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KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind

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Posted: 17 Nov, 2010
by Valerie Bogart (New York Legal Assistance Group)
Updated: 20 Sep, 2022
by Valerie Bogart (New York Legal Assistance Group)

This Fact Sheet (updated 9/2022 with 2022 figures and heads up for big increases in 2023!) 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 for Medicaid if you are seeking home care.  

Community Medicaid  includes all hospital and doctors' care, and the various home care programs.   The rules for eligibility for Medicaid to pay for nursing home care are different, such as the rules on transfer of assets.  These are explained very briefly here but more extensively in these articles.

This fact sheet explains how to calculate if you to "spend down" excess income.   See this article for tips on special strategies to reduce or eliminate the spend-down.  

The reason this Fact Sheet is only for people who are Disabled, Aged 65+ and Blind ("DAB")(a/k/a "SSI-related) is that the rules are very different for people under age 65 who are not disabled.   

HEADS UP -  Thanks to Gov. Hochul and the NYS Legislature, big increases in the Medicaid income and asset limits are coming in 2023 - amounts in updated Fact Sheet 

  • These 2023 limits are estimated  using the 2022 Federal Poverty Line figures.  They will change when the Federal Poverty Level will be announced in 2023).  Stay tuned for updates here.

Meanwhile the current rules in 2022:

  • Individuals  who are under age 65 and who do not receive Medicare (with a few exceptions) - known as MAGI MEDICAID -- they have:

    •  No limit on resources or assets . 

    • Higher income limits compared to age 65+ and disabled (DAB) individuals (but in 2023 they will have the same income limits). . Also, their income is counted differently than for Disabled, Aged, and Blind or DAB budgeting.   They use "MAGI" (Modified Adjusted Gross Income") budgeting.  

    • See more links to various national and state resources about the ACA and MAGI budgeting  in this article  and  State directives implementing the Affordable Care Act   

  • Disabled, Aged 65+ and Blind  (DAB) people - known as NON-MAGI MEDICAID 


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

NYLAG

Attached files
item ResourceDisregards.pdf (66 kb) Download
item Medicaid Basic - 2022-09.pdf (679 kb) Download
item IncomeDisregards.pdf (106 kb) Download

Also read
item Medicaid Personal Care or Home Attendant Services
item Income and Resource Limits for New York State Public Health Insurance Programs
item How to use funeral planning to become eligible for Medicaid (updated fact sheet - 2015)
item Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
item The Various Types of Medicaid Home Care in New York State
item Medicaid Spend-Down
item The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
item Medicaid Certified Home Health Agency (CHHA) Services
item Where to Apply for Medicaid and Medicaid Home Care in New York City
item Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections
item Medicaid Resource and Income Disregards
item NYS Directives on Medicaid changes under the Affordable Care Act
item "Immediate Need" Personal Care or CDPAP - Fast-Track Application for Medicaid and Home Care - New Procedures
item Know Your Rights: NYLAG Webinars on Medicare and Medicaid -
item Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"

Also listed in
folder Medicaid -> Getting Started
folder Medicaid -> Financial Eligibility
folder Medicaid -> Home Care
folder Medicaid -> Applying For and Keeping Medicaid

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Medicaid Alerts & Other Protocols published by the NYC HRA...       Fundamental Changes to NY Medicaid in the 2011 State Budget


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