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NYS BUDGET for 2015-2016 Again Proposes End to Spousal Refusal and "Immediate Need" Medicaid

12 Feb, 2015

The Governor's proposed New York State budget for 2015-16 includes some good and some bad for health care for low-income New Yorkers.  Click here to see the actual  Health and Mental Hygiene (HMH) Bill  and the Governor's Health and Mental Hygiene (HMH) Memorandum in Support.

NYLAG is one of many organizations that submitted testimony about the budget.  See NYLAG's Testimony posted here.

I.  NYLAG BUDGET PRIORITIES ON Medicaid Eligibility and Services:

  1. Preserve Spousal/Parental Refusal  (§ 33) –The Governor’s bill would eliminate spousal refusal for many needy spouses as well as children with cancer and other severe conditions whose parents cannot afford the high cost of their care.  While many New Yorkers benefit from the new expanded eligibility limits under the Affordable Care Act [ACA], nearly a million low-income New Yorkers are over age 65 or have permanent disabilities.  For them, Medicaid remains unchanged by the ACA, with so-called "non-MAGI" income limits well below the Federal Poverty Level - singles may have only $825/mo and couples only $1209/mo.  Any income over that must be contributed through as a Spend-down.  They also may keep only minimal savings and other resources.     Spousal/parental refusal provides a vital protection for vulnerable populations, including abused spouses and children. 

    1. While Managed Long Term Care now has Spousal Impoverishment Protections, there is a Catch-22.  To get in the Medicaid door, and have the application accepted, a "community spouse" of an MLTC applicant must first use a Spousal Refusal on the application.  Only after the Medicaid application is accepted and the spouse needing home care is enrolled in an MLTC plan, may the "community spouse" keep up to $2,980.50 of the couple's combined income.  At that point, the spousal refusal is no longer necessary, because now the spouse can have a spousal impoverishment allowance. But if spousal refusal is abolished, the couple's combined income would be too high for the Medicaid application to be approved in the first place.  See details in our testimony.

    2. Moreover, many married individuals do not need MLTC.  They need Medicaid for other vital health care coverage, or for help with Medicare out-of-pocket costs.   Spousal Impoverishment protections only help married individuals who need MLTC.

    3. Chronically ill children also are barred from Medicaid eligibility if their parents' income must be counted.  "Parental refusal" is vital for them to obtain critical medical care.

    4. See page 5 of our testimony for examples   of all of these needy individuals.

  2. Reject Elimination of Medicaid Personal Care and Other Services for  IMMEDIATE NEEDS Pending the Medicaid Application and Enrollment in a Managed Long Term Care plan (§§ 36-37) See details in our testimony.

  1. Preserve “Prescriber Prevails.”  See details in our testimony.

II.  SUPPORT FUNDING FOR ADVOCACY ASSISTANCE TO HELP VULNERABLE INDIVIDUALS NAVIGATE AND PROTECT THEIR RIGHTS IN THE EXPANDING MANAGED CARE DELIVERY SYSTEM

  1. Support Expansion of Managed Care Ombudsprogram – “ICAN”

  2. Support Continuing Funding and Restore Prior Funding Levels of the Managed Care Consumer Assistance Program (MCCAP)

  3. Support Funding for the Community Health Advocates (CHA) program

C.  We support other items in testimony of our colleagues at:

For information please contact  Valerie Bogart, Director, Evelyn Frank Legal Resources Program at NYLAG,  7 Hanover Square, 18th fl, NY NY 10004 vbogart@nylag.org  212-613-5047


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