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Eligibility Expanded for Medicaid and Medicare Savings Program for Disabled/Age 65+/ Blind (DAB) in NYS Budget!

08 Apr, 2022

On April 8, 2022, the NYS Legislature and Governor reached an agreement on the NYS Budget, which included some important wins for New Yorkers  age 65+ and those who have disabilities, and for undocumented immigrants age 65+.  While advocates did not get everything we proposed, NYLAG thanks the Governor and Legislature for taking important steps to make health care more affordable for all and address racial disparities in health care.

We are still analyzing all of the changes but here are key changes on Medicaid eligibility:

Medicaid  -- for those Age 65+, Blind, or Disabled ("Non-MAGI" Medicaid)

1.  INCOME LIMIT for “Non-MAGI” Medicaid, covering people Age 65+,  Blind, or Disabled, will increase in Jan. 2023 to the same limit used for MAGI -- for people under 65 who do not have Medicare.   This limit is 138% of the Federal Poverty Line.   

Using 2022 FPL, the new income limits in 2023 would be:

    • Singles -  $1563/mo  (a big increase from $934/mo)
    • Couples - $2106/mo  (a big increase from $1367/mo)
  • By using the same income limit for MAGI and Non-MAGI Medicaid, many Medicaid recipients who have MAGI Medicaid on NYS of Health will be able to keep Medicaid when they become enrolled in Medicare, whether based on turning age 65 or because they receive SS Disability benefits.  

  • Those with incomes above these limits will still be able to “spend down” excess income on medical bills, or enroll in Pooled Trusts to shelter income.

  • TIMING – We hope that the timing will work out so that when the Public Health Emergency is expected to be declared over later in 2022, and all Medicaid recipients must go through a renewal,  those who have MAGI Medicaid will be able to stay on Medicaid and not fall off the cliff – if their renewals are processed after Jan. 1, 2023, when the new income limits go into effect.

  • Caveat – Some rules for counting “income” for MAGI are different than for non-MAGI. For example, for MAGI, Veterans’ benefits, Workmens’ Comp, and gifts or inheritances do not count as income, but they do count for non-MAGI.. So there will be some people eligible for MAGI Medicaid who will still have a spend-down when they switch to non-MAGI Medicaid.  But – at least they will be able to “spend down” excess income or use pooled trusts, or use “spousal refusal” – none of which are possible in MAGI Medicaid.

2.  ASSET LIMIT – Unfortunately, the limit on assets was NOT repealed, as a coalition of consumer advocates had proposed.  (See more below).  However,  the asset limit will increase by about 50% in January, 2023.  We estimate that the levels will be:

  • Single    increase from   $16,800 to $28,134          
  • Couples increase from   $24,600 to  $37,908.         

3.  UNDOCUMENTED IMMIGRANTS – While Coverage4All did not pass,  undocumented immigrants age 65+ will  be eligible for Medicaid effective Jan. 1, 2023.  They will be required to join a “mainstream” Medicaid managed care health plan.   
NY SSL Sec. 366, subd. 1(g)(4)(a). 

4.   ESSENTIAL PLAN -  For those under age 65, whose income is above the MAGI level, eligibility for the Essential Plan will increase from 200% to 250% FPL, and the benefit package will expand to include long term care services not previously covered.  These are defined as  "certain services and supports" for those "who have functional limitations and/or chronic illnesses that have the primary purpose of supporting the ability of the enrollee to live or work in the setting of their choice, which may include the individual's home, a worksite, or a provider-owned or controlled residential setting."   it is unclear whether these long term care services are the same as those covered by Medicaid.                                  

Medicare Savings Program (see this article)

  • QMB limits will be increased to the same level as the new Medicaid income limits138% FPL (from current level of 100% FPL)($ figures here).  All people who have Medicaid under the new expanded limits, without a spend-down, will be eligible for QMB.

  • SLIMB – this program will no longer exist in NYS, as everyone who had SLIMB will now get QMB, a better benefit because of balance billing protections.

  • QI-1 – The income limit for this benefit will increase from 135%  to 186% FPL.  Like now, those who choose this benefit may not also have Medicaid, even with a spenddown.  They must choose one or the other.  Using 2022 figures, the income limits would be:

  • Singles - $2107/mo
  • Couples - $2838/mo

The three Medicare Savings Programs (MSP) are a crucial subsidy for Medicare beneficiaries. All 3 MSP programs:

  • Pay for the monthly Part B premium, which in 2022  rose to $170.10 -- ten percent of a Social Security check of $1,701/mo. 

  • Automatically qualify a Medicare beneficiary for FULL EXTRA HELP - the Medicare Part D prescription drug subsidy.  

  • Have NO ASSET limit.

When:  Both the Medicaid and Medicare Savings Program increases will take effect Jan. 1, 2023, as long as CMS approves them, which is expected. 

DOWNLOAD this Fact Sheet on the Changes from Medicare Rights Center here.

The fine print - read the actual bill A9006-C here. These changes are in Part AAA Sections 2-4, starting at page 259.

 Background on Campaign  to Expand Medicaid for Older New Yorkers and People with Disabilities

Background:  In August 2021, a  letter  to Governor Hochul was sent by over 50  organizations that asked her to expand Medicaid eligibility for older adults and people with disabilities in the 2022-23 Executive Budget.  These groups were left out of Medicaid expansion under the Affordable Care Act (ACA). Lead organizations on the letter included  New York Legal Assistance Group, along with Medicaid Matters New York, the Medicare Rights Center, Community Service Society of New York, The Legal Aid Society, New York StateWide Senior Action Council 

  • NYLAG and the coalition sent a follow up letter  to the Governor in December 14, 2021.

The Governor heard our message and in her State of the State message agreed that it's time for New York to catch up to California and other states that have equalized access for seniors and people with disabilities.  Her State of the State message stated,  "This coverage expansion will eliminate the resource eligibility test and raise the income level to 138 percent of the federal poverty level for these populations for these populations. These changes will enable extremely low-income seniors and individuals with disabilities to easily maintain secondary Medicaid coverage when their Medicare eligibility begins — significantly reducing health disparities across the State, reducing unnecessary eligibility redeterminations, and increase administrative efficiencies."  Plan at page 35.

  • Gov. Hochul's landmark proposal to align rules for INCOME and ASSETS for Medicaid for people age 65 and disabilities  with  Medicaid for younger people, which was expanded under the Affordable Care Act  -- "so that low-income New Yorkers age 65 and up, as well as those with disabilities, are able to maintain Medicaid eligibility after they become eligible for Medicare. These changes would be effective January 1, 2023.    New York's current asset rules are biased against people of color, who statistics show are less likely to own homes and retirement funds, assets that are given special treatment as exempt from the current asset limit, while cash assets count.  Medicaid requires a senior or person with a disability to  "spend down" all income above  $934/month (single) on medical care - which  they cannot afford to do and still pay rent and buy food.  Raising the limit to $1563/mo. - the same used for younger people -- will ensure access to health care for thousands more low-income seniors and people with disabilities.   See more here

  • Expand the income limits for the Medicare Savings Program or "MSP" - a lifesaving subsidy that saves low-income Medicare beneficiaries $170.10/mo. by paying their Part B premium, and also automatically qualifies them for Full Extra Help, the low income subsidy for Medicare Part D that makes prescription drugs affordable.  NYLAG commends the NYS Assembly for including  MSP expansion in its one-house Budget Bill A09007B.    

  • See all of NYLAG's Health Priorities for NYS Budget SFY 22-23 here

  • READ NYLAG's Memo in Support of the MSP Expansion here

 Under the FINAL BUDGET,  people like Sonya will no longer fall off the "Medicaid cliff" and lose Medicaid when they lose "MAGI" eligibility under the ACA because they get Medicare or turn 65.

  • At age 64, Sonya has Medicaid with Social Security of $1481/mo. and $28,000 in life savings. 

  • But when she turns 65,  under current rules, she will have to "spend down"  $527month on medical expenses AND reduce her assets to $16,800 to qualify for Medicaid.   She needs all of her income to pay bills, and her savings for emergencies.

  • Had she owned her home or retirement funds, these would not count as an asset under current rules  -- but people of color are less likely than white people to own a home or have retirement funds.   This is why we sought to repeal asset limits. While the final budget does not repeal asset limits, the increase in limits will still help many low income New Yorkers.

  • Under the final budget, Sonya will be able to keep full Medicaid!! 

Read NY Times article For Older Americans, Some Positive Health News, online Feb. 28, 2022

Read NYLAG's statement applauding the Governor's momentous position here.  

Read NY Focus article Jan. 7, 2022 - Hochul Proposes Medicaid Expansion for Seniors and Disabled, Marking a Shift From Past Governors

 The Final NYS Budget adopts at least in part all 3 points of our proposal:

  1. RAISES the Medicaid income eligibility level for people 65 and over and people with disabilities to 138% of the federal poverty level (FPL);

  2. INCREASES  the Medicaid asset limit for people 65 and over and people with disabilities; and

  3. Raises the eligibility level for the Medicare Savings Program from 100% to 138% of the federal poverty level for QMB and to 186% FPL for  QI-1.   


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