lots of information.

Basically, Medicaid has rules about how much you can own in assets and still qualify for their programs. It is considered a "welfare" program, and you have to qualify for it financially as well as medically.

If you own 2 apartment buildings, or a collection of classic cars, or a valuable piece of art, you own too many assets to qualify. If you have $11,000 in the bank and are single, you own too many assets to qualify.

Medicaid expects you to sell the apartment building or cars or artwork and use that money for your own care before you ask for public assistance. The same is true of the money in the bank. You must spend your "excess" assets (over the amount you are allowed by Medicaid rules) before you can qualify.

The process of using your assets until they are under the limit is called "spending down."

The main rule about the spending down is that it must be for yourself. You cannot pay off your grandson's college loans, but you can pay off your own credit cards. You cannot donate large amounts to your church's roofing fund, but you can put a new roof on your own house. You can't buy your daughter an expensive gown for a special occasion, but you can completely update your own wardrobe.

And you can, of course, use those assets to pay for in-home help or a care center, for as long as the money lasts.

And then you can apply for and hope to qualify for Medicaid.

Do you have some specific questions about a particular spend down situation?

If your financial situation is complex, it is probably worthwhile to consult a lawyer specializing in Elder Law in getting it spent down to qualify.
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