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Financial Eligibility
 
document Income and Resource Limits for New York State Public Health Insurance Programs
The Affordable Care Act changes the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers, expanding eligibility for many people who were not eligible before, and allowing others to be eligible for Medicaid without a "spend-down." New York City Human Resources Administration...
document Medicaid in 2014: Understanding MAGI & the Marketplace
Medicaid eligibility rules changed significantly on January 1, 2014 for some New Yorkers as a result of the Affordable Care Act’s eligibility expansion and streamlining provisions. The expansion only applies to a population called the "MAGI" population. Generally, the new rules do NOT apply to...
document NYS Directives on Medicaid changes under the Affordable Care Act
The New York State Department of Health (DOH) has issued additional directives outlining the new procedures for Medicaid applications and renewals under the Affordable Care Act, effective in 2014: 1. 13 ADM-04 - Medicaid Application and Renewal Processing for Modified Adjusted Gross Income...
document When Documentation of Resources and Income is Required for Medicaid Applications & Renewals - and When is "Attestation" Enough?
Since 2004, Medicaid documentation requirements have been simplified by allowing some applicants merely to "attest" rather than document certain eligibility factors. In that year, attestation to the amount of one's resources was first allowed for Medicaid applicants who were not seeking Medicaid...
document How to use funeral planning to become eligible for Medicaid
One common reason why people are ineligible for Medicaid or SSI is if their assets are over the limit.  Rather than give money away to make yourself eligible, it is better to find ways either to spend the money or convert it into an exempt form.  One way to do this is through funeral...
document Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
On February 8, 2006, former President Bush signed into law the Deficit Reduction Act of 2005 (DRA). Among other things, this Federal law made major changes to financial eligibility rules of the Medicaid program. The main changes were to the transfer penalty rules for nursing home coverage. (Note...
document Medicaid Spend-Down
Because Medicaid is a health insurance program for the poor, one must have income and assets below a certain limit to be eligible. For a single elderly or disabled person in New York State in 2013, these limits are $800/mo. of income and $14,400 in total assets. (The income limits for people...
document Medicaid Spend-down: NYC Medicaid Now Accepts FAXED Medical Bills
In May 2009, the NYC Medicaid Program announced a pilot program that allows consumers who must "spend down" to qualify for Medicaid to fax their medical bills each month to the Medicaid Centralized Surplus Unit.   See announcement.   You can download the official Spend-down fax...
document Medicaid Reimbursement of Home Care and other Medical Expenses
Reimbursement in General Because Medicaid coverage can be retroactive up to three months, it is possible for a Medicaid applicant or his or her family member who paid the applicant's medical expenses to get reimbursed for some of the home care costs and other medical bills they incurred and paid...
document The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) is a special program for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. This allows...
document Holocaust or Nazi Victim Reparations -- Effect on Medicaid, SSI and other Federally Funded and New York State Benefits
Under a 1994 law, (h.r. 1873 or public law 103-286), Holocaust compensation payments made to individuals based on their status as victims of Nazi persecution are excluded from being counted as income and resources in determining both eligibility for and the amount of benefits to be provided under...
document Advocacy to Improve the Medicaid Spend-down Program in New York State
In May 2009,  the New York State Health Foundation issued a report titled Streamlining New York's Excess Income Program, written  by Manatt Health Solutions.   The report presents a clear picture of the daunting complexity of the Excess Income or “spend-down”...
document Elimination of resource test for adults in Family Health Plus and many adults in Medicaid
Beginning January 1, 2010 the resource test for all adults in Family Health Plus and many adults in Medicaid is eliminated.  There is no resource test for Medicaid recipients who are Singles/Chlldless Couples (S/CC)(over age 21 and under age 65 and not disabled and not caring for...
document Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections
Medicaid rules are different for people living in the "community" than people living in institutions. For this article, the word "institution" means nursing home care. If you live in your home, someone else's home, or an Assisted Living Program, you are considered to live in the "community." ...
document Keeping Medicaid after Cash Public Assistance or SSI Benefits Are Terminated
Scenarios: Susie is 49 years old and single, with no children. She has been receiving cash public assistance and Medicaid for three years, while she appeals the denial of Social Security Disability Insurance Benefits ("SSD" or "DIB"). She finally was approved for SSD, and will start receiving...
document Medicaid Resource and Income Disregards
When determining eligibility for Medicaid in New York state, the local district determines the gross income and resources of the applicant, and then deducts certain items which may be disregarded.  If any of these disregards apply to a particular applicant, then they may be eligible for...
document Financial maintenance requirements at application and renewal
 In September, 2011, NYS Department of Health (DOH) clarified the administrative directive 10ADM-06 Standardized Financial Maintenance Requirements for Medicaid Applicants/Recipients,  which in June, 2010,  established a standardized methodology by which local social...
document Maintaining Community Medicaid Budgeting During Temporary Nursing Home Stays
Many Medicaid recipients are admitted to nursing homes but plan to return to their homes in their community. Financially, it is important for them to maintain community Medicaid budgeting so that they can continue to pay rent, utility, and other living expenses to preserve their apartment or home...
document KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind
This Fact Sheet (updated May 2013) is intended for people who are age 65+ or who have disabilities, or their family members and caregivers. It explains the basic financial rules on eligibility for Medicaid in the community for this category of people. Community Medicaid includes all hospital and...
document Medicaid Alerts & Other Protocols published by the NYC HRA Medical Insurance and Community Services Administration (MICSA)
HRA MICSA Alerts are periodic announcements of policy, staff and office changes published by the Medical Insurance and Community Services Administration (MICSA). MICSA is the part of New York City’s Human Resource Administration (HRA) that administers HRA’s medically- related programs such as...

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