What Are The Qualifications For Medicaid In New York State

Past Income & Resource Levels

Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 through 2019, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

What Are The Medicaid Application Guidelines

Application guidelines for Medicaid in New York differ from other states, as you must adhere to specific instructions when submitting your paperwork. Since the qualifying criteria is spread into two groups â MAGI eligibility groups and non-MAGI eligibility groups, you must follow suit depending on the category in which you fall. Now that you understand income requirements for Medicaid, you can familiarize yourself with both eligibility groups.

What are the Medicaid application guidelines in NY for the MAGI groups? Categorized into the first group are foster care children, infants, and children under 19, pregnant women, relatives of parents or caretakers, and beneficiaries in the Family Planning Benefit Program .

A new adult group also falls into the MAGI eligibility groups. This group contains those eligible for Medicaid who are adults without dependents, including beneficiaries that:

• Are age 19 to 64
• Are not pregnant
• Are potentially certified disabled
• Lack Medicare and therefore require Medicaid

If you belong to any of the above groups, the state department requests that you apply for Medicaid through the New York State Department of Health Marketplace, when the time comes.

Non-MAGI eligibility requirements for Medicaid include recipients of:

• Medicare Savings Program

Do You Qualify For Medicaid In New York State

Medicaid Eligibility and Income Requirements for New York

Medicaid is a government sponsored program that covers medical expenses for low-income patients who cannot otherwise afford healthcare services. Not to be confused with Medicare, which is an insurance program, Medicaid is actual assistance provided by government. The main difference between the two is that Medicare serves primarily older adults aged 65 and up, whereas Medicaid covers low-income people of all ages. Medicare is a federally funded program where patients pay a percentage of their medical costs through deductibles and the rules are generally the same in all 50 states. However, Medicaid is run by state and local governments, and out-of-pocket costs are pretty much next to none.

Medicaid covers a broad range of healthcare services including doctor visits, hospital stays, nursing home care, home health care, and more. The amount you have to pay for copay will be relatively small and your prescription drugs may also be covered. Of course, you will have to qualify to receive these benefits.

New Yorks state department has developed several factors to determine who is eligible for these benefits. If youre unable to pay for your medical bills and are on other programs such as SSI , for example, you may be able to qualify for Medicaid as long as your income level does not exceed 138% of the Federal Poverty Level .

The chart below shows each income level according to the number of persons in your household:

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Apply Through The Dutchess County Department Of Community & Family Services If You Are:

• Age 65 and older
• Enrolled in Medicaid Buy-In for Working People with Disabilities enrollees
• Former foster care youth
• Resident of adult homes and nursing homes
• Resident of treatment center/community residences operated by the Office of Mental Health
• Applying for AIDS Health Insurance Program or Medicaid Cancer Treatment Program
• Applying for Medicare Savings Program
• Your eligibility is based on being blind or disabled or you request coverage for community based long term care services including those individuals with an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services

What Is The Look Back Period

Before October 1, 2020, there was no lookback for Community Medicaid. However, due to the passage of the 2020-2021 state budget, a 30 month lookback period will eventually be required. The effective date for the lookback period has been postponed many times due to the Families First Coronavirus Act which forbids states from restricting eligibility for Medicaid benefits during the pandemic.

Upon implementation of the lookback, assets that are transferred since Oct. 1, 2020, will in fact, be subject to the lookback. If the lookback starts May 1, 2022, the lookback period will be 15 months.

The lookback period will increase on a monthly basis until it is 30 months in April 2023. As of now, the lookback will go into effect for Community Medicaid applications that are received beginning January 1, 2022. However, this date has changed multiple times and may be pushed back again.

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Are You Eligible For The Essential Plan

There are three qualifying elements for you to be eligible for the NY Essential Plan. They are:

Income limits are related to your family size. The following chart explains how your income and family size is structured.

Essential Plan Residency Requirements

Low and moderate-income families that are residents of New York State and legal immigrants are eligible for the Essential Plan program.

All four Essential Plans don’t have a monthly premium, yet plan benefits are generous and provide you the ten essential health benefits mandated by the Affordable Care Act. Following are the different variations of the NYS Essential Plan:

Essential Plan 1 – Individuals with income greater than 150% and less than or equal to 200% of the FPL.

Essential Plan 2 – Individuals with income greater than 138% and less than or equal to 150% of the FPL.

Essential Plan 3 – Individuals with income equal to or greater than 100% and less than or equal to 138% of the FPL and not eligible for Medicaid due to immigration status.

Essential Plan 4 – Individuals with income below 100% of the FPL and not eligible for Medicaid due to immigration status.

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How Many People Are On Medicaid

According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:

• 78,521,263 individuals were enrolled in Medicaid and CHIP
• 72,204,587 individuals were enrolled in Medicaid
• 6,695,834 individuals were enrolled in CHIP

How Do I Enroll In Medicaid In New York

Older adults can apply for Medicaid in New York by writing, phoning or visiting their local department of social services. In addition, residents of New York City can contact the Human Resources administration at 557-1399 to apply. Generally, applications take around 45 days to process. It may take longer for people who need to have their medical needs assessed, such as those seeking nursing home coverage.

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Can A Homeowner Qualify For Medicaid In New York State

This article is not intended to provide you with legal advice. Should you seek legal advice, please consult an attorney. KTS would gladly recommend an attorney should you need one. Its important to have an attorney take appropriate actions on your behalf and to avoid issues that may be discussed in this article.

Many New York residents may not know if they are eligible for New York Medicaid if they own their own homes. To find out, youll need to explore the eligibility requirements for Medicaid for individuals who own their own homes, commonly referred to as the homestead.

Its important to understand the different types of Medicaid available to New York residents. Youll also need to know what assets are looked at in determining Medicaid eligibility. In addition, learn how you can protect your assets if you decide to apply for and take advantage of Medicaid benefits.

Intent To Return Home

The intention of an individual to return home is subjective and depends on each individual homeowners situation. The intent to return home can be written in the form of a signed statement/letter or an affidavit. A letter or affidavit may also be written and signed by the individuals friends or family if they possess personal knowledge of the intent to return home. Goldfarb Abrandt & Salzman says that, When these circumstances apply, the subjective intent to return home holds, even if there is the possibility or expectation that the individual will not be discharged and return to the home.

A lien can be placed on the home by the state even though the individual is still alive. This may be the case if the individual is considered permanently absent and no discharge is reasonably expected. In such cases, the lien can be imposed even when the individual has a subjective intent to return home.

However, if certain occupants reside in the home, the state is not able to impose liens. These occupants include the individuals spouse, a minor child who is either blind or disabled, or a sibling with equity interest. The sibling must also have lived in the home for a required minimum amount of time prior to the individuals admission to the nursing home.

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New York Medicaid Expansion Update

The state of New York expanded Medicaid as of January 1, 2014.

Between the fall of 2013 and August 2018, the states total Medicaid enrollment grew by 14 percent, to nearly 6.5 million people.

Medicaid expansion covers more than 2 million New Yorkers.

New York Medicaid relies on managed care, and numerous plans provide Medicaid coverage plan availability varies by county.

New York Medicaid Income Limit

The New York Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.

To qualify, you must meet the New York Medicaid Income limits listed below.

Here is the Federal Poverty Level for 2021.

Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

• Children up to age 1 with family income up to 218 percent of FPL
• Any child age 1-5 with a family income up to 149 percent of FPL
• Children ages 6- 18 with family income up to 149 percent of FPL
• CHIP for children with family income up to 400 percent of FPL
• Pregnant women with family income up to 218 percent of FPL
• Parents of minor children with family income up to 133 percent of FPL
• Individuals who are elderly, blind, and disabled with family income up to 83% of the FPL
• Adults without dependents under Medicaid expansion with income up to 200% of the FPL

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What Does Medicaid Cover In New York

Medicaid gives beneficiaries quite a broad range of coverage with regards to health insurance. This includes visits to the doctor, hospital stays, care in a nursing home, home health care, and more.

Medicaid also pays for prescriptions. If you ever have to pay a copay, it will be one that is relatively small.

New York State Passes New Law To Qualify For Community

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On April 3, 2020, New York State passed the 2020/2021 Budget, which contains a number of changes for New York residents. Among those, one of the most significant changes impacts the way New Yorkers qualify for Community Medicaid benefits. These changes have been codified in amendments to Social Services Law Section 366. Below we have summarized the new law for you in the form of a Q & A.

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Medicaid Offers A Full Range Of Health Services For Eligible Persons Including:

• All regular medical checkups and needed follow-up care.
• Immunizations.
• Medical equipment and appliances .
• Lab tests and x-rays.
• Eye care and eye glasses.
• Emergency care.
• Emergency ambulance transportation to a hospital.
• Hospital stays.

For some pregnant women, services may be limited to perinatal care if their incomes are too high to qualify for full Medicaid coverage.

For children birth to 21 years old, Medicaid offers the Child/Teen Health Program , which provides the services listed above for all Medicaid recipients. C/THP places an emphasis on preventive care and treatment. For example, Medicaid requires that all children be screened with a blood lead test at one and two years of age. C/THP is available from fee-for-service healthcare providers. Also, all managed care plans must offer C/THP to Medicaid recipients under 21 years of age who are enrolled in their plan.

Child Health Plus and Family Health Plus provide services to eligible children and adults, respectively, through managed care plans.

Medicaid For New Yorkers In Nursing Homes

Nursing homes are residential facilities that offer round-the-clock skilled nursing care in addition to other supportive services. People who are sixty-five or older, disabled, or blind, can qualify for Medicaid that will cover a nursing home stay if they meet income and asset limits and if they need skilled nursing care.

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New York Medicaid Income Limits Summary

We hope this post on New York Medicaid Income Limits was helpful to you.

If you have any questions about Medicaid in the state of New York, you can ask us in the comments section below.

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Be sure to check out our other articles about Medicaid.

What Benefits Does Community Medicaid Provide

The NYS Department of Health lists the following Community Medicaid benefits and services:

• Doctor and clinic services, lab tests, and x-rays
• Medicaid drug coverage for prescription and non-prescription drugs
• Home care and personal care aides
• Adult daycare and transportation to medical care
• Physical, occupational, and speech therapy
• Mental health services
• Durable medical equipment, orthotic and prosthetic appliances
• Light housekeeping

Patients who continue to live at home, as well as residents in assisted-living facilities, may be eligible for these services through Community Medicaid.

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Medicaid Application Strategies For Homeowners

If you are a senior citizen or disabled person in need of coverage through Medicaid and you own your own home, dont despair. Having large assets such as a home does not automatically disqualify you for Medicaid coverage. Familiarizing yourself with the eligibility requirements early on is crucial.

Find an elder-law attorney who specializes in asset protection and Medicaid planning strategies. They can help you and your loved ones prepare an asset spend-down strategy to meet the requirements. Doing so will let you receive coverage without incurring penalties, liens, or estate-recovery tactics.

About the author, Carlos Nath:

Carlos Nath is the Senior Trust Advisor with KTS Pooled Trust. As a seasoned professional with over four years of experience in the New York pooled trust space, Carlos has helped thousands to enroll and set up their accounts with KTS. He is proficient in understanding the Medicare process and provides assistance in clarifying what clients may need. Previously, Carlos worked with a Medicaid consulting firm as an advisor who helped clients who were seeking Medicaid assistance.

Overview Medicaid For Seniors In Ny

While Medicaid programs target different groups of people, this report is concerned only with long-term care that benefits the seniors and elderly, with a focus on the state of New York. Medicaid is a joint venture between the Federal government and each state, catering mostly to low-income people. The Federal government provides subsidies and sets basic standards while, generally speaking, each state sets eligibility requirements and other rules that govern services. Some 66 million people received Medicaid benefits in 2018, of those 7.2 million , making it the largest payer of healthcare benefits in the United States.

Here is a brief summary of the type of elderly-related programs that Medicaid offers in the state of New York:

• Nursing homes: If you are a senior or elderly Medicaid beneficiary, Medicaid has traditionally paid for long-term care in all Medicaid-certified nursing homes or senior living homes.

• Home-based programs:For at-home care, Medicaid has several programs in the state of New York for seniors and elderly that cover home health care as well as personal care .

Home and community-based programs: In 2018, every state in the country, as well as D.C., offered at least one program that pays for elderly-related services for those who choose not to become nursing home residents. The state of New York has various programs that provide assistance at home for seniors, in assisted living facilities , in day care, and with other home-related chores.

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How To Determine Size Of Household To Identify Which Income Limit Applies

The income limits increase with the “household size.” In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the “category” of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.

New rule is explained in State’s directive 13 ADM-03 – Medicaid Eligibility Changes under the Affordable Care Act of 2010 pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also seeLegal Aid Society and Empire Justice Center materials