Medically Needy & Share of Cost

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Medicaid Related Assistance
Medicaid & Long-Term Care
 
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What you need to know

​​​​​​​​​Medically Needy

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 incom​e 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.

​Qualifying for Medically Needy means that you will be paying a monthly share of cost. For more information on Medically Needy and share of cost, view these resources.

What is Share of Cost?​​​​​

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."

A share of cost is most helpful to those with ongoing medical needs. Depending on the share of cost amount, it may not be the best fit for everyone.

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Who is eligible for share of cost?

Many different people whose income is above the household limits may have to pay a share of cost. People who are aged, blind, or disabled, as well as low-income parents or families may be eligible. Additionally, people who are receiving long-term care services and supports, such as the Aged & Disabled (AD) or Developmental Disability (DD)​ waivers may be eligible.

How is share of cost calculated?​​​

Share of cost is based on the MNIL and the size of your household. It is calculated by the difference between your income and the MNIL using the table below.

​Household Size
​Medically Needy Income Level (MNIL)
​​1
​$392
​​2​
​​$392
​3
​$492
​4
​$584
​5
​$675
​​6
​$775
​​7
​$867
​​8
​$967
9
​​$1,059
​10​
​$1,150​

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 MNIL for their household, $492, subtracted from their monthly income, $1,000, which then equals $508 as the share of cost.

What medical services can share of cost cover?

Most expenses normally covered under Medicaid can also be covered under a share of cost. Some examples include:

  • ​Physicians' appointments
  • Dental care
  • ​Medical equipment 

Medical expenses accumulated by other members of your household can also be included in share of cost.

How will DHHS know that the share of cost has been met to recieve Medicaid assistance?

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.

Exceptions to the share of cost form process:

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.​

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