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Medicaid & MSP: Must apply for Social Security and Enroll in Medicare

Views: 10664
Posted: 14 Mar, 2013
by Cathy Roberts (Empire Justice Center)
Updated: 05 Nov, 2017
by Valerie Bogart (New York Legal Assistance Group)

Medicaid applicants and recipients can be required to pursue potentially available income as a condition of receiving Medicaid, and also to apply for Medicare.  (42 CFR 435.608; 18 NYCRR sec. 360-2.3 (c)(1); Medical Assistance Resource Guide [MARG] pp. 488-489.)  

1.  Must apply for Social Security and other "Potentially available income"

This means entitlement benefits like annuities, pensions, retirement and disability benefits, veterans benefits and unemployment compensation.  It does NOT include cash support. (MARG p. 561; 99 ADM-05)

The NYS Department of Health recently clarified in  GIS 13 MA/005 - Buy-In for Individuals with Medicare who have not applied for Social Security Retirement Benefits  [PDF] that this requirement to pursue potentially available income applies to Medicare Savings Program (MSP) applicants/recipients who are eligible for Social Security retirement benefits.  These individuals cannot delay enrollment in Social Security and still qualify for MSP.   This rule affects some people who would otherwise prefer to delay receipt of Social Security until after age 66 since the amount of the benefit increases for every year of delay until age 70.   But one doesn't have that option if one wants Medicaid or an MSP.  

EXCEPTION announced Oct. 2016:  If the client is working full-time, they do NOT have to apply for Social Security benefits at age 62 or later. This was announced in GIS 16 MA/012, "Applying for Entitlement Benefits," which states, "When an A/R is still working full time, districts must not require the A/R to apply for Social Security Retirement benefits."

Enrolling in a pooled supplemental needs trust is an option to reduce countable income to qualify for Medicaid and/or MSP (re MSP see See Fair Hearing No. 4399513P (Nassau Co., Jan. 31, 2006)(available in WNYLC Online Resource Center, Fair Hearing Database, free registration required) .

2.  Must apply for Medicare - New requirements November 2017

In Oct. 2017, NYS DOH issued 17 OHIP ADM-01:  "Medicare Enrollment at Age 65" (PDF) (Click here for html version and attachments).  This ADM further implements NY Social Services Law  Sec.366(2)(b)(1) which states: "Any person who is eligible for, or reasonably appears to meet the criteria of eligibility for, benefits under title XVIII of the federal social security act [Medicare] shall be required to apply for and fully utilize such benefits in accordance with this chapter."  Also see NYS DOH Medicaid Reference Guide (MRG) page 415.

The ADM requires for the first time certain Medicaid applicants and beneficiaries to submit proof that they applied to enroll in Medicare -  for new applicants at the time of application, or at the time of renewal, for current recipients.   

In November 2017, letters are going out to 30,000 NYS Medicaid recipients over age 65 (half of which are in NYC) telling them they must enroll in Medicare to keep Medicaid, and must return proof of application for or enrollment in Medicare to their local Dept. of Social Services.  A sample notice is on page 3 of this Tip Sheet by the Medicare Rights Center.   The notices are being mailed to Medicaid recipients who are:

  1. age 65+  and 

  2. Do not have Medicare Part A or Part B (which means they likely do not receive Social Security benefits, since Medicare is automatic for people age 65+ receiving Social Security),

  3. Are US Citizens or have been Permanent Resident Aliens for 5+ years

  4. Have incomes below the Medicare Savings Program SLIMB level  (120% Federal Poverty Level)
    ($1226  singles /  $1644 couple)

WARNING -- These 30,000 Medicaid recipients can have their Medicaid discontinued in December 2017 if they do not return proof that they applied for Medicare to the Local Dept. of Social Services.  If they applied but have not been accepted they should be given an extension.  Since discontinuance of Medicaid can have serious consequences, including termination of home care, ask for a Fair Hearing right away if you did not receive an advance Notice of discontinuance or if there was an error.    Get help from your local legal services program - see www.lawhelpNY.org or call the Medicare Rights Center at 1-800-333-4114. 

The Medicare Rights Center created a Tip Sheet which explains this enrollment effort and provides helpful information on Medicare enrollment for those with Medicaid and no parts of Medicare.  The Tip Sheet explains how they can enroll in Medicare without having to pay a premium.   

  • Some recipients can enroll in premium-free Medicare Part A and Part B -- these are those who are Qualified Medicare Beneficiiaries, (QMB) with incomes under 100% FPL.   

  • Others do not qualify for free Part A, but can enroll in Part B without a premium.  These are SLIMB's - a Medicare Savings Program for people whose income is between 100 FPL - 120% FPL.  

WARNING -- Medicaid recipients can have their Medicaid discontinued in December 2017, or after they submit their renewals,  if they do not return proof that they applied for Medicare to the Local Dept. of Social Services.  Since discontinuance of Medicaid can have serious consequences, including termination of home care, ask for a Fair Hearing right away if you did not receive an advance Notice of discontinuance or if there was an error.    Get help from your local legal services program - see www.lawhelpNY.org or call the Medicare Rights Center at 1-800-333-4114. 


This article was authored by the Empire Justice Center and New York Legal Assistance Group.  

Empire Justice Center

Also read
document When Documentation of Resources and Income is Required for Medicaid Applications & Renewals - and When is "Attestation" Enough?
document Where to Apply for Medicaid and Medicaid Home Care in New York City
document Medicare Savings Programs (MSP) in New York
document New Application Form (2010, updated 3/2015) Used for Medicaid, Child Health Plus and Family Health Plus in New York State
document Applying for Medicaid Personal Care or CDPAP Services in New York City - 2016 Changes
document Know Your Rights: NYLAG Webinars on Medicare and Medicaid -

External links
https://www.health.ny.gov/health_care/medicaid/publications/pub2017adm.htm
http://www.medicarerights.org/fliers/Medicaid/NY-Medicare-enrollment-project-tip-sheet-back-log-notice-recipients.pdf?nrd=1

Also listed in
folder Medicare Savings Program
folder Medicaid -> Financial Eligibility

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