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Income and Resource Limits for New York State Public Health Insurance Programs

Views: 83620
Posted: 15 Jan, 2009
by David Silva (New York Legal Assistance Group)
Updated: 03 Jan, 2014
by Valerie Bogart (New York Legal Assistance Group)

Income and Resource Limits for Medical Assistance Programs in New York State

The Affordable Care Act will change the rules for Medicaid income eligibility for many New Yorkers, expanding eligibility for many people who were not eligible before, and allowing others to be eligible for Medicaid without a "spend-down."    

The 2014 income limit that will apply for many New Yorkers will be 138% of the Federal Poverty Line (FPL)  (133% + 5% income disregard). Based on the 2013 FPL levels, that limit will be:

SINGLE  $1321/month              MARRIED/HOUSEHOLD OF TWO:  $1783/month.     THREE: $2246/mo.

RESOURCES - Since 2010, there has been no resource limit for most people under age 65 who are not disabled or blind.  This will continue to be true in 2014. 

Certain populations will have an even higher income limit - 224% FPL for pregnant women and babies < age 1, 154% FPL for children age 1 - 5.  See these and other new income limits at MAGI Eligibility Groups and Income Levels  (Attachment 1 of 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010)

CAUTION 1These new Medicaid income limits DO NOT APPLY TO PEOPLE WITH MEDICARE:

  • Disabled, Aged 65+ or Blind ("DAB" or SSI-related category) who receive MEDICARE.  They will continue to have the same Medicaid income and resource limits as before, just slightly increased for 2014 as shown in this chart.   They are called "Non-MAGI".    
2014 LIMITS - Disabled, Age 65+, Blind 1 2
Income $809 $1,192
Resources $14,550 $21,550

Similarly, Medicare Savings Program limits will remain as before - up to 135% FPL with no resource limits.

SOURCEGIS 13/MA/022 2014 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards 

  • PDF
  • Attachment 1  - Annual and monthly income and resource limits for "non-MAGI" population -
  • Attachment 2   - Explains what income limits -- usually a percentage of the Federal Poverty Level -- apply to different categories of people, for use with Attachment 1 of same GIS.  (this is for NON-MAGI)

A complete chart of income limits for 2014 is not yet available.  New York City Human Resources Administration has always published 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)   Levels  tied to the federal Poverty Level are highlighted and will go up around April 1, 2014.  PResumably this chart will be extensively revamped for 2014.  

CAUTION #2:  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" (MAGI).   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 (but there still is for the Disabled/Aged/Blind.) and some other rules.  For all of the rules see:

HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES

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. 

  1. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size.   These same rules apply to the Medicare Savings Program, with some exceptions explained in this article

  2. Everyone else -- MAGI - All children and adults under age 65, including  people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.  Their household size will be determined using federal income tax rules, which are very complicated.

New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010  (PDF)  pp. 8-10 of the PDF,   This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.  See slides 28-49. Also see Legal Aid Society and Empire Justice Center materials

OLD RULE used til end of 2013 --  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.    See 18 NYCRR 360-4.2,  MRG p. 573,  NYS GIS 2000 MA-007

  • CAUTION:   Different people in the same household may be in different "categories" and hence have different household sizes AND  Medicaid income and resource limits.  If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI.  

The 2013 chart includes income and resource (if any)  levels for the following programs, but will be obsolete in 2014 for many of them

  • Prenatal Care Assistance Program (PCAP) (Box 1 of chart) is Medicaid  for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL).  

  • Child Health Plus (CHP)* (Box 2 of Chart)  for children under age 19 only to receive Child Health Plus, 

  • "Regular" Medicaid levels (Box 3 of Chart) for:

    • Children under age 21 if not eligible under Boxes 1 or 2 (NO ASSET TEST AS OF 1/1/10)
    • Parents/other relatives who live with &care for a child under 21 (NO ASSET TEST AS OF 1/1/10)
    • "DAB" category - Disabled, Aged, or Blind --  People between ages 21-65 who are disabled or blind , or people who are Age 65 or Over  - STILL HAS AN ASSET LIMIT 

  • Family Health Plus (FHP)* (Boxes 4a and 4b of Chart)  2010 NOTE:   The Resource test was eliminated for FHP effective Jan. 1, 2010.  See this article.
  • Family Planning Benefit Program (FPBP)* (Box 5 of Chart)

  • Medicaid Buy-In for Working People with Disabilities (MBI-WPD)* (Box 6 of Chart)

  • Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. (Box 7)   It is sometimes known as "S/CC" category for Singles and Childless Couples.  This category has lower income limits than Box 3 -- but has no asset limits.  It does not allow "spend down" of excess income.  

  • Medicare Savings Programs (MSP)*(Box 8 of Chart) - NOTE that some exceptions to the Household Size rules explained above apply for MSP recipients.  See this article.  

    • Qualified Medicare Beneficiary (QMB)*

    • Specified Low-Income Medicare Beneficiary (SLIMB)*

    • Qualified Individual - 1 (QI-1)*

  • Help paying COBRA premiums* (Box 9 of Chart)

  • AIDS Health Insurance Program (AHIP)* (Box 9 of Chart)

  • Qualified Working Disabled Individuals (QWDI)* (Box 9 of Chart)

  • Medicaid Spousal Impoverishment Protections for spouses of someone in a nursing home (Box 10 of chart)

  • Regional Nursing Home Rates for calculating the Medicaid Transfer Penalty (Box 11 of Chart)

* 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 2013, 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 New York Legal Assistance Group.

NYLAG

Attached files
file MAPDR-01 2014 NYS Income and Resource Standards and FPL.pdf (79 kb)
file HOUSEHOLD SIZE FOR SSI RELATED CHART.pdf (205 kb)
file MAPDR - 71 Eligibility Level Supplement 2013.pdf (337 kb)
file 2001_to_2013_income__rsource_level_charts.pdf (2.24 mb)
file NYLAG ACA Part 2 - MAGI.ppt (2.71 mb)

Also read
document Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
document Family Health Plus Overview
document Keeping Medicaid after Cash Public Assistance or SSI Benefits Are Terminated
document Elimination of resource test for adults in Family Health Plus and many adults in Medicaid
document Medicare Savings Programs (MSP) in New York
document Medicaid Resource and Income Disregards
document New Application Form (2010) Used for Medicaid, Child Health Plus and Family Health Plus in New York State
document The Affordable Care Act --New York State Health Exchange to Open in October 2013 for January 2014 Enrollment
document KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind
document The Affordable Care Act Implementation: New Opportunities and New Hurdles for Low-Income Communities in New York City
document NYS DOH releases more directives on Medicaid changes under the Affordable Care Act
document The Affordable Care Act Implementation: Medicaid Expansion and MAGI Budgeting
document Medicaid in 2014: Understanding MAGI & the Marketplace

External links
MAPDR-01
http://www.health.state.ny.us/health_care/medicaid/publications/docs/gis/10ma026.pdf

Also listed in
folder Federal Health Reform

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Financial Eligibility     Medicaid in 2014: Understanding MAGI & the Marketplace


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