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NYS Directives on Medicaid changes under the Affordable Care Act

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Posted: 01 Oct, 2013
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Updated: 17 Nov, 2022
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 NYC directives click here.

NYS DIRECTIVES (beginning with oldest - scroll down for newer ones)

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

    • Attachment IV was revised in  GIS 19 MA/11 -- See  Attachment to that GIS - list of non-taxable income under MAGI - replaces Attachment IV

  • "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)

9.  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.  UPDATED 2018 - click here

10.  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.

11.  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

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

15.  GIS 17 MA/011: Treatment of Federal Income Tax Refunds and Advanced Payments  PDF

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  

17. GIS 19 MA/11 – Changes to Countable Income for Modified Adjusted Gross Income (MAGI) Based Eligibility Determinations (PDF)

Alimony changes - how treated under MAGI rules:

  • Alimony received under a divorce or separation agreement  finalized AFTER 12/31/2018 NOT countable as income; if finalized BEFORE that date it IS countable as income.

  • Alimony PAID under agreement finalized before 12/31/18 is deductible from income; if paid under agreement finalized after that date, it IS NOT deductible from income.

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.

  • Attachment (PDF)  List of Non-Taxable Income Sources Excluded from Gross Income for MAGI
    Budgeting," (corrects and amends attachmentpreviously distributed as Attachment IV to 13 ADM-04) 

18.  2021-09-27  Transition some MAGI-Like cases DSS/HRA to NYSofHealth  NYC Medicaid Alert: Transitioning of MAGI-Like Medicaid Cases from DSS/HRA Medicaid to NY State of Health Exchange

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 were to be transitioned in phases and the first transition began in June 2018. NYS has resumed the transition and approx. 158,600 individuals transitioned between April 2021 through July 2021. The alert details which groups of MAGI recipients were transitioned and those who will not be transitioned. Clients will not be required to renew their coverage in NYSOH until after the COVID-19 Health Emergency ends.

NYC HRA DIRECTIVES

2021-09-27  NYC Medicaid Alert: Transitioning of MAGI-Like Medicaid Cases from DSS/HRA Medicaid to NY State of Health Exchange

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 were to be transitioned in phases and the first transition began in June 2018. NYS has resumed the transition and approx. 158,600 individuals transitioned between April 2021 through July 2021. The alert details which groups of MAGI recipients were transitioned and those who will not be transitioned. Clients will not be required to renew their coverage in NYSOH until after the COVID-19 Health Emergency ends.

2015-03-10   Transition Exchange to LDSS  Consumers with Medicaid on Exchange Needing Enrollment into MLTC or HIV SNP (updates previous alert 1/10/2015 and 6/11/2014)

2015-02-03   Transition Exchange to LDSS       Medicaid Recipients Transferred at Renewal from NYS of Health to Local Dept. of Soc. Services

Procedure for transitioning people from expanded "MAGI" Medicaid generally for people under 65 who do not have Medicare -- when they turn 65 or become enrolled in Medicare, they must transfer to Non-MAGI Medicaid, using a stricter income and resource test.   The procedure provides some coverage to fill the gap during the transition.  It implements State DOH 14-LCM-02   PDF  (Dec. 2014) with Attachments to State DOH LCM:

  • Attachment I -Renewal form notice language and Medicaid Renewal Form
  • Attachment II - Statewide Provider IDs (Medicaid managed care plans)
  • Attachment III - Recipient Referral Information - Data Elements

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://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 2015-03-10 CORRECTED UPDATE Transition coverage from NYSOH to WMS with copy of 2014-06 Original Alert + Transmittal form.pdf (505 kb) Download
item 2015-02-03 Medicaid Recipients Transferred at Renewal from the New York State of Health to the Local Department of Social Services.pdf (143 kb) Download
item 2015-01-05 Consumers transitioned from NYSOH to WMS update (HIV SNP).pdf (53 kb) Download
item 2013-12-24 Important Changes in Medicaid Application Submissions-MAGI and Non-MAGI.pdf (93 kb) Download
item 2014-06-11 Transition coverage from NYSOH to WMS.pdf (286 kb) Download
item 2021-09-27 Transitioning of MAGI - Like Medicaid Cases.pdf (213 kb) Download

Also read
item Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits
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 Federal Health Reform
folder Medicaid -> Applying For and Keeping Medicaid

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"MAGI" Medicaid Eligibility under the Affordable Care Act -...       Medicaid Renewals/Recertifications in NYC- Resume March 2023 -...


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.