Starting Jan. 1, 2024, immigrants age 65+ can get FULL MEDICAID even if they do not qualify for PRUCOL status (PRUCOL is discussed in this article). This include most services - including home care, prescription drugs, and Nursing Home care. See more below about services covered. Until now, undocumented immigrants could only receive temporary EMERGENCY Medicaid, discussed in this article, with some exceptions for pregnant women and children. This change was enacted in the NYS budget in April 2022. Implementation was postponed one year from January 2023 to January 2024.
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Undocumented immigrants who do not have PRUCOL status between ages 19- 64 are still eligible only for EMERGENCY Medicaid. All children under 19, regardless of immigration status, who can prove NYS residency, may be eligible for Child Health Plus.
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Income and Resource eligibility is the same as for others Age 65+ (see Non-MAGI Medicaid limits and Fact Sheet with more information about financial eligibility here).
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Once approved eligible for Medicaid, coverage must be accessed through Medicaid managed care plans except for prescription coverage, which is through NYRx. See more below.
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As of Jan. 22, 2024, DOH reported that 16,000 undocumented adults age 65+ already are receiving full Medicaid. 24,000 are expected to qualify. (From DOH webinar).
In this article:
I. DOH FACT SHEET, GUIDANCE, Recorded Webinar, STATE LAW & NYC Medicaid Alert
II. How Undocumented Immigrants Age 65+ Can Obtain Full Medicaid
1. Those who had Emergency Medicaid in December 2023 were Automatically Transitioned to Full Medicaid.
2. Those who are uninsured and are applying for Medicaid after Jan. 1, 2024
3. Those Who Already Have Emergency Medicaid on NYSOH and AGE IN - Turn 65 after Jan. 1, 2024
4. Enrolling in a Medicaid Managed Care Plan - and How to Access Services
III. Will Enrolling In Medicaid Make You a "Public Charge?"
IV. Nursing Home Coverage for Undocumented Immigrants Age 65+
V. Retroactive Coverage is Limited
VI. Provider Billing Information
VII. For Help
I. DOH FACT SHEET, GUIDANCE, Recorded Webinar, STATE LAW & NYC Medicaid Alert:
1. Those who had Emergency Medicaid in December 2023 were Automatically Transitioned to Full Medicaid.
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They should have received a joint heads-up letter from the NYS Dept. of Health and their local DSS/HRA in November or December 2023 alerting them to this change and to what they can expect (Page 2 of this PDF)
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If their Medicaid was administered by the local Dept. of Social Services (DSS) (HRA in New York City) their Medicaid case was transferred to NYSoH. See NYS DOH GIS 23 MA/20 - Expanded Monthly Transition from WMS to NY State of Health. They received two notices about their Medicaid.
- The local DSS/HRA sent Notice to the consumer that Medicaid case transferred from LDSS to NYSOH (Spanish version is last part of PDFs below)
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NYSOH then sends a notice to consumer that the Medicaid case was transferred to NYSOH, which will handle future renewals. (See last 3 pages of this PDF).
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No Transition to NYSOH During Renewal Period- Consumers will be unable to transition from the local Medicaid office to NYSOH during their renewal period which can be three to four months depending on the local Medicaid office; consumers are advised to renew their coverage as soon as they receive their renewal application to avoid any delays in moving out of their renewal period. (Per Q&A in DOH webinar Jan. 30, 2024)
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Most people age 65+ must apply for Medicaid at their local Dept. of Social Services (HRA in NYC) with the paper application and Supplement A, and include all of the regular documentation of residency, income, and resources. See this article for links to the forms. Most people cannot apply on NYSOH because NYSOH cannot review assets or use non-MAGI budgeting, also known as budgeting for the Disabled/Aged/Blind category of Medicaid. See Fact Sheet about non-MAGI or DAB budgeting).
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EXCEPTION: Some people age 65+ may apply for Medicaid on NYSOH because they are in the MAGI category as parents or "caretaker relatives" of a child under age 18 or who is age 18 and in school full-time. See more in 23 INF-02 p. 2. Once NYSOH approves their Medicaid, they must enroll in a managed care plan. See below.
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If eligible -- LDSS/HRA will authorize coverage using coverage code 07 (Emergency Medicaid). Then the LDSS/HRA will transfer case to NYSoH. See NYS DOH GIS 23 MA/20 - Expanded Monthly Transition from WMS to NY State of Health. Notices will be sent to the consumer as follows:
- The local DSS/HRA sends Notice that Medicaid case was transferred from LDSS to NYSOH (Spanish version is last part of PDFs below)
- NYSOH then sends a notice that the Medicaid case was transferred to NYSOH, which will handle future renewals.
3. Those Who Already Have Emergency Medicaid on NYSOH and AGE IN - Who Turn 65 after Jan. 1, 2024
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They will be automatically transitioned to Full Medicaid.
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Their Medicaid will remain on NYSoH with MAGI Medicaid. This is because of the special "waivers" that CMS granted to NYS during the "unwind" of the Public Health Emergency: Specifically, assets are not counted toward eligibility when Medicaid is renewed, and NYSOH continues to use MAGI budgeting rules even for people who normally would become Non-MAGI because they turn 65 or obtain Medicare based on disability.
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They will be given the chance to enroll in a Medicaid managed care plan or be auto-assigned to one if they do not select one in 10 days. See next section.
4. Accessing Medicaid Services - Selecting and Enrollng in a Medicaid Managed Care plan - and Services Provided Outside of Managed Care
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Consumers whose Medicaid is transferred from the LDSS to NYSOH, or consumers whose Medicaid is already on NYSOH and whose Medicaid is converted from Emergency Medicaid to full Medicaid will receive a notice telling them how to select a Medicaid Managed Care plan and the deadline by which they need to do so in order to have full coverage as soon as possible.
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Which plans? They may join only "mainstream" Medicaid managed care plans. They may not join HARP plans, HIV Special Needs Plans, or MLTC plans. See 23 INF-02 p. 1.
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NYSoH “15th of the Month Rule:” If the individual enrolls in a plan on or before the 15th of the month, the effective date of their plan enrollment will be the 1st of the following month. If they enroll in a plan after the 15th of the month, they will be enrolled in their plan on the 1st of the next following month.
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Example: Pat enrolls in a plan on March 16th. The enrollment will not be effective unil May 1st.
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AUTO- ASSIGNMENT - if they do not pick and enroll in a plan within 10 days of receiving a letter telling them to do so, they will be assigned to a plan.
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How they receive Medicaid before their Managed Care Plan enrollment is effective - They can access only Emergency Medicaid and NYRx pharmacy benefits until they are enrolled in a plan.
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After the plan enrollment is effective - They access most services from the Medicaid managed care plan. This includes all primary and acute medical care, all types of home care (personal care, CDPAP, private duty nursing), adult day health care (medical model), and nursing home care.
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Services accessed OUTSIDE of the managed care plan:
The answer is NO if you are using Medicaid for medical care and services in the community - all primary care, home care, hospital care, and any other primary or acute care or long-term care in the community. Medicaid for these purposes cannot be considered for making you a "Public Charge."
In 2022, the Biden administration updated the U.S. Citizenship & Immigration Services (USCIS) Public Charge resource webpage "to ensure that immigrants and their families, many of whom are essential and frontline workers, are not deterred by undue fear or confusion from obtaining access to important government services for which they are eligible to keep their families safe and healthy."
Receipt of Medicaid coverage for institutional long-term care (i.e., long-term nursing home care), however, may be considered a factor if you are adjusting your immigration status or in some other situations. The only benefits that can be considered to make one likely to become a public charge are: (a) ongoing cash assistance for income maintenance including SSI (e.g, not one-shots or ERAP; and (b) government funded long-term institutional care.
All Medicaid services other than institutional care do NOT make someone a public charge. For more info about Public Charge and FAQs see:
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Nursing Home benefits will be authorized by the Medicaid Managed Care plan, as they are for other managed care enrollees, if they are financially eligible under existing rules used to determine coverage of long-term nursing home care, including the 5-year lookback and transfer penalties.
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NYSoH cannot determine eligibility for Nursing Home coverage, so eligibility will be handled by DOH staff, including the 5-year lookback
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All documentation related to Nursing Home eligibility should be sent by email to MCfor65PlusUndoc@health.ny.gov
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Any documents received by DOH staff to determine eligibility for long-term NH coverage will be uploaded to consumer’s NYSoH account.
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WARNING about PUBLIC CHARGE - See above information stating that Medicaid coverage of nursing home care may be a factor considered in whether you are likely to become a "public charge." Individuals age 65+ needing Medicaid coverage of nursing home care about these risks and their rights.
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FOR Immigration Advice and Legal Assistance - click here.
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Normally, Medicaid applicants can request retroactive coverage up to 3 calendar months before the month of application.
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However, full retroactive coverage is not available to undocumented immigrants age 65+ (per DOH webinar Jan. 30th)
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Up to 3 months of retroactive Emergency Medicaid is available.
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NYRx prescription drug coverage will be retroactively available for new applicants if they are eventually approved for full Medicaid. Retroactive NYRx coverage will be authorized only back to January 1, 2024.
Providers should see the NYS DOH eMedNY Medicaid Update December 2023 for billing information. This Update has new billing code information.
Questions regarding the coverage expansion or eligibility should be emailed to MCfor65PlusUndoc@health.ny.gov.
