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 for 2021

• Attachment V (PDF)  PICKLE reduction factors - see more about Pickle here

Here is the 2021 HRA Income and Resources Level Chart   

2020 levels are in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates  and attachments here 

* MAGI and ESSENTIAL plan levels are based on Federal Poverty Levels, which are not released until later in 2021.  2020 levels are used until then. 

NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?

• See income levels for past years from 2001  through 2020 here.   

WHAT IS THE HOUSEHOLD SIZE?   See rules here.

HOW TO READ THE  HRA Medicaid Levels chart -  

• Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels.  
• Box 10 on page 3 are the MAGI income levels -- The Affordable Care Act  changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.  People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down."   They have NO resource limit.
• Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care & Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility
• Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65  (still 2017 levels til April 2018)
• Box 6 are Medicare Savings Program levels  (will be updated in April 2018)

MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.  42 C.F.R. § 435.4.

  Certain populations have an even higher income limit -

• 224% FPL for pregnant women and babies < age 1,
• 154% FPL for children age 1 - 19. 

• See all income limits on MAPDR-01 HRA income limits chart.  

CAUTION:  What is counted as income may not be what you think. 

For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline  and these charts on income disregards.    However, for the MAGI population  - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI).   There are good changes and bad changes. 

GOOD:  Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. 

BAD:  There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules.  For all of the rules see:

• 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

ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules 

HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES

The income limits increase with the "household size."  In other words, the income limit for a family of 5 may be higher than the income limit for a single person.  HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical.  There are different rules depending on the "category" of the person seeking Medicaid.     Here are the 2 basic categories and the rules for calculating their household size. 

1. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size.   These same rules apply to the Medicare Savings Program, with some exceptions explained in this article. 

2. Everyone else -- MAGI - All children and adults under age 65, including  people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.  Their household size will be determined using federal income tax rules, which are very complicated.

New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010  (PDF)  pp. 8-10 of the PDF,   This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.  See slides 28-49. Also see Legal Aid Society and Empire Justice Center materials

OLD RULE used until end of 2013 --  Count the person(s) applying for Medicaid who live together, plus any  of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient.   Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21  (though if the child is disabled, use the rule in the 1st "DAB" category.    Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility.    See 18 NYCRR 360-4.2,  MRG p. 573,  NYS GIS 2000 MA-007

• CAUTION:   Different people in the same household may be in different "categories" and hence have different household sizes AND  Medicaid income and resource limits.  If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI.  

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:

• Prenatal Care Assistance Program (PCAP) was Medicaid  for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL).  

• Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples.  This category had lower income limits than DAB/ADC-related, but had no asset limits.  It did not allow "spend down" of excess income.  This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.

• Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL.  This has now been folded into the new MAGI adult group whose limit is 138% FPL.  For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange.

PAST INCOME & RESOURCE LEVELS --

Past Medicaid income and resource levels in NYS are shown on these old NYC HRA  charts for 2001 through 2019, in chronological order.    These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS. 

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