How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In New York
Many Medicare beneficiaries receive Medicaid financial assistance that can pay for Medicare premiums, lower prescription drug costs, and cover expenses not reimbursed by Medicare such as long-term care.
Our guide to financial assistance for Medicare enrollees in New York includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
How To Apply For Medicaid In In New York
Due to the fact that you must stick to specific instructions with regards to submitting your paperwork, the application guidelines are different in New York than those in other states. The qualifying criteria are actually spread into two separate groups. These are MAGI and non-MAGI groups. You have to file differently depending on which group you fall into.
When it comes to MAGI application guidelines, this group includes foster children, children under 19, beneficiaries of the FPBP , relatives of caregivers or parents, women undergoing fertility treatments and pregnant women. If you fall into this group, you will have to apply for the Medicaid program via the New York State Department of Health Marketplace.
To be eligible under the non-MAGI eligibility group, you must be a recipient of one of the following:
- Medicaid Cancer Treatment Program
- ADC-related medical needy, or the
- Medicare Savings Program
If you belong to this group, you should apply for Medicaid at your local Department of Social Services.
Income Requirements For New York Medicaid
The income requirements for Medicaid are based on various resource levels for the state. For example, the income requirements for people who are over the age of 65, blind, or otherwise disabled are different than they are for people who are single or who are married but without any children. Additionally, assets are to be accounted for. When it comes to getting around the Medicaid financial requirements, you can only have more money if you are over 65, a child, pregnant, blind, or otherwise disabled.
In general, you can only have income that is not over 138% of the FPL for your size family or household. If you would like to see specifics as far as what you can earn for your household size, click here.
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If You Qualify Under A Magi Eligibility Group You Will Have To Provide Documents To Verify Eligibility If Necessary
- If you are applying for Medicaid through the Marketplace , you may attest to your household income for the upcoming year. If your income is different than the income found on the data matches, income documentation may need to be provided.
- Citizenship/Immigration status and social security number will be verified through federal data sources. If citizenship/immigration status or social security number does not match, documentation must be provided.
Frequently Asked Questions For Current Medicaid Beneficiaries
What is a Community Spouse?
A community spouse is someone whose husband/wife is currently institutionalized or living in a nursing home. The community spouse is not currently living in a nursing home and usually resides at the couple´s home.
I am a community spouse. Will I be allowed to keep any income or resources?
If your spouse is institutionalized or living in a nursing home, you will be permitted to keep some income known as a minimum monthly maintenance needs allowance . If you are currently receiving income in excess of the minimum monthly maintenance needs allowance, you may be asked to contribute twenty-five percent of the excess income to the cost of care for the institution
How do I find my local Medicaid office?
The Medicaid office is located in your local department of social services. A listing of offices can be located here:
If you live in the five boroughs of New York City, your offices are run by the Human Resources Administration . A listing of offices can be found here:
How do I order a new benefit card?
If your Medicaid is with your LDSS, to order a new Medicaid Benefit Identification Card, please call or visit your
If your Medicaid is with the and you need to order a new benefit card please call the call center at 1-855-355-5777.
Members residing in the five boroughs of NYC can call the HRA Infoline at 1 557-1399 or the HRA Medicaid Helpline at 1 692-6116.
How often do I have to renew?
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Medicaid Chronic Care Nursing Home Placement
- Placement of Albany County residents in Nursing Homes
- Pickup of Albany County residents already in Nursing Homes
- Long Term Home Health Care cases Married couples where one is looking for a waiver program:
- Nursing Home Transition Diversion or Traumatic Brain Injury or to enroll in a Managed Long Term Care Plan . This allows a spouse to receive care at home and still qualify for Medicaid.
Please call the above number for further information.
Eligibility Requirements For New York Medicaid Benefits
In order for New York seniors to be eligible for Medicaid services, they must meet certain financial eligibility requirements. First of all, an individual must be disabled or 65 years of age or older at the time of application.
There are additional requirements for New York Institutional Medicaid. In order for an individual to be eligible to receive New York Institutional Medicaid benefits, he or she must be under the appropriate asset limit set by Medicaid. Those limits are currently as follows:
- Single person $15,150
- Couple $22,200
In the event that only one spouse is seeking admission to a facility, the community spouse will be able to retain at least $74,820or a maximum of one-half of the couples joint liquid assets up to a maximum of $123,600. In the event the assets are over $123,600,there may be other rules that apply.
In Medicaid terminology, the snapshot date refers to the first day of the month on which one spouse goes to a facility, and the assessment of the couples joint liquid assets occurs from this date.
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How Do I Apply
If you apply at one of our Department of Community and Family Services locations, you will need the following documents:
- If you are a U.S. citizen and provide a valid Social Security Number , a match with the Social Security Administration will verify your SSN, date of birth, and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization or a U.S. passport.
- Proof of citizenship or immigration status.
- Proof of age , like a birth certificate.
- Four weeks of recent paycheck stubs .
- Proof of all your income including sources like Social Security, Veteranâs Benefits , retirement benefits, Unemployment Insurance Benefits , Child Support payments.
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information of all bank accounts, insurance policies and all other resources.
- Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, current utility bill or envelope from mail you received recently.
- Copy of insurance benefit cards .
- Copy of Medicare Benefit Card .
Note: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition and you meet all other Medicaid eligibility requirements.
Talk To A New York Elder Law Attorney Today
If you are new to the New York Medicaid process, you no doubt have many questions about how the process works. At Goldfarb Abrandt & Salzman LLP, our New York elder law attorneys understand the many complexities and nuances associated with Medicaid law at both the state and federal levels. We can help you determine your eligibility for benefits and assist you with every aspect of the application process.
To schedule a free consultation and case evaluation with a New York senior law attorney, please call us at 387-8400, or contact us online today.
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Governor Pushed Back Against Gop Efforts To Repeal The Aca
In January 2017, as President Trump was poised to take office and it was clear that GOP lawmakers were going to push hard for ACA repeal, New Yorks then-Governor Andrew Cuomo announced that 2.7 million people were at risk of losing Medicaid coverage in New York if the ACA was repealed and not replaced with something equally robust, and that the state budget impact would be $3.7 billion.
Although most of the New Yorks Medicaid enrollees were already eligible under the states pre-2014 guidelines, the state estimated that several million Medicaid enrollees would have lost coverage if the ACA had been repealed. Thats because the state was using 1115 waivers to expand coverage eligibility in the years prior to ACA implementation, and the federal government was splitting the cost with the state as called for in the waivers.
But those waivers expired after Medicaid expansion was implemented. If the ACAs Medicaid expansion had been repealed, eligibility would have reverted to much lower thresholds: parents with dependent children would have been covered with income up to 94% of the poverty level , and childless adults wouldnt have been eligible at all. The state would have been allowed to spend their own money to extend those guidelines, but it would have been fiscally challenging without the federal match.
Ultimately, the ACA survived the legislative onslaught in 2017 and a Supreme Court case that upheld the law in 2021.
Medicaid expansion in New York
Helping Individuals Determine Their Eligibility For Medicaid And Complete The Necessary Paperwork
In a nutshell, both federal and New York state law govern Medicaid. It helps senior citizens afford the high cost of long-term healthcaremost often in nursing homes, at home, or in assisted living facilities.
With all of the benefits of the New York Medicaid Program, the program can still be extremely difficult to navigate and often leaves many applicants with few answers and many more questions. This is due, in part, to the complex state and federal laws that govern the program, as well as the fact that these requirements are changing and evolving on a continuous basis. In cases where applicants make even a small financial mistake, they could receive a denial of coverage, or they could face other significant losses.
Fortunately, you do not need to handle the complex Medicaid application process on your own. The experienced New York senior law attorneys at Goldfarb Abrandt & Salzman LLP, are ready and willing to assist you throughout the process. Our knowledgeable legal team can sit down with you during an initial consultation and assist you in determining your eligibility.
Furthermore, our attorneys can be by your side during the entire process, from the initial application consultation up through your final approval. Given our many years of experience in the business, we can help you seamlessly navigate the process and avoid the common challenges and pitfalls.
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Learn About Requirements For Medicaid In New York
To learn how to qualify for Medicaid in New York, applicants need to understand the eligibility requirements set by state and federal guidelines. Obtaining Medicaid benefits eligibility means that applicants have met essential qualifications, such as income level and medical expenses. Unlike Medicare, Medicaid focuses more on income levels instead of age. The program uses federal, state and local funding to provide health insurance to families struggling with purchasing care. The process to qualify for Medicaid involves understanding Medicaid eligibility requirements and knowing what information potential beneficiaries need to provide officials. Once an applicant knows and gathers the necessary details, the process to get benefits starts with an application form. Get answers to the question What are the income requirements for Medicaid in NY? and others by reading the information below.
Who qualifies for Medicaid in New York?
What are the requirements for Medicaid in New York?
To meet qualifications for Medicaid in New York, some applicants will need to demonstrate that their household income falls below a certain percentage of the federal poverty level . However, these specific income levels will depend on the particular Medicaid program for which the applicant qualifies. To learn more about income requirements for Medicaid, .
What are the Medicaid application guidelines in New York?
What are common Medicaid disqualifications in New York?
New York Has Accepted Federal Medicaid Expansion
- 7,201,854 Number of New Yorkers covered by Medicaid/CHIP as of September 2021
- 1,523,437 Increase in the number of New Yorkers covered by Medicaid/CHIP fall 2013 to September 2021
- 47% Reduction in the uninsured rate from 2013 to 2017
- 20% Increase in total Medicaid/CHIP enrollment in New York since Medicaid expansion took effect
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Medicaid Buy In Program For Working People With Disabilities And Medicare Savings Programs
The Medicaid Buy-In Program for Working People with Disabilities provides Medicaid coverage for people ages 16-64 who have a disability and are engaged in a work activity for which they are paid. In order to be considered for this program, the individual must be determined disabled as defined by the Social Security Administration. The persons net income must be at or below 250% of the federal poverty level.
Learn About Medicaid In New York
You may have asked, What is Medicaid in New York? while you were searching for affordable health care options. Medicaid is a national program funded by both the federal government and the state. Furthermore, NY Medicaid is responsible for providing health insurance to millions of New York residents who would otherwise go without coverage. In accordance with the programs standards, Medicaid beneficiaries are low-income and in high need of medical services, as the program was developed to provide assistance for households with the most need. Each state has varying Medicaid provisions for their medical assistance program, so it is helpful to understand exactly what New York requires of its beneficiaries before submitting an application.
Finding more information on Medicaid in New York also means understanding what services the program covers. Medicaid insurance will certainly cover basic medical services, but if you or another household member has specific health care needs, then you will want to make sure those services are covered before applying. Moreover, certain Medicaid services might have extra costs associated with them, and learning more about those cost can help you budget your expenses. While there is a lot of information about Medicaid and how the program works, you can find answers in the pages below. Continue reading the following NY Medicaid categories to find the information you need.
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No Existing Medicaid Coverage
If you dont already have Medicaid coverage, and you meet the above conditions, you may ask to have your Medicaid application processed more quickly by sending in a completed Access New York Health Insurance Application and the Access New York Supplement. If needed, you will also need to provide a physicians order for services and a signed
Attestation of Immediate Need.
How To Apply If In Ny City:
If you are in New York City, you can easily obtain applications from Human Resources Administration. You can also request information and applications on phone by calling at 718 557 1399.
NOTE: If you need any further assistance, you can call helpline at 693-6765.
Other requirements for applying
In order to apply for Medicaid, you will need to provide
- Proof of age
- Proof of citizenship
- If someone above 65 years of age, disabled or blind lives with you, you will need to provide proof of your income and resources
- Proof of your residence
- If you have any other insurance, you’ll be required to provide its proof and information about it
Medicaid provides a comprehensive coverage for various health services including
- Inpatient and outpatient services
- Home health care through approved agencies
- Access to smoking cessation agents
- Lab facilities and access to tests
- Eye, dental and mental health services
- Prescription drugs, medical supplies, and necessary medical equipment
- Transportation services
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New Requirement For Medicaid Effective November 2017
If you are turning age 65 within the next three months or you are age 65 or older, you may be entitled to additional medical benefits through the Medicare program. You may be required to apply for Medicare as a condition of eligibility for Medicaid.
Medicare is a federal health insurance program for people age 65 and for certain people with disabilities, regardless of income. When a person has both Medicare and Medicaid, Medicare pays first and Medicaid pays second.
You are required to apply for Medicare if:
- You have Chronic Renal Failure or Amyotrophic Lateral Sclerosis OR
- You are turning age 65 in the next three months or are already age 65 or older AND your income is below 120% of the Federal Poverty Level , or is at or below the applicable Medicaid Standard, then the Medicaid program will pay or reimburse you the cost of your Medicare premiums. If the Medicaid program can pay your premiums, you will be required to apply for Medicare as a condition of Medicaid eligibility.
If you have Medicaid and appear to be eligible for Medicare based on any of the criteria above, you must apply and show proof of Medicare application, or risk losing your Medicaid coverage.
When you apply for MEDICARE:
If you go to your local SSA office, you should bring:
- Proof of date of birth and
- Proof of U.S. citizenship or lawful residence and
- A copy of your Social Security card and your Medicaid card.
Proof of Medicare application can be:
- Social Security Administration 1-800-772-1213