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The New York State Department of Health (DOH) has issued additional directives outlining the new procedures for Medicaid applications and renewals under the Affordable Care Act, effective in 2014. For NYC directives click here. NYS DIRECTIVES (beginning with oldest - scroll down for newer ones)1. 13 ADM-04 - Medicaid Application and Renewal Processing for Modified Adjusted Gross Income (MAGI) Eligibility Groups (Dec. 4, 2013) PDF
2. 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF)
13 ADM-03 describes "expanded Medicaid coverage under the ACA, a new method for counting household income based on modified adjusted gross income (MAGI), Medicaid benefits under the ACA and Medicaid enrollment in New York's Health Benefit Exchange." The directive contains several attachments, including these desk aids explaining - MAGI Eligibility Groups and Income Levels (Attachment 1) - MAGI and Non-MAGI Eligibility Groups (Attachment 2) and - the notice to households whose applications are being referred to the local district for non-MAGI processing. (Attachment 3) 3. GIS 13 MA/021 Renewal Processing for MAGI Eligibility Groups Beginning January 2014 (PDF) (11/15/2013) 4. GIS 13/MA/022 2014 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards
5. GIS 14/MA-007 Update on Self-Employment Policy for MAGI-like Budgeting (3/21/2014) 6. GIS 14 MA/016: Long Term Care Eligibility Rules and Estate Recovery Provisions for MAGI Individuals 7. GIS 14 MA/022 - Medicaid Eligibility for Pregnant Minors PDF (7/1/2014) 8. 2014 LCM-02 - Medicaid Recipients Transferred at Renewal from New York State of Health to Local Departments of Social Services (Dec. 1, 2014)
9. GIS 15 MA/008 - Treatment of Income of Dependents Under MAGI-like Rules (4/9/2015) Child's Social Security or other income may be disregarded from household income, depending on amount and type of income. UPDATED 2018 - click here 10. GIS 15 MA/022 - Continuous Coverage for MAGI Individuals (12/23/15) PDF
Clarifies that "MAGI-like" category -- those who fall into a MAGI category but are getting their Medicaid coverage through their LDSS or HRA -- are entitled to the same 12-month continuous coverage protections as MAGIs (people who fall into a MAGI category and are getting their coverage through the Marketplace). Some people must get coverage through their LDSS because they need long term care such as home care, a waiver program, or nursing home care. They are eligible for these services with MAGI eligibility- see GIS 14 MA/016 above- but need eligibility processed by the local district. 11. GIS 15 MA/020 - IRS Tax Form 1095-B Guidance PDF
12. 2016 LCM-01 - Transitioning MAGI Consumers from WMS to NY State of Health - attachments at this link 13. 16 ADM-01 - Transitioning Essential Plan Consumers from WMS to NY State of Health PDF -- read more about the Essential Plan here 14. GIS 16 MA/004 -Referrals from NY State of Health to Local Departments of Social Services for Individuals who Turn Age 65 and Instructions for Referrals for Essential Plan Consumers (PDF) -- read more about the Essential Plan here 15. GIS 17 MA/011: Treatment of Federal Income Tax Refunds and Advanced Payments PDF 16, GIS 18 MA-07: "Treatment of Income of Dependents Under MAGI-like Rules, 2018 Update (worksheet attachment) - Updates GIS 15 MA/008 - Treatment of Income of Dependents Under MAGI-like Rules to implement 2017 federal tax law changes in the threshold at which a tax dependent is required to file a tax return, used in MAGI determinations immediately. This income threshold is used to determine if the income of a child or tax dependent is included in the MAGI-like budget. This information is generally released via IRS publication 501 (2017). Use attached worksheet to calculate whether a dependent’s income is countable
Alimony changes - how treated under MAGI rules:
Lottery and Gambling winnings - if over $80,000, now countable as income over several months or years depending on amount received. Countable solely for the individual who received the winnings. The NHeLP Advocates Guide to MAGI (updated 2018) has more info about the changes in how lottery winnings are treated under changes enacted in 2018. The changes are meant to disqualify winners from MAGI by creating an exception to the rules that normally exempt non-recurring lump sums. See more about lump sums in the SNT outline posted in this article. Also view webinars on Lump Sum impact on benefits, including MAGI Medicaid.
18. 2021-09-27 Transition some MAGI-Like cases DSS/HRA to NYSofHealth NYC Medicaid Alert: Transitioning of MAGI-Like Medicaid Cases from DSS/HRA Medicaid to NY State of Health Exchange. Since the New York State of Health was introduced in 2014, it has been responsible for all MAGI Medicaid cases. However, there were many Medicaid consumers with MAGI-like budgeting who were found eligible before January 1st, 2014. Their cases have remained with HRA until they could be transitioned. Those consumers were to be transitioned in phases and the first transition began in June 2018. NYS has resumed the transition and approx. 158,600 individuals transitioned between April 2021 through July 2021. The alert details which groups of MAGI recipients were transitioned and those who will not be transitioned. Clients will not be required to renew their coverage in NYSOH until after the COVID-19 Health Emergency ends. NYC HRA DIRECTIVESSince the New York State of Health was introduced in 2014, it has been responsible for all MAGI Medicaid cases. However, there were many Medicaid consumers with MAGI-like budgeting who were found eligible before January 1st, 2014. Their cases have remained with HRA until they could be transitioned. Those consumers were to be transitioned in phases and the first transition began in June 2018. NYS has resumed the transition and approx. 158,600 individuals transitioned between April 2021 through July 2021. The alert details which groups of MAGI recipients were transitioned and those who will not be transitioned. Clients will not be required to renew their coverage in NYSOH until after the COVID-19 Health Emergency ends. 2015-03-10 Transition Exchange to LDSS Consumers with Medicaid on Exchange Needing Enrollment into MLTC or HIV SNP (updates previous alert 1/10/2015 and 6/11/2014) 2015-02-03 Transition Exchange to LDSS Medicaid Recipients Transferred at Renewal from NYS of Health to Local Dept. of Soc. Services Procedure for transitioning people from expanded "MAGI" Medicaid generally for people under 65 who do not have Medicare -- when they turn 65 or become enrolled in Medicare, they must transfer to Non-MAGI Medicaid, using a stricter income and resource test. The procedure provides some coverage to fill the gap during the transition. It implements State DOH 14-LCM-02 PDF (Dec. 2014) with Attachments to State DOH LCM:
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