What You Need to Know About NYS Medicaid Expansion in 2023

By the Legal Aid Society

Many Medicaid recipients who are 65+, and/or who have a disability and receive Medicare, are now able to have higher income and more resources while still qualifying for Medicaid.

Improvements to Medicaid

Medicaid recipients who are 65 and over, and/or who have a disability and receive Medicare, receive Medicaid through the Local District of Social Services (LDSS). In New York City the LDSS is the New York City Human Resources Administration (NYC HRA). This population is also referred to as DAB (Disabled, Aged, and Blind), ABD (Aged, Blind, and Disabled), non-MAGI, SSI-related, or Medically-Needy. Until now, many Medicaid recipients became ineligible for Medicaid once they began to receive Medicare because they suddenly had different income eligibility requirements and new resource limits. Now, with these changes, their resource limits have been raised, and the income eligibility limit is equal across most groups of Medicaid recipients, including those under and over 65, as well as those with or without Medicare.

In addition, many Medicaid recipients who have had a spenddown, or Excess Income, will no longer have a spenddown or will have a much lower one. The spenddown program means that you need to pay-in to get Medicaid or submit bills to activate your Medicaid.

Increased Income Limits

Medicaid recipients can now receive more income. Starting January 1, 2023, the income limit for the DAB population increased from $934 to $1,677 for an individual and from $1,367 to $2,268 for a couple.

Increased Resource Limits 

Medicaid recipients can have more resources. Starting January 1, 2023, the resource limit for the DAB population increased from $16,800 to $30,182 for an individual and $24,600 to 40,821 for a couple.

Increased Resource Limits to MBI-WPD

Starting January 1, 2023, the resource limit for the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) population increased from $20,000 to $30,182 for an individual and $30,000 to $40,821 for a couple. The monthly income limits for this program are $3,038 for an individual and $4,109 for a couple. These income limits are higher than the regular Medicaid income limits.

Changes to the Medicare Savings Program (MSP)

The Medicare Savings Program, a state-run Medicaid program that pays the Part B Medicare premiums and sometimes other costs for low-income individuals, has also expanded. As of January 1, there are only two MSP programs, Qualified Medicare Beneficiary (QMB) and Qualifying Individuals (QI). There is no longer a Specified Low-Income Medicare Beneficiary (SLMB) program. SLMB recipients are included in the QMB program. QMB is a more generous program – it pays for a recipient’s Part B premium and also provides coverage for all Medicare cost-sharing such as co-pays, deductibles, and co-insurance.

Increased Income Limits for MSP

MSP recipients can now receive more income. Starting January 1, 2023, the income eligibility limit for QMB increased from $1,133 to $1,677 for an individual and $1,546 to $2,268 for a couple. The income limit for QI will increase from $1,529 to $2,260 for an individual and $2,060 to $3,057 for a couple.

Current Recipients

If you are a current Medicaid recipient and have a spenddown you should have received a letter in December 2022 from the Department of Health letting you know that you may now qualify for Medicaid without a spenddown or with a smaller spenddown. If you live in NYC and your Medicaid is administered through HRA, you will also receive a letter from HRA.

If you want your spenddown to decrease as soon as possible, you can ask your LDSS (HRA in NYC) to review your budget. You will need to provide your current gross income and any deductions you may have (such as for health insurance premiums, etc.). HRA mailed an attestation form directly to spenddown recipients where they can include this information. No proof of income is necessary. Forms should be sent back with the pre-addressed envelopes provided by HRA. Mailing back the pre-addressed envelope is the best way to have your budget reviewed. But, if you misplace this envelope, you can still send in the form. If you do not receive home care, you can fax the documents to 917-639-0645 or bring it to a community office. If you do receive home care, you should mail the form to: HRA/HCSP, 785 Atlantic Ave., 7th Floor. Brooklyn, NY 11238 or drop it off at Window 16 at 785 Atlantic Ave., Brooklyn.

*For those in New York City, the best way to have your budget adjusted is to fill out the form that HRA sends and mail it back right away.

Otherwise, if you do nothing, your Medicaid budget will be adjusted during your normal renewal period. The first renewals since before the COVID pandemic are beginning soon, and current Medicaid recipients will receive renewals as early as March 2023, for coverage beginning July 1, 2023. All Medicaid recipients remain on the same renewal cycle that they were on before the pandemic, so some people could receive their first renewal as late as February 2024.

*Now is a good time to make sure HRA has your updated mailing address and contact information. You can do this by calling 718-557-1399 or updating your ACCESS HRA profile.

Newly Eligible Recipients 

If you are not a Medicaid recipient, but think you may now be eligible submit a Medicaid application, along with a Supplement A form, to be considered for Medicaid. These will be processed using the new income and resource limits.

Spenddown
The spenddown program will still exist for those with “excess income” above the new income limits.

Supplemental Needs Trusts (SNTs)
Pooled trusts are still an option for those with income above the new limits who will be told they have a spenddown. If your spenddown decreased due to the new income limits, you can alert your trust to the decrease, and arrange to contribute less each month.

What if you no longer have a spenddown and want to stop contributing to your pooled trust?
You can stop contributing to a pooled trust at any time. If you have remaining funds in the trust you can continue to spend them down. However, the pooled trust will remain in existence even if you do not make any future contributions. Pooled trusts terminate when the beneficiary dies. We advise you to call your trust organization if you intend to stop contributing to see what best practices they recommend.

MSP Recipients

If you are a current MSP recipient who is in SLMB or QI you should have received a letter in December 2022 from the Department of Health letting you know that you may now qualify for the QMB MSP program, as well as Medicaid.

If you want to benefit from these changes as soon as possible, you must submit a new MSP application that will be processed using the new eligibility guidelines. You may also submit a Medicaid application, along with a Supplement A form, if you also want to be considered for Medicaid. As of January, these will be processed using the new income and resource limits.

Otherwise, if you do nothing, your MSP budget will be adjusted during your normal renewal period.

Non MSP Recipients

You may now be eligible for both MSP and Medicaid, even if you were not in the past. We encourage you to apply for both Medicaid (including the Supplement A form) and the MSPprogram.

Get Help

For more information, or for assistance with your individual case, you may call The Legal Aid Society’s Access to Benefits helpline at 888-663-6880.

Disclaimer

The information in this document has been prepared by The Legal Aid Society for informational purposes only and is not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. You should not act upon any information without retaining professional legal counsel.