Income and Resource Limits for New York State Public Health Insurance Programs

Here is the 2018 HRA Income and Resource Levels chart.   The green highlighted figures are updated for 2018.  The yellow highlighted figures are for MAGI Medicaid and other Medicaid programs for which eligibility is based on the Federal Poverty Line, for which 2018 levels will not be announced until April 2018.  Those programs include the Medicare Savings Program, Medicaid Buy-In for Working People with Disabilities, Breast Cancer Program, etc. The 2017 income levels still apply for those programs until the federal poverty line is updated around April 2018. 

This short summary chart shows that income limits have increased for the new "MAGI"  category created by the Affordable Care Act, but not for the "Non-MAGI" population - the Disabled, Aged 65+ and Blind (DAB).

2017-2018

Non-MAGI

Disabled, 65+ or  Blind  ("DAB" or SSI-Related) and have Medicare

MAGI
(< 65, Does not have Medicare)(OR has Medicare and has dependent child < 18 or < 19 in school)
138% FPL***
     1 2 1 2 3
Income $842 (up from $825 in 2017) $1233 (up from $1,209 in 2017) $1,387 $1,868 $2,349
Resources

$15,150 (up from $14,850 in 2017)

$22,200 (up from $21,750 in 2017)

NO LIMIT**

THE NYS directive with the 2018 figures is GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates  PDF

See income levels for past years through 2017 here.   

Which household size applies?  The rules are complicated.  See rules here.

On the HRA Medicaid Levels chart -  

MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.  42 C.F.R. § 435.4.

  Certain populations have an even higher income limit -

CAUTION:  What is counted as income may not be what you think.  For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline  and these charts on income disregards.    However, for the MAGI population  - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI).   There are good changes and bad changes. 

GOOD:  Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. 

BAD:  There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules.  For all of the rules see:

HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES

The income limits increase with the "household size."  In other words, the income limit for a family of 5 may be higher than the income limit for a single person.  HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical.  There are different rules depending on the "category" of the person seeking Medicaid.     Here are the 2 basic categories and the rules for calculating their household size. 

  1. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size.   These same rules apply to the Medicare Savings Program, with some exceptions explained in this article

  2. Everyone else -- MAGI - All children and adults under age 65, including  people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.  Their household size will be determined using federal income tax rules, which are very complicated.

New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010  (PDF)  pp. 8-10 of the PDF,   This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.  See slides 28-49. Also see Legal Aid Society and Empire Justice Center materials

OLD RULE used until end of 2013 --  Count the person(s) applying for Medicaid who live together, plus any  of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient.   Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21  (though if the child is disabled, use the rule in the 1st "DAB" category.    Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility.    See 18 NYCRR 360-4.2,  MRG p. 573,  NYS GIS 2000 MA-007

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:

PAST INCOME & RESOURCE LEVELS --

Past Medicaid income and resource levels in NYS are shown on these old NYC HRA  charts for 2001 through 2017, in chronological order.    These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS. 


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

NYLAG



Article ID: 15
Last updated: 03 Jan, 2018
Revision: 44
Medicaid -> Financial Eligibility -> Income and Resource Limits for New York State Public Health Insurance Programs
http://www.wnylc.com/health/entry/15/