People who are over the income requirements for Medicaid but who have a medical need and costly medical expenses can qualify for Medicaid through the Medically Needy program. People in this program must obligate their monthly income above the Medically Needy Income Level (MNIL) to their medical bills to establish Medicaid eligibility. These medical expenses must be at least equal to the difference between the individual's income and the MNIL.
This program is suited to people who live in nursing facilities or those who receive waiver services. Other people who may be a good fit for the program are those with very high monthly medical costs. If you think you may qualify, submit a Medicaid application and note in the comments section of the application that you would like to be considered for Medically Needy.
Share of cost allows people with income that exceeds Nebraska's limits to be eligible for Medicaid, and receive health care coverage. In order to qualify, you must pay for a certain share of the cost of your medical expenses before receiving assistance from Medicaid. This can also be called a “spenddown."
Share of cost is based on the medically needy income level (MNIL) and the size of your household. It is calculated by the difference between your income and the MNIL using the table below.
For example, someone who lives with a spouse and one child, a household of three, and has an adjusted household monthly income of $1,000. Their share of cost comes from the medically needy income level (MNIL) for their household, $492, subtracted from their monthly income, $1,000, which then equals $508 as the share of cost.
Most expenses normally covered under Medicaid can also be covered under a share of cost. Some examples include:
Medical expenses accumulated by other members of your household can also be included in share of cost.
DHHS will send you a form each month for your health care provider to fill out and sign that verifies the medical costs you have every month. These forms can show that you have enough medical expenses to be eligible to receive assistance from Medicaid.
If you have a share of cost that is paid to a nursing home, assisted living waiver, or in-home waiver, you do not receive the share of cost forms for your health care provider to verify your share of cost. This is because your monthly share of cost amount is paid directly to your health care or waiver service provider.