Medicaid's spend-down program operates on what basis?

The spend-down program for Medicaid operates on a state-by-state basis because Medicaid is a joint federal and state program that provides healthcare assistance to eligible low-income individuals. Each state has the flexibility to design its own rules and eligibility requirements within the federal guidelines, which includes the management of the spend-down program.

The spend-down program is a mechanism that allows individuals with income slightly above the established Medicaid eligibility limit to qualify for benefits by incurring certain medical expenses, thereby "spending down" their income to bring it below the threshold. Since each state can decide how to implement this program, including what expenses may qualify and how the spend-down amounts are calculated, it reflects the program's operation on a state-specific level.

This variability means that not all states may offer the same features for the spend-down program, and the specifics can differ significantly, contributing to Medicaid's state-centric governance structure.