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Medicaid & MSP: Must apply for Social Security and Other Potentially Available Income - and Medicare

Views: 10102
Posted: 14 Mar, 2013
by Cathy Roberts (Empire Justice Center)
Updated: 17 Oct, 2016
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 "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

NY SSL 366(2)(b)(1) 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 from the NYS DOH Medicaid Reference Guide (MRG) page 415: Enrollment in Medicare is a condition of eligibility for Medicaid.

This article was authored by the Empire Justice Center.

Empire Justice Center

Also read
document Medicare Savings Programs (MSP) in New York
document Know Your Rights: NYLAG Webinars on Medicare and Medicaid -

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

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