Updated August 27, 2026. Quick answer: Michigan’s manual states an instruction that reads like a rule of fairness: “The individual must be given the most advantageous use of their old bills (also known as incurred expenses).” And when expenses finally cover the excess, coverage starts “The day after the day the expenses equaled the excess income.”
What Michigan requires
| What the state sets out | What it says |
|---|---|
| Michigan’s name for it | deductible (BEM 545, MA Group 2) |
| Old bills | “The individual must be given the most advantageous use of their old bills (also known as incurred expenses).” |
| Months you may request | “The individual may request coverage for the current month, up to six future months (see eligibility based on old bills in this item), and for any prior months.” |
| Order of testing | “Determine income eligibility in calendar month order, starting with the oldest calendar month.” |
| When coverage begins | “The day after the day the expenses equaled the excess income.” |
| What Medicaid pays on the day it is met | “MA may only be billed for the amount that exceeds the group’s liability” |
How it works in practice
- “Most advantageous” is a direction to the worker, not a courtesy. Old incurred expenses are meant to be applied where they do the client the most good, which is why producing every old bill is worth the effort.
- The day the deductible is met is a split day. Coverage runs from the day after, and for the day itself “MA may only be billed for the amount that exceeds the group’s liability”.
- The request window is wide: the current month, up to six future months, and any prior months. Months are then tested in calendar order starting with the oldest.
The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the record for Michigan.
What this page does not settle
- A pregnancy usually clears the deductible immediately, because the full cost of obstetric care including labour and delivery is incurred at the first visit.
- This page reads one source: Michigan DHHS Bridges Eligibility Manual, BEM 545 (MA Group 2 Income Eligibility). It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
- A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
- Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.
Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.
Sources
The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.
Spending down to the income limit is only half of what Michigan Medicaid can do for a household that is already providing the care itself, and getting paid as a family caregiver in Michigan names the Michigan program that pays one and answers the family-member and the spouse question separately.
Before the excess-income rule applies, there is the eligibility test itself: Michigan’s Medicaid nursing-home income test sets out the figure or the mechanism the state actually uses, with its primary-source citation.
Related: Michigan’s Medicaid home equity limit for a single applicant with no spouse or dependent child at home.
Related: Michigan’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.