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 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 

  • Have resource or asset limits, which are explained briefly in this Fact Sheet.  They are explained more extensively in the resource disregard chart, and in this article on expenses allowed to pre-pay for burial of oneself and certain family members.  HEADS UP that these limits are INCREASING In 2023!    Stay tuned here!

  • The income limits have been much lower than for non-MAGI - but in 2023 the limits will be the same for MAGI and NON-MAGI!    Stay tuned here! 

  • But - the rules for how income is counted  for people who are Disabled, Aged, or Blind are different than for MAGI Medicaid, and are explained  in this Fact Sheet. 

  • See also  Medicaid Spend-down (or "excess income" or "surplus income" program)  the Income Disregard chart, and  this article about special budgeting rules.  

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