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 Jan.. 2017) is intended for people 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.  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.

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. 

• Since January 2010, individuals  who are under age 65 and who are not disabled have had no limit on the resources or assets they are allowed to have. 

  • Disabled, Aged 65+ and Blind  (DAB) people still 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.

• The rules for how income is counted are also different for people who are Disabled, Aged, or Blind than other people.  These are explained briefly in this Fact Sheet, and more extensively in Medicaid Spend-down (or "excess income" or "surplus income" program) and the Income Disregard chart, and in other articles on this website. 

  • MAGI - Under the Affordable Care Act, individuals who do NOT have Medicare have no asset test and higher income limits compared to age 65+ and disabled (DAB) individuals. Also, their income is counted differently than for "DAB."   They use "MAGI" (Modified Adjusted Gross Income") budgeting.  DAB individuals are "non-MAGI."  For  more on MAGI see here:

    • State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010  (PDF)   ,    
    • PowerPoint by NYLAG on MAGI Budgeting
    • Training materials by Empire Justice Center 
    • Training materials by Legal Aid Society
    • National Health Law Program Advocates Guide to MAGI

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