My Mother's spend down is $472.00,My Mother makes less then $500.00 a month on disability and my step-father makes over $1,000.00 a month on disability.What steps could we take to meet the spend down?

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You can already take care of her if you like. Medicaid will not pay for that but you can certainly do it. I presume you want to meet the spend down in order for her to receive Medicaid. The spend down is something you have to do every single month (sorry!) in order to receive Medicaid . You have three options:
(1) Ongoing- If your mother has regular, ongoing medical bills that amount to $472 (her spend down amount) every single month, you can take proof of this to the social worker and they can give her a Medicaid card. You would have to let them know immediately if this changed at any time or they could charge you (her) with fraud and removed her from Medicaid eligibility.
(2) Delayed- This would involve keeping all medical related receipts each month. When she has spent $472 on medical expenses in a given month, you turn in the receipts and get Medicaid coverage for the rest of the month. She would get a dated temporary card for that month only.
(3) Pay-In This options means paying the $472 to your social worker every month in exchange for having Medicaid. In effect, you just pay the spend down directly. I would not advise this option unless she has no insurance at all and has high medical expenses and needs.
Here is something I hope will encourage you. The Supreme Court has upheld President Obama's Affordable Care Act as being constitutional. In late 2013, Medicaid eligibility is going to greatly expand and your mother and stepfather will both be eligible for Medicaid with NO spend down due to their income.
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