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Financial Eligibility
Income and Resource Limits for New York State Public Health Insurance Programs
NYS updated the 2021 levels with GIS 21 MA/06 -with the 2021 Federal Poverty Levels (April 2021) Attachment I ( MAGI & non-MAGI limits for Aged, Blind & Disabled - non-MAGI) Attachment II non-MAGI levels Attachment III (PDF) MAGI levels for 2021 Attachment IV (PDF) MAGI levels...
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 for 2021 in Jan. 2021) is intended for New Yorkers 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, and explains how to apply...
Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"
Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting - used for people age 65+, Disabled, or...
Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan
A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...
Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan - Pooled Trusts Allowed as an Option
A. What are Spousal Impoverishment Rules? Since 1998, a spouse of a nursing home resident on Medicaid is allowed to keep a reasonable level of income and resources to live on, while still permitting Medicaid payment for the nursing home resident's care. Congress enacted the "spousal...
Know Your Rights: NYLAG Webinars on Medicare and Medicaid -
The Evelyn Frank Legal Resources Program conducted a five-part Continuing Legal Education Webinar program in April and May 2016 that provides tools to understand and navigate the complex world of Medicare and Medicaid in New York. The focus is on eligibility and application procedures for older...
Medicaid & MSP: Must apply for Social Security and Enroll in Medicare
Medicaid applicants and recipients can be required to pursue potentially available income, including Social Security, as a condition of receiving Medicaid, and also to apply for Medicare. (42 CFR 435.608; 18 NYCRR sec. 360-2.3 (c)(1); Medical Assistance Resource Guide [MARG] pp. 488-489.) ...
Maintaining Community Medicaid Budgeting and SSI Benefits 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...
"MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare
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...
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. For newest directives scroll to the bottom of this page. 1. 13 ADM-04 - Medicaid Application...
Medicaid Renewals/Recertifications in New York City- TIPS
This article available as a fact sheet in ENGLISH and SPANISH This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration (HRA). If your Medicaid is handled by the New York State of Health – your renewal is not covered in...
Medicare Insurance Premium Payment Program (MIPP)
Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who...
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...
How to use funeral planning to become eligible for Medicaid (updated fact sheet - 2015)
Download Fact Sheet on Pre-Paid Funeral Planning as Method to Qualify for Medicaid in New York State BACKGROUND: One common reason why people are ineligible for Medicaid or SSI is if their assets are over the resource limit. Rather than give money away to make yourself eligible, which can cause...
Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
The Deficit Reduction Act of 2005 (DRA, enacted in 2006, made major changes to the transfer penalty rules for eligibility for Medicaid to pay for nursing home care. At the time, and until now, nursing home care was the only Medicaid service that had a lookback and transfer penalty.See GIS 06...
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 2021, the income limit is $904/mo. of income. (after subtracting $20/mo disregard) (The income limits for...
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...
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...
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. The income...
Holocaust or Nazi Victim Reparations -- Effect on Medicaid, SSI and other Federally Funded and New York State Benefits
Under a 1994 federal law, (h.r. 1873 or public law 103-286), known as the Victims of Nazi Persecution Act of 1994, 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...

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