Big increases in income and asset limits for Age 65+, Blind & Disabled (ABD) take effect Jan. 1, 2023 - read about how these will be rolled out here. and see these DOH directives: The 2022 HRA Income and Resources Level Chart has been partially updated for 2023 - figures highlighted in green in 2023 HRA Income and Resources Level Chart will be updated once NYS DOH adopts the 2023 increases in the Federal Poverty Levels that were announded in mid-January 2023. See explanation of the different boxes on the HRA chart here. The figures in the table below use the NYS Department of Health Chart (as of 12/22/22 -- here) (using 2022 FPL. Stay tuned for increases applying 2023 FPL). WARNING: Whether to use the income level for 1, 2 or more persons is not intuitive. See rules on household size here.
** Non-MAGI budgeting for Aged, Blind and Disabled only allows a Household size of 1 or 2. See more here. Also, for MAGI -- children < 5 and pregnant women have HIGHER INCOME LIMITS than those shown. See NYS 2023 Chart here. for larger size MAGI households. NYS DOH DIRECTIVES with 2023 INCREASES:
The table above uses the figures in the above DOH directives that use the 2022 Federal Poverty Levels to calculate the 2023 Income limits. Income levels will increase once the 2023 Federal Poverty Levels announced in Jan. 2023 are applied by NYS DOH. COVID-19 NOTE - Because of the ongoing Public Health Emergency, current Medicaid recipients will have eligibility continued under their current budgets. Though income for many increased in 2022 with the 5.9% COLA for Social Security, their spend-down was not increased. Likewise the 2023 COLA is 8.7%. The "unwinding" of the Public Health Emergency starts in March-April 2023. See more here. The renewals sthat begin at that time will redetermine eligibility using 2023 income and income limits, and the 2023 Medicare Part B premium ($164.90).See this article for tips on renewals. For new applications filed or approved in 2023, the 2023 limits will be used for non-MAGI. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?
WHAT IS THE HOUSEHOLD SIZE? See rules here. They are not intuitive!!!!HOW TO READ 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 MAGI 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:
ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules HOW TO DETERMINE SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIESThe 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.
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 2021, 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.
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