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NYS Directives on Medicaid changes under the Affordable Care Act

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Posted: 01 Oct, 2013
by Cathy Roberts (Empire Justice Center)
Updated: 30 Dec, 2015
by Valerie Bogart (New York Legal Assistance Group)

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.

1.     13 ADM-04 - Medicaid Application and Renewal Processing for Modified Adjusted Gross Income (MAGI) Eligibility Groups  (Dec. 4, 2013)  PDF  

  • Links to the appendix (which is just a list of the attachments) and ten attachments that accompany it available a: http://www.health.ny.gov/health_care/medicaid/publications/pub2013adm.htm

  • "This ADM advises local districts of the referral process for applicants in a Modified Adjusted Gross Income (MAGI) eligibility group to New York State of Health (NYSOH), New York’s Health Insurance Marketplace, and the requirements for determining or renewing Medicaid eligibility for certain individuals using MAGI-like budgeting rules. This directive also informs districts of the actions the State will take to transition Family Health Plus (FHPlus) Single Individuals and Childless Couples to coverage under the Affordable Care Act (ACA) effective January 1, 2014, and advises districts of special instructions for processing Medicaid referrals from NYSOH for coverage/payment of medical bills in the three-month retroactive period.”

  •  NYC HRA has also issued a directive re applications procedures - see Important Changes in Medicaid Application Submissions -MAGI and Non-MAGI (Dec. 24, 2013)

2.     13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010  (PDF) 

  • This directive outlines the changes to Medicaid eligibility that become effective January 1, 2014 under the ACA.   

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

- MAGI Eligibility Groups and Income Levels (Attachment 1)

- MAGI and Non-MAGI Eligibility Groups  (Attachment 2) and

- the notice to households whose applications are being referred to the local district for non-MAGI processing. (Attachment 3)

3.    GIS 13 MA/021 Renewal Processing for MAGI Eligibility Groups Beginning January 2014 (PDF) (11/15/2013)

4.    GIS 13/MA/022 2014 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards

  • PDF
  • Attachment 1  - Annual and monthly income and resource limits for "non-MAGI" population -
  • Attachment 2   - Explains what income limits -- usually a percentage of the Federal Poverty Level -- apply to different categories of people, for use with Attachment 1 of same GIS.

5.    GIS 14/MA-007   Update on Self-Employment Policy for MAGI-like Budgeting  (3/21/2014)

6.   GIS 14 MA/016: Long Term Care Eligibility Rules and Estate Recovery Provisions for MAGI Individuals

7.   GIS 14 MA/022 - Medicaid Eligibility for Pregnant Minors   PDF  (7/1/2014)

8.     2014 LCM-02 - Medicaid Recipients Transferred at Renewal from New York State of Health to Local Departments of Social Services   (Dec. 1, 2014)

8.  GIS 15 MA/008 - Treatment of Income of Dependents Under MAGI-like Rules  (4/9/2015)

Child's Social Security or other income may be disregarded from household income, depending on amount and type of income.

9.  GIS 15 MA/022 - Continuous Coverage for MAGI Individuals  (12/23/15)   PDF 

  • Attachment 1
  • Announces that beginning January 1, 2016, 12-month continuous coverage protections will no longer be extended to MAGI recipients who turn 65.

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.

10.  GIS 15 MA/020 - IRS Tax Form 1095-B Guidance   PDF  

  • Attachment 1   
  • Attachment 2 
  • Explains form sent to MAGI Medicaid recipients to prove they are enrolled in Medicaid so they are not charged with a tax penalty charged to those who did not enroll in a health insurance plan - under the ACA

his site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship.  To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information.  To report a dead link or other website-related problem, please e-mail us.


Attached files
item 2014-06-11 Transition coverage from NYSOH to WMS.pdf (286 kb) Download
item 2013-12-24 Important Changes in Medicaid Application Submissions-MAGI and Non-MAGI.pdf (93 kb) Download

Also read
item Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
item Where to Apply for Medicaid and Medicaid Home Care in New York City
item The Affordable Care Act Implementation: New Opportunities and New Hurdles for Low-Income Communities in New York City
item The Affordable Care Act Implementation: Medicaid Expansion and MAGI Budgeting
item "MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare

Also listed in
folder Medicaid -> Getting Started
folder Medicaid -> Financial Eligibility
folder Federal Health Reform
folder Medicaid -> Applying For and Keeping Medicaid

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This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.