Told you make too much for Apple Health?

Washington has a second pathway for people whose income is above the standard. It is called Medically Needy, most people call it spenddown, and it does not always get mentioned when someone is turned down.

What this is

Washington's Medically Needy program can potentially help certain people who meet an Apple Health category — aged, blind or disabled, for instance — in every respect except that their income sits above the categorically needy standard.

In other words: if the only thing standing between you and coverage was the income figure, this is the pathway built for that situation.

How spenddown works, in plain English

The nearest everyday comparison is a deductible. You take on a certain amount of medical cost yourself first. Certain allowable medical expenses may be applied toward that spenddown amount, and coverage can begin once it has been met.

The amount is not a fixed number that applies to everybody. It comes out of your income, your household and which of your expenses count.

We will not estimate your spenddown, and you should not trust anyone who does

Your amount depends on details only the state has in front of it. A figure from a website — including this one — would be a guess, and a guess is exactly what makes someone decide not to bother applying.

Washington HCA and DSHS make the determination. Ask them.

Two practical things

Ask about it by name. If you have been told your income is too high, say the words “Medically Needy” or “spenddown” and ask whether they apply to you. It does not always come up on its own.
Keep your medical bills. Allowable expenses are what get applied toward the amount, and people throw away precisely the paperwork that would have helped them.

Who to contact

Call DSHS: 877-501-2233 Apply through Washington Connection

Do not send us your documents. American Senior Choices does not process Medicaid applications and does not determine eligibility. For questions about estate recovery, trusts, gifting or spousal impoverishment, speak with an elder-law attorney rather than an insurance agent.

Questions people actually ask

I was told I make too much for Apple Health. Is that the end of it?

Not necessarily. Washington has a Medically Needy pathway for people who meet an Apple Health category but whose income is above the standard. It is not always mentioned when someone is turned down, so it is worth asking about by name.

How much is my spenddown?

We cannot tell you and no website should try. It is calculated from your income, your household and which of your medical expenses count. Washington HCA and DSHS make that determination. Anyone giving you a figure without your paperwork in front of them is guessing.

Is spenddown like a deductible?

That is the closest everyday comparison. You take on a certain amount of medical costs yourself first, and coverage can begin once allowable expenses have been applied toward it. The details of what counts and over what period are set by the state.

What kinds of expenses count?

Allowable medical expenses. Which specific ones count, and how they are applied, is determined by Washington. Keep your bills and receipts rather than throwing them out — people discard exactly the paperwork that would have helped them.

Does this affect my Medicare?

It can. Qualifying through this pathway can change what your care costs and can affect which Medicare options are open to you. That is worth reviewing once you know where you stand, not before.

Official sources

For free, unbiased help understanding any of this, call SHIBA at 800-562-6900.

Once you know where you stand

Qualifying through this pathway can change what your Medicare costs and which options are open to you. Tim can review the plans he represents against your doctors, prescriptions and hospital preferences once you have an answer from the state.

Talk With Tim About Medicare: (360) 472-4261

This line is recorded, as Medicare requires for plan conversations.

Last reviewed September 2026. American Senior Choices does not determine eligibility for government assistance programs. Eligibility is determined by the appropriate government agency. Program rules can change.

Disclaimer: American Senior Choices is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Currently we represent 5 organizations which offer 33 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.