How Much Income For Medicaid Ny

How To Apply For Ny Medicaid

You may apply for Medicaid in the following ways:

• Enrollment Assistors offer free personalized help.
• To speak with the Marketplace Customer Service Center call 355-5777
• Through a Managed Care Organization
• Call the Medicaid Helpline 541-2831
• Through your Local Department of Social Services Office

Where you apply for Medicaid will depend on your category of eligibility. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service . No matter where you start, representatives will help make sure you are able to apply in the correct location. For more information on determining your category of eligibility and where you should apply read on.

NY State of Health determines eligibility using Modified Adjusted Gross Income Rules. In general, income is counted with the same rules as the Internal Revenue Service with minor variations. Individuals who are part of the MAGI eligibility groups listed below should apply with NY State of Health.

• Adults 19-64 years of age and not eligible for Medicare,
• Children 1 – 18 years of age
• Pregnant Individuals,
• Parents and Caretaker Relatives of any age

Individuals who are part of the non-MAGI eligibility groups listed below should apply with their Local Department of Social Services .

Other factors that may affect your eligibility include:

• State Residency
• Family or Household size

Medicaid Application for Non-MAGI Eligibility Group

Supplement A

Past Unpaid Medical Bills

Past unpaid medical bills may be used to meet your excess income amount even if they are old, as long as they are still viable, meaning that the medical provider is still able to bring a legal action to collect them. These bills may be applied to meet your excess income indefinitely into the future.

• Example: You have a hospital bill from four years ago and received a collection notice from the hospital this year. The bill is for $2,000. Your excess income is $200. You may submit this bill to meet your excess income for six consecutive months. After the six months is over, if the provider is still trying to collect on the bill, you can continue to use the balance of the bill for four more consecutive months.

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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How To Apply For New York City Medicaid

You can apply for Medicaid through New York City HRA if you:

• Need Medicaid because of a disability or blindness
• Get Medicare and are not a parent or caretaker of minor children
• Are a former foster young adult under 26

If any of these categories describe your case, call the HRA Helpline at 1-888-692-6116 or visit any one of the Medical Assistance Program Offices.

to Find a Medicaid Office near you.

Additionally, Low-income pregnant women, children, and adults under 65 must apply for coverage through NY State of Health .

It is operated by New York State and is the Official Health Plan Marketplace. Contact the Marketplace at 1-855-355-5777.

What Is The Highest Income To Qualify For Medicaid

Washington D.C. has the highest allowable income to qualify for Medicaid, at 215% of the FPL for individuals and 221% for a family of three.

That means an individual in Washington D.C. can make up to $27,692 per year and still be eligible for Medicaid. Washington D.C.s high cost of living factors into its higher income limit for Medicaid. No other state uses more than the standard 138% limit for individuals.

A family of three can make up to $48,531.60 and still qualify for Medicaid in Washington D.C. Connecticut is the only other state to use a limit higher than 138%.

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Medicare: Excellent Insurance But Without Further Help You Could Go Broke

Medicare Parts A & B Traditional Medicare

Medicare is a federal program available to persons who are sixty five years of age and older, and disabled persons of any age who receive Social Security Disability benefits. Basically, it is the health insurance component of Social Security. Medicare Part A covers hospital and limited amounts of skilled nursing and home health care. Medicare Part B is optional and covers part of physicians costs and other medical services and supplies. Medicare is the most cost-effective health insurance a senior citizen can buy! Everyone eligible should have Medicare coverage and take the optional Part B coverage at the earliest time allowable . Medicare, however, is far from perfect it is in fact a safety net with many holes. Medicare has certain deductibles, limited payment periods, and restrictions on the types of services covered. Two of the most severe restrictions are that it only covers nursing home care if it is skilled rather than custodial care, and it covers only 100 days of nursing home care per spell of illness. A spell of illness begins with the first day of inpatient care in a hospital or nursing home and ends when the beneficiary has been hospital and nursing home free for 60 consecutive days. Recipients of Medicare Parts A and B should have a supplemental Medigap policy .

Medicare Part C

Medicare Part D

Are There Any Exceptions To The Look

The 2019 Coronavirus pandemic has had a significant impact on Medicaid eligibility. The COVID Public Health Emergency has been extended several times, most recently in April 2022, prohibiting the government from discontinuing Medicaid or increasing the spend-down until August 1, 2022.

As a result, the 30-month look-back period that disqualifies many applicants from home care or minimum requirements for CDPAP services will not apply until October 1, 2022. If applicants complete their Medicaid planning and submit their Home Care Medicaid Application before October 1, 2022, they may not be subject to the standard 30-month look back or penalties for transfers to a Medicaid Asset Protection Trust. For this reason, anyone who needs these services now should speak with our Medicaid planning team as soon as possible.

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What Is The Maximum Income To Qualify For Medicaid In Ny

As of 2019, this means a single applicant can have income up to $771 / month, and a married couple, up to $1,157 / month. For those that do not receive SSI, there is a spend down program that allows one to spend income over the ABD eligibility limit on medical expenses to qualify for Medicaid.

What is the minimum income to qualify for Medicaid waiver?

This is the minimum amount of monthly income to which the non-applicant spouse of a nursing home Medicaid applicant or a HCBS Medicaid waiver applicant is entitled. From July 2021 June 2022, this figure is $2,177.50 / month.

New Yorks Requirements For Medicaid Qualification

Eligibility for New York Medicaid is something that is determined by a few different factors that have been developed by the New York state department. The benefits given by Medicaid will aid those who are unable to pay their medical bills, such as those on SSI and others who meet the requirements for eligibility. Before those requirements even come in to play though, you first have to fall into one of the following categories:

• Adults who have an income that does not exceed 138% of the FPL
• Infants and/or women who are pregnant whose income does not exceed 218% of the Federal Poverty Level

To qualify for Medicaid – aside from being in one of the preceding two categories – you need to meet predetermined requirements for eligibility. You have to reach, without exceeding certain income thresholds. Additionally, you have to prove that you are a citizen of the US as well as proving that you are a state resident. You also need to have documentation regarding your living situation and your marriage license if you are married, along with your SSN .

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What If My Income Exceeds Medicaid Thresholds

If someone is under 21, age 65 or older, certified blind or certified disabled, pregnant, or a parent of a child under age 21, they may be eligible for the Medicaid Excess Income program, better known as the Spend-down program.

A client who falls into this classification, but who still has income over Medicaids allowance amount, is said to have excess income. If the clients medical bills for that month exceed his excess income, Medicaid will pay their medical bills beyond the excess.

Additionally, special needs and pooled income trusts can be utilized by disabled Medicaid recipients who would otherwise have to give their excess income to Medicaid. For example, if an individual receives Social Security, SSI, pension, or other income which exceeds $842 a month, he can place the excess income into a pooled income trust which would allow him to qualify for Medicaid while allowing the trust to use the remaining income to pay the individuals bills such as rent.

What Does The Essential Plan Cost

Starting in 2021 all Essential plans have removed their monthly premium requirements and are now free! There are a total of 4 Essential plan options, each based on your current income. There are no family plans with the essential plan, only individual coverage. Children are not eligible for the Essential Plan, however, if the parent qualify for the Essential then the children are most likely eligible for Child Health Plus

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Cost And Coverage Of Medicaid In New York

Estimates for the cost of Medicaid can vary depending on things like the individual patient and services needed. These copays will be small. People who will receive free healthcare from Medicaid include those who are under the age of 21, women who are pregnant, and patients who are in long-term care.

As far as coverage goes, Medicaid typically pays for most medical services, along with any medications and supplies that are needed. This includes coverage for things like:

• Family planning services and prenatal care
• Ambulance rides to the hospital in emergency situations
• Public transportation or car mileage to the patients medical appointments
• Medicines, supplies, medical equipment, and appliances
• Early screening, diagnosis, and treatment for beneficiaries who are under 21
• Other various services that might be needed

Who Qualifies For Medicaid

In all but 13 states, adults who make below a certain income may qualify for Medicaid. In all states, Medicaid is available to people who make a low income and also meet other criteria such as being at least 65 years old, disabled, pregnant or other qualifications.

Each state runs its own Medicaid programs with its own set of qualifying criteria.

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How To Read The Hra Medicaid Levels Chart

MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare,AND MAGI can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R. § 435.4.

Certain populations have an even higher income limit –

• 224% FPL for pregnant women and babies < age 1,
• 154% FPL for children age 1 – 19.

• See all income limits on MAPDR-01 HRA income limits chart.

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.

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The Following Programs Were Available Prior To 2014 But Are Now Discontinued Because They Are Folded Into Magi Medicaid:

• Prenatal Care Assistance Program was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year than for children ages 1-18 .

• Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as “S/CC” category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow “spend down” of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.

• Family Health Plus – this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange.

Caution: What Is Counted As Income May Not Be What You Think

For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population – which is virtually everyone under age 65 who is not on Medicare – their income will now be determined under new rules, based on federal income tax concepts – called “Modifed Adjusted Gross Income” . There are good changes and bad changes.

GOOD: Veteran’s benefits, Workers compensation, and gifts from family or others no longer count as income.

BAD: There is no more “spousal” or parental refusal for this population and some other rules. For all of the rules see:

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Applying For Ny Medicaid Long Term Care Programs

The first step in applying for a NY Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one want to apply for Nursing Home Medicaid, Home and Community Based Service Waivers or Disabled, Aged 65+ or Blind / Regular Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for NY Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, its important to start gathering documentation that clearly details the financial situation for the NY Medicaid applicant. These documents will be needed for the official NY Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts a letter from the Social Security Administration showing the applicants gross Social security income and deductions tax forms to verify income streams including wages, pensions, royalties and interest lists of items of any trusts proof life insurance and a list of beneficiaries Power of Attorney documentation.

Choosing a NY Medicaid Nursing Home

Asset & Income Limits

First, the applicant must meet the necessary assets levels. In 2021, an individual applying for home care Medicaid may have up to $15,900.00 in non-exempt assets. Certain assets are exempt, and include an irrevocable pre-paid burial fund, life insurance with a cash surrender value not to exceed $1,500.00, and retirement accounts so long as the minimum distributions are being taken.

A primary residence is also an exempt resource for Community Medicaid eligibility if a spouse, minor child, or disabled child is living in the home or if single, the equity value in the home is less than $893,000. However, where the applicant owns a home it is advisable to consult an attorney to avoid any potential estate recovery after the Medicaid recipient passes away, which can result if the applicant enters a nursing home or if the spouse, minor or disabled child no longer live there.

Second, the applicant is permitted to keep $875.00 per month in income plus a $20.00 disregard. However, where the applicant has income which exceeds that $895.00 threshold, a Pooled Income Trust can be established to preserve the applicants excess income and direct it to a fund where it can be used to pay his or her household bills.

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Past Income & Resource Levels

Past Medicaid income and resource levels in NYS are shown on these oldNYC HRA charts for 2001 through 2021, 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 If You Are Above The Levels Of Income For Eligibility

If your monthly income exceeds eligibility income levels, you can still qualify for Medicaid long-term home care benefits in two ways. You can spend down your excess income or join a pooled trust. Both are accepted and common ways to gain eligibility.

• Spend down your excess income

In order to be eligible for Medicaid, the government requires you to spend down your excess income by subtracting medical expenses, including deductibles and premiums, to lower your monthly income to a level that qualifies you.

• Join a pooled income trust

If you apply for Medicaid but discover you are not eligible due to excess income and dont want to spend down, joining a pooled trust can help you qualify for benefits. To gain eligibility, you would deposit your monthly excess income into the trust, which can be used to pay qualified monthly bills.

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