New York State Medicaid Eligibility


New York Has Accepted Federal Medicaid Expansion

NY Medicaid program: $272K Cystic Fibrosis drug is too expensive
  • 7,386,139 Number of New Yorkers covered by Medicaid/CHIP as of January 2022
  • 1,706,722 Increase in the number of New Yorkers covered by Medicaid/CHIP fall 2013 to September 2021
  • 56% Reduction in the uninsured rate from 2010 to 2019
  • 21% Increase in total Medicaid/CHIP enrollment in New York since Medicaid expansion took effect

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.

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.

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Transfer Of A Homestead

If title of a homestead is transferred to one of the following persons, no penalty period will be imposed:

  • a spouse
  • a child under the age of 21, or a blind or disabled child
  • a sibling of the applicant/recipient who has an equity interest in the home and who was residing in the home for a period of at least one year immediately prior to the date the applicant/recipient became institutionalized and
  • an adult child who resided in the home for a period of at least two years before the date the applicant/recipient became institutionalized and who :provided care to such individual which permitted such individual to reside at home rather than an institution.
  • How Do I Apply

    NYS Medicaid: Coverage, Eligibility, Application &  More

    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.

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    What Are The Medicaid Plans In New York

    Medicaid Managed Care

    Medicaids Managed Care program offers primary care case management and managed care organizations as choices for acute, primary, specialty, limited long-term care, and limited behavioral health.

    Managed Long Term Care Programs

    Only institutional and community-based long-term services and supports are covered by the Managed Long Term Care program, commonly known as partial capitation. In contrast, Medicaid-funded primary and acute care are covered on a fee-for-service basis.

    Medicaid Advantage and Medicaid Advantage

    The Medicaid Advantage and Advantage Plus programs are only available in a few locations, including New York City.

    Eligible Worker Titles For The Bonus

    Employee worker titles eligible for the bonus include certain workers that provide hands-on assistance with health services or care services . To be front-line, such workers must provide or directly support the provision of health or care services to patients in certain settings and work under one of the titles listed in the statute. These eligible worker titles are listed under SOS § 367-w and and mirror titles from the Bureau of Labor Statistics job listings and the Stateâs Consolidated Fiscal Reporting and Claiming manual or under the authority provided by SOS § 367-w.

    Note on “All Other Health Care Support Workers”: This title refers to other workers that are similar to the titles listed in this statute, and that support the provision of health care services to patients in front-line settings for these titles. Such workers must support patient-facing care provided within a patient care unit of a hospital or other institutional medical setting in support of treating and caring for patients.

    The full list of Eligible Worker Titles are listed in the table below:

    Frontline Direct Care Health and Mental Hygiene Workers All Other Health Care Support Workers Titles Determined by the Commissioner
    • Assistant Program or Assistant Site Director
    • Case Manager

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    How A Senior Law Attorney Can Help With The Process

    Applications for New York Medicaid can be complex. The experienced elder law attorneys at Goldfarb Abrandt & Salzman LLP can help develop a plan for determining your Medicaid eligibility. We can assist you by doing the following:

    • Finding out which of your assets are countable and which are exempt
    • Resolving common issues that arise over the course of the process, including spousal refusal, promissory notes, and the Medicaid spend down process
    • Gathering your past 60 months of financial and bank statements as part of the application process
    • Obtaining the necessary bank verifications regarding withdrawals and deposits
    • Offering you a Medicaid consultation in which we determine the best possible method of moving forward
    • Completing the various parts of the Medicaid application

    Institutional Medicaid Eligibility Pre

    Free In NYC: Medicaid Excess Income

    Transfers of Assets for Less Than Fair Market Value the agency to which institutional application is made will look back at an individuals financial records for a period of 36 months prior to the requested pick-up date . Under OBRA-93, the look back period in the case of payments to or from certain trusts has been increased to 60 months. The look-back period is used to determine whether income or resources have been transferred by the applicant for less than fair market value .

    When a gift has occurred within the look-back period, Medicaid will impose a period of ineligibility, or penalty period on the applicant. The applicant will then be required to pay privately for his or her care during that period. New York calculates the penalty period as commencing on the first day of the month following the month in which the transfer was made.

    To apply these regulations, consider a New York City resident who has gifted the sum of $100,000 to his daughter on January 1, 2005. To calculate the penalty period for Medicaid nursing home benefits, divide the $100,000 gift by $9,132 . The resulting penalty period is 10.95 months commencing February 1, 2005 and ending September 30, 2006. Thus, the individual may apply for, and be eligible for institutional Medicaid benefits as of October 1, 2006, provided his or her resources do not exceed Medicaid eligibility levels.

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    What Are The Income Limits For Community Medicaid In New York

    Income limits for Community Medicaid do exist in New York. Currently these limits are $875 monthly per each individual and for couples the limit is $1284. The disabled, elderly, and/or blind applicants will be entitled to what is called a disregard of $20 on any unearned income.

    This disregard means it will not be considered or budgeted. When taking this $20 disregard into account, individual income limits are $895 per month and the couples limit is at $1,304 per month. Resource limits are also in place. These limits are $23,100 for couples and for individuals is $15,750.

    New York Medicaid Long Term Care Programs Benefits & Eligibility Requirements

    SummaryMedicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. In New York, Medicaid is referred to as NY Medicaid, NYS Medicaid, Medicaid Managed Care, or simply, Medicaid. This article focuses on NY Medicaid Long Term Care, which is different from regular Medicaid. Medicaid will help pay for long term care for New York residents in a nursing home, in their home and in other residential settings including assisted living through one of three programs Nursing Home / Institutional Medicaid, Home and Community Based Service / Medicaid Waivers and Disabled, Aged 65+ or Blind Medicaid.

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    Medicaid Resource Limits In New York

    To qualify for non-MAGI Medicaid, the kind of Medicaid that will cover long-term care services, you must have few resources. Resources are assets, like money in the bank, retirement accounts, land, and personal property like cars. The resource limit for a single person to qualify for non-MAGI Medicaid is $15,150, and it is $22,200 for a married couple who both want to qualify.

    Some property does not count toward the resource limit. For example, you are allowed to have up to $814,000 of equity in your home, and you are also allowed to exempt one vehicle.

    When A Nursing Home Is Medically Necessary In New York

    Everything you Need to Know About NYS Medicaid

    Medicaid will pay for a nursing home only when having access to skilled care is medically necessary. In New York, when you are admitted to a nursing home, an evaluator will meet with you to review all of your medical conditions and your ability to do some activities of daily living like eating, moving between a bed and chair or wheelchair, using the bathroom, and getting around. The evaluator will use a form called a Hospital and Community Patient Review Instrument to assign a particular score to your need for nursing home care. Medicaid uses that information to decide whether you need a nursing home, what kind of nursing home is appropriate for you, and what services Medicaid will pay in the nursing home. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.

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    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.

    New York’s Essential Front Line Health Care And Mental Hygiene Workers Have Seen Us Through A Once

    To attract talented people into the profession at a time of such significant strain, while also retaining those who have been working so tirelessly these past two years, we must recognize the efforts of our health care and mental hygiene workforce and reward them financially for their service. To do so, as part of the Fiscal Year 2023 New York State Executive Budget legislation, $1.2 billion in funding has been allocated for the payment of bonuses for certain frontline healthcare workers.

    Located within Part ZZ of Chapter 56 of the Laws of 2022, the HWB provision allows for the payment of bonuses to “recruit, retain, and reward health care and mental hygiene workers” meeting specified eligibility requirements. Bonus amounts will be commensurate with the number of hours worked by eligible workers covered by the HWB Program during designated vesting periods for up to a total of $3,000 per covered worker.

    The official New York State press release can be found at the following link: Governor Hochul Launches Health Care Worker Bonus Program.

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    Please Answer A Few Questions To Help Us Determine Your Eligibility

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    Long-term care in New York, like nursing homes, assisted living facilities, and even home health care, are expensive. The average cost of a nursing home in New York is more than $100,000 per year. Private health insurance policies and Medicare generally do not cover long term care, and very few people purchase private long-term care insurance policies. For New Yorkers needing long-term care, Medicaid is the most common source of funding. In 2011, more than 70% of nursing home residents in New York received Medicaid.

    How To Apply For Medicaid In In New York

    Myths and Facts of Value Based Payment (VBP) Reform

    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.

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    What Are The Eligibility Requirements For Community Medicaid In New York

    Since Community Medicaid is a means-tested program, there are specific requirements that must be met in order to qualify for benefits. Firstly, an individual must be aged 65 or older or disabled. There must also be an established need for services. Prior to 2021, an applicant needed to show that they need assistance with at least two activities of daily living .

    As of July 1, 2021, applicants must show a need for assistance with a minimum of three ADLs. If the individual has an Alzheimers or dementia diagnosis, the applicant needs to show they need help with more than one ADL. These ADLs include:

    • Bathing
    • Bed mobility turn and position
    • Eating

    There are also personal care tasks that may be factored in when determining eligibility. Examples of Level II personal care tasks include:

    • Administration of medications
    • Preparation of meals with modified diets
    • Providing routine skincare
    • Changing of simple dressings

    Also, recipients need to be financially eligible. In order to determine someones eligibility, there is an assessment of the applicants income as well as assets. The state will review two categories within the applicants financials including their income and applicable resources.

    In this case, income is considered as any monies generated regardless of the source. This income can include Social Security, wages, pensions, alimony, IRA in distribution, or gifts.

    Medicaid Eligibility Income Chart By State Updated Jul 2022

    The table below shows Medicaids monthly income limits by state for seniors. Income is not the only eligibility factor for Medicaid long term care there is also an asset limit and level of care requirements. Additionally, there are state-specific details. Click on the state name below to see that states complete Medicaid eligibility criteria.

    The maximum income limits change dependent on the marital status of the applicant, whether a spouse is also applying for Medicaid, and the type of Medicaid for which they are applying. Nursing home Medicaid may have a different income limit than home and community based Medicaid services, and both of those may differ from the Aged, Blind and Disabled income limits.

    Exceeding the income limits does not mean an individual cannot qualify for Medicaid. Most states have multiple pathways to Medicaid eligibility, such as a medically needy pathway. Furthermore, many states allow the use of Miller Trusts or Qualified Income Trusts to help person who cannot afford their care costs to become Medicaid eligible. There are also Medicaid planning professionals that employ other complicated techniques to help persons become eligible. Finally, candidates can take advantage of spousal protection laws that allow income to be allocated to a non-applicant spouse.

    Medicaid Eligibility Income Chart Updated July 2022

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