NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC

"MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare

print  Print
share  Share
Views: 67561
Posted: 15 Nov, 2013
by --
Updated: 28 Dec, 2018
by Valerie Bogart (New York Legal Assistance Group)

Medicaid eligibility rules changed significantly on January 1, 2014 for some New Yorkers as a result of the Affordable Care Act’s eligibility expansion and streamlining provisions.   The expansion only applies to a population called the "MAGI" population.  Generally, the new rules do NOT apply to people over age 65 or who have Medicare at any age.  There are limited exceptions to this.   Various resources are available to explain the new rules and benefits:

CMS - Federal Medicaid and Medicare Agency

Guidance for Medicaid and CHIP Eligibility Workers


NYS Dept. of Health

Health Care for All New York coalition - interactive Marketplace eligibility questionnaire

Click here for an interactive Marketplace eligibility questionnaire, designed to help enrollment assistors and consumers better assess their potential eligibility for Marketplace coverage based on immigration status, age and income. This questionnaire is not an official assessment of eligibility. To receive an official determination of eligibility contact the New York State of Health Marketplace at http://www.nystateofhealth.ny.gov or 1-855-355-5777

  • This tool was created jointly by the Children's Defense Fund - New York, the Empire Justice Center, and the Community Service Society through their work in the Health Care for All New York coalition.

Empire Justice Center 

This training, Medicaid in 2014: Understanding MAGI & the Marketplace, covers the following topics, with case examples to help illustrate how the rules apply to our clients:

  • The new MAGI (Modified Adjusted Gross Income) income levels and budgeting rules for Medicaid;
  • Qualified Health Plans and the types of benefits these plans will provide;
  • Eligibility for assistance with affording the new qualified health plans - Advance Premium Tax Credits and Cost Sharing Reductions; and
  • The new online process for applying for all of these forms of assistance. 
  • Trilby de Jung, Former Senior Attorney at Empire Justice is the presenter for the bulk of the slides.  The last seven slides are presented by Lisa Ball, attorney and certified navigator, with LAW-NY.  For a video recording of the webinar visit http://www.empirejustice.org/training-center/



Helpful MAGI worksheet from another state.. but should be valid in NYS

MAGI Medicaid New York
Attached files
item NYLAG ACA Part 2 - MAGI.ppt (2.72 mb) Download

Also read
item Income and Resource Limits for New York State Public Health Insurance Programs
item Affordable Care Act --New York State Health Exchange Open Year-Round for Medicaid Applications and for Certain "Special Enrollment" categories
item Health Plan Appeal Rights in New York After the Affordable Care Act
item New York Medicaid Expansion
item Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange
item The Affordable Care Act Implementation: New Opportunities and New Hurdles for Low-Income Communities in New York City
item NYS Directives on Medicaid changes under the Affordable Care Act
item The Affordable Care Act Implementation: Medicaid Expansion and MAGI Budgeting

Also listed in
folder Medicaid -> Getting Started
folder Medicaid -> Financial Eligibility
folder Federal Health Reform
folder Medicaid -> Applying For and Keeping Medicaid

External links
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.healthlaw.org/publications/browse-all-publications/MAGI-Webinar#.UvU9-IXYOwV

Prev     Next
Know Your Rights: NYLAG Webinars on Medicare and Medicaid -       Affordable Care Act --New York State Health Exchange Open...

This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.