Each year, New York City's Human Resources Administration publishes this handy two-page chart listing income and resource limits, and other helpful figures, relating to most of the public health insurance programs available in New York State. (2013 chart, revised 1/7/2013) Levels tied to the federal Poverty Level are highlighted and will go up around April 1, 2013. (The 2012 FPL levels applicable to the Medicare Savings Program are shown in this article -- Medicare Savings Programs (MSP) in New York)
REMINDER: The Resource limit in BOX 3 of the chart is only for people who Disabled, Aged 65+ or Blind (DAB or SSI-related category). There is no longer any Resource Limit for all other Medicaid applicants, including people who are AFDC-related (under age 21, a caretaker relative for a child under age 21, or pregnant) or Singles/Childless Couples (S/CC = between ages 21-65 and not disabled).
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:
Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. That child may apply for Child Health Plus -- and would not be in the "household unit" for Medicaid for the other family members. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007
The chart includes income and resource (if any) levels for the following programs:
* The indicated programs have income limits derived from the Federal Poverty Level (FPL), which are generally updated around February 1. As a result, local districts continued to use the prior year's limits after January 1st each year until the new amounts are released.
The 2013 regional nursing home transfer penalty rates can be found in 13MA001 - Medicaid Regional Rates for Calculating Transfer Penalty Periods for 2013
In 2013, NYC published a new supplement to the MAPDR-01, the MAPDR-71, which contains key figures for the Disabled Adult Child, Congregate Care, and SSI programs.
Note: New York City's Human Resources Administration publishes this eligibility levels chart, and has recently posted it on their website here. Unfortunately, they do not keep this version updated, so it still reflects 2012 levels. Use the version hosted on WNYLC to get the most current levels.
PAST INCOME & RESOURCE LEVELS --
Past Medicaid income and resource levels in NYS are shown on these old NYC HRA charts for 2001 through 2011, in chronological order. These include Family Health Plus, 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 Selfhelp Community Services, Inc.