The New York State Department of Health (DOH) has issued additional directives outlining the new procedures for Medicaid applications and renewals under the Affordable Care Act, effective in 2014.
For newest directives scroll to the bottom of this page.
13 ADM-03 describes "expanded Medicaid coverage under the ACA, a new method for counting household income based on modified adjusted gross income (MAGI), Medicaid benefits under the ACA and Medicaid enrollment in New York's Health Benefit Exchange."
The directive contains several attachments, including these desk aids explaining
5. GIS 14/MA-007 Update on Self-Employment Policy for MAGI-like Budgeting (3/21/2014)
7. GIS 14 MA/022 - Medicaid Eligibility for Pregnant Minors PDF (7/1/2014)
Child's Social Security or other income may be disregarded from household income, depending on amount and type of income. UPDATED 2018 - click here
10. GIS 15 MA/022 - Continuous Coverage for MAGI Individuals (12/23/15) PDF
Clarifies that "MAGI-like" category -- those who fall into a MAGI category but are getting their Medicaid coverage through their LDSS or HRA -- are entitled to the same 12-month continuous coverage protections as MAGIs (people who fall into a MAGI category and are getting their coverage through the Marketplace). Some people must get coverage through their LDSS because they need long term care such as home care, a waiver program, or nursing home care. They are eligible for these services with MAGI eligibility- see GIS 14 MA/016 above- but need eligibility processed by the local district.
12. 2016 LCM-01 - Transitioning MAGI Consumers from WMS to NY State of Health - attachments at this link
13. 16 ADM-01 - Transitioning Essential Plan Consumers from WMS to NY State of Health PDF -- read more about the Essential Plan here
14. GIS 16 MA/004 -Referrals from NY State of Health to Local Departments of Social Services for Individuals who Turn Age 65 and Instructions for Referrals for Essential Plan Consumers (PDF) -- read more about the Essential Plan here
16, GIS 18 MA-07: "Treatment of Income of Dependents Under MAGI-like Rules, 2018 Update (worksheet attachment) - Updates GIS 15 MA/008 - Treatment of Income of Dependents Under MAGI-like Rules to implement 2017 federal tax law changes in the threshold at which a tax dependent is required to file a tax return, used in MAGI determinations immediately. This income threshold is used to determine if the income of a child or tax dependent is included in the MAGI-like budget. This information is generally released via IRS publication 501 (2017). Use attached worksheet to calculate whether a dependent’s income is countable
Since the New York State of Health was introduced in 2014, it has been responsible for all MAGI Medicaid cases. However, there were many Medicaid consumers with MAGI-like budgeting who were found eligible before January 1st, 2014. Their cases have remained with HRA until they could be transitioned. Those consumers will now be transitioned in two phases: one in June 2018 and one in April 2019. The alert details which groups of MAGI-like recipients will and will not be transitioned. Some groups that are excluded from the transition are consumers with the Medicare Savings Program and consumers who are 64 years of age.
Alimony changes - how treated under MAGI rules:
Lottery and Gambling winnings - if over $80,000, now countable as income over several months or years depending on amount received. Countable solely for the individual who received the winnings. The NHeLP Advocates Guide to MAGI (updated 2018) has more info about the changes in how lottery winnings are treated under changes enacted in 2018. The changes are meant to disqualify winners from MAGI by creating an exception to the rules that normally exempt non-recurring lump sums. See more about lump sums in the SNT outline posted in this article. Also view webinars on Lump Sum impact on benefits, including MAGI Medicaid.
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