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Income and Resource Limits for New York State Public Health Insurance Programs
The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down."
On Dec. 16, 2014, the NYS Dept. of Health released the 2015 income and resource limits for the NON-MAGI population - these are mostly people Age 65+ or people with disabilities who receive Medicare:
This short summary chart shows that income limits have increased for the new "MAGI" category created by the Affordable Care Act, but not for the "Non-MAGI" population - the Disabled, Aged 65+ and Blind (DAB).
NOTE: MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare. Certain populations have an even higher income limit -
CAUTION: 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:
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.
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 until 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
The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:
PAST INCOME & RESOURCE LEVELS --
Past Medicaid income and resource levels in NYS are shown on these old NYC HRA charts for 2001 through 2014, in chronological order. These include Medicaid levels for MAGI and non-MAGI populations, 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.