Income and Resource Limits for New York State Public Health Insurance Programs

Income and Resource Limits for Medical Assistance Programs in New York State

Each year, New York City's Human Resources Administration publishes this handy two-page chart listing income and resource limits, and other helpful figures, relating to most of the public health insurance programs available in New York State.  (2011 chart  -- most levels not changing from 2010 effective 01/01/11) - MAPDR-01)  Only levels  tied to the federal Poverty Level will go up about $5/month -- but regular Medicaid isn't tied to the FPL.

2011 ALERT:  The Medicaid income and resource levels for aged, blind and disabled is NOT increasing in 2011.      See NY Dept. of Health 10MA026 - 2011 SSI, LIF/SCC Medicaid Standard and Medicaid Income and Resource Levels   REMINDER: The Resource limit in BOX 3 of the chart is only for people who Disabled, Aged 65+ or Blind (DAB or SSI-related category).  There is  no longer any Resource Limit for people who are "AFDC-related," meaning they are under age 21, a caretaker relative for a child under age 21, or pregnant, or Singles/Childless COuples (S/CC = between ages 21-65 and not disabled).      See this article 

The chart includes levels for the following programs:

• Medicaid - different income levels and rules apply to different categories of people:

  • Box 1 of Chart is for pregnant women and children under age 19

  • Box 2 of Chart is for children under age 19 only

  • Box 3 of Chart is known as the "regular" Medicaid levels and is for:

    • Children under age 21 if not eligible under Boxes 1 or 2                                    )  NO LONGER HAVE
    • Parents or other relatives who live with and care for a child under age 21      ) ANY ASSET TEST AS OF 1/1/10 See this article 

    • "DAB" category - Disabled, Aged, or Blind --  People between ages 21-65 who are disabled or blind , or people who are Age 65 or Over  - STILL HAS AN ASSET LIMIT 

  • Box 7 of Chart is for adults between ages 21-65 who are not disabled and without children under 21 in the household.  It is sometimes known as "S/CC" category for Singles and Childless Couples.  This category has lower income limits than Box 3 and does not allow "spend down" of excess income or assets.   Numbers went up  slightly in 2010 - see NYS DOH GIS 09 MA/026

NOVEMBER 1, 2011 CHANGE - not yet reflected in the chart,  Children ages 6-18 are now eligible for Medicaid at the same income level as younger children – 133% of the federal poverty limit.  This change should reduce the need for families to move their children between Medicaid and Child Health Plus after their sixth birthday, and is viewed by many as a step in the direction of the simplifications required by the Affordable Care Act.  See NYS DOH GIS 11MA/021.

• Prenatal Care Assistance Program (PCAP) (Box 1 of Chart)

• Child Health Plus (CHP)* (Box 2 of Chart)

• Family Health Plus (FHP)* (Boxes 4a and 4b of Chart)  2010 NOTE:   The Resource test was eliminated for FHP effective Jan. 1, 2010.  See this article.  

• Family Planning Benefit Program (FPBP)* (Box 5 of Chart)

• Medicaid Buy-In for Working People with Disabilities (MBI-WPD)* (Box 6 of Chart)

• Medicare Savings Programs (MSP)*(Box 8 of Chart)

  • Qualified Medicare Beneficiary (QMB)*

  • Specified Low-Income Medicare Beneficiary (SLIMB)*

  • Qualified Individual - 1 (QI-1)*

• Help paying COBRA premiums* (Box 9 of Chart)

• AIDS Health Insurance Program (AHIP)* (Box 9 of Chart)

• Qualified Working Disabled Individuals (QWDI)* (Box 9 of Chart)

• Medicaid Spousal Impoverishment Protections for spouses of someone in a nursing home (Box 10 of chart)(will not increase in 2010)

• Regional Nursing Home Rates for calculating the Medicaid Transfer Penalty (Box 11 of Chart)

* The indicated programs have income limits derived from the Federal Poverty Level (FPL), which are generally updated around  February 1.  As a result, local districts continued to use the  prior year's limits  after January 1st each year until the new amounts are released.      2011 amounts will not be released til around 2/10.

The 2011 regional nursing home transfer penalty rates can be found in  11MA001 - Medicaid Regional Rates for Calculating Transfer Penalty Periods for 2011 

This article was authored by the Evelyn Frank Legal Resources Program of Selfhelp Community Services, Inc.