2023 Updated Increases Announced for Medicaid and Medicare Savings Program for Disabled/Age 65+/ Blind - View Webinar recording from Jan. 18, 2023

2/10/23 UPDATE - NYS Dept. of Health updated the income and resource limits based on the 2023 Federal Poverty Levels.  See NYS DOH GIS 23 MA/02 - 2023 Federal Poverty Levels and ATTACHMENT  New York State Income and Resource Standards for Non-MAGI Population.  These update the levels previously announced by NYS in December 2022 for 2023.   See tables below.  GIS 23 MA/02 specifies that the updated figures are to be used for all new and pending applications and for any redeterminations made since Jan. 1, 2023.

WHAT IS CHANGING -- Starting in 2023,  financial eligibility has expanded for MEDICAID  and the Medicare Savings Program for New Yorkers age 65+ and those who have disabilities. These changes were enacted in the NYS Budget for 2022-23.  While advocates did not get everything, NYLAG thanks the Governor and Legislature for following California's lead in taking important steps to make health care more affordable for all and address racial disparities in health care.  Unfortunately,  undocumented immigrants age 65+ were scheduled to  qualify for Medicaid starting Jan. 2023, but the Governor has proposed to delay this and the expansion of the Essential Plan for a year until 2024.

 View recording of NYLAG's Jan. 18, 2023 webinar on these changes and how to help clients benefit from them - and download the materials --  

1. View the recorded webinar here (no CLE credit  for viewing recording)
2. PowerPoint from Jan. 18, 2023 webinar
3. Appendix of references, forms, and case examples from webinar (with updated HRA Chart of Medicaid levels updated Jan. 24, 2023 and updated MAP-3190 form (1-10-23) to request rebudgeting)
4. Excel Template to estimate Medicaid eligibility and spenddown (using 2023 FPLs - not that as of 1/25/23, NYS levels are based on 2022 FPLS, and guidance is expected soon updating to  2023 FPLS)

The campaign ito expand Medicaid access and reduce racial disparities in health care sn't over - in Nov. 2022, advocates renewed their request to Gov. Hochul to repeal, or at least expand the asset limit in the SFY 2023-24 Budget.  

IN THIS ARTICLE:

I.  Five Key Changes Coming in 2023

II.  Timing - When Will This Happen in 2023 - and What Can You Do To Help Consumers?   

• See note re NYC procedures 
• Triaging - priority cases for rebudgeting 

III.  Background on Campaign to Expand Medicaid & MSP for Older New York & Those with Disabilities - and What's Next

 I.  FIVE Key Changes Coming in 2023 

1. RAISES the Medicaid income eligibility level for people 65 and over and people with disabilities to 138% of the federal poverty level (FPL);

2. INCREASES  the Medicaid asset limit for people 65 and over and people with disabilities; and

3. Raises the eligibility level for the Medicare Savings Program from 100% to 138% of the federal poverty level for QMB and to 186% FPL for  QI-1.   Eliminates the 3rd MSP program -- the SLIMB program.

4. Qualifies undocumented immigrants age 65+ for full Medicaid. 

5. Increases the income limit from 200% to 250% FPL for the Essential Plan (must be under age 65) and expands coverage to include long term care 

A.   Increased Medicaid Income Limit for 65+, Blind, or Disabled  INCOME LIMIT  will increase to the same limit used for MAGI for people under 65 who do not have Medicare --  138% of the Federal Poverty Line (FPL). 

Feb. 10, 2023 - DOH updated the new 2023 income  and resource limits in NYS DOH GIS 23 MA/02 - 2023 Federal Poverty Levels and ATTACHMENT  - New York State Income and Resource Standards for Non-magi Population.  These  update the earlier GIS 22 MA/11 also GIS 22 MA/14 - 2023 Medicaid Levels and Other Updates  and Attachment 1 (Chart of Eligibility Levels)

• Initially, in Dec. 2022, DOH announced lower  limits than the ones above, based on 2022 Federal Poverty Levels - in GIS 22 MA/14.  They were increased to the amounts above with NYS DOH GIS 23 MA/02 - 2023 Federal Poverty Levels and ATTACHMENT, based on the 2023 FPL's that  were announced on 1/12/23.  

• HRA Income and Resources Level Chart  Updated Feb. 23, 2023 

• Many Medicaid recipients who have MAGI Medicaid on NYSofHealth will now be able to keep Medicaid when they become enrolled in Medicare, whether based on turning age 65 or because they receive SS Disability benefits.    Before, someone with Social Security of $1500/mo. would "fall off the cliff"  when they enrolled in Medicare.  Their income was under the MAGI Medicaid limit, but when they switched to non-MAGI they  have a  spend-down of $600/month.  

• If income is above the new limits, they may still “spend down” excess income on medical bills, or enroll in Pooled Trusts to shelter income.

• Warning– Some  “income” is excluded for MAGI but counts for non-MAGI. This includes Veterans’ benefits, Workmens’ Comp, and gifts or inheritances. People with these types of income may lose Medicaid, or have  spend-down, when they switch to non-MAGI Medicaid.  But – at least they will be able to “spend down” excess income or use pooled trusts, or use “spousal refusal” – none of which are possible in MAGI Medicaid.

  B.  INCREASED MEDICAID ASSET LIMIT

* Initially, in Dec. 2022, DOH announced lower  limits than the ones above, based on 2022 Federal Poverty Levels - in GIS 22 MA/14.   They were increased to the amounts above with NYS DOH GIS 23 MA/02 - 2023 Federal Poverty Levels and ATTACHMENT, based on the 2023 FPL's that  were announced on 1/12/23.     Under NY Law, the asset limit equals 1.5 times the annual income limit. 

Medicaid Buy-In for Working People with Disabilities - Asset limits will increase to the same limits from current $20,000 single and $30,000 couple.  GIS 22 MA/11. 

NYLAG and other consumer advocates had urged total repeal of the asset limits, which are biased against people of color, who are statistically less likely than white people to own a home or have retirement funds.   Yet homes and retirement funds are largely exempt, while cash assets count dollar for dollar. (See more below). For the next NYS budget  in 2023,  NYLAG and other advocates have already asked the Governor to repeal or at least increase the asset limit further.  See Nov. 2022 letter to Gov. Hochul.   

C.  Medicare Savings Program - Increased Income Limits (see more here)

The two Medicare Savings Programs (MSP) are a crucial subsidy for Medicare beneficiaries.  A third MSP program (SLIMB) is eliminated in 2023. Both MSP programs - QMB and QI-1:

1. Pay for the Part B premium, which in 2023 will be $164.90, slightly reduced from $170.10 IN 2022. 

2. Automatically enroll the beneficary in Full Extra Help - the Medicare Part D subsidy.  

3. Have NO ASSET limit. 

QMB has the added benefit of paying for the Medicare coinsurance under Part A and Part B, and protecting the beneficiary from balance billing for these charges.  See more here. 

Here are the 2023 Changes in MSP - see GIS 22 MA/10 --

1. QMB limits will increase to the same level as the new Medicaid income limits – 138% FPL (from current 100% FPL)($ figures here).  All people who have Medicaid under the new limits, without a spend-down, will be eligible for QMB. QMB has a 4th benefit (in addition to the 3 for all MSPs above) - protecting beneficiaries from Balance Billing. 

2. SLIMB – this program will no longer exist in NYS, as everyone who had SLIMB will now get QMB, a better benefit because of balance billing protections.

3. QI-1 – The income limit  will increase from 135%  to 186% FPL.  Like now, those who choose this benefit may not also have Medicaid, even with a spenddown.  They must choose one or the other.  Using 2022 figures, the income limits would be:

*Initially,  in Dec. 2022, DOH announced the  2023 limits that were lower than the ones in the above table,  based on 2022 Federal Poverty Levels.  On Feb. 10, 2023, they were increased to the amounts above - see NYS DOH GIS 23 MA/02 - 2023 Federal Poverty Levels and ATTACHMENT, based on the 2023 FPL's that  were announced on 1/12/23.      

DOWNLOAD this Fact Sheet on the Changes from Medicare Rights Center here.

D.  UNDOCUMENTED OLDER  IMMIGRANTS –POSTPONED UNTIL 2024

While Coverage4All did not pass,  the 2022-23 NYS Budget said undocumented immigrants age 65+ woild  be eligible for Medicaid Jan. 1, 2023. However, the Governor's NYS Budget proposal for 2023-24 says this will be postponed for a year until Jan. 1, 2024. When implemented, they will be required to join a “mainstream” Medicaid managed care health plan.   NY SSL Sec. 366, subd. 1(g)(4)(a).  

 E.  ESSENTIAL PLAN (People under age 65) --The income limit for the Essential Plan will increase from 200% to 250% FPL.  This Insurance is for those under age 65 with income above the MAGI level.  Also, the benefit package will expand to include long term care services not previously covered.  These are defined as  "certain services and supports" for those "who have functional limitations and/or chronic illnesses that have the primary purpose of supporting the ability of the enrollee to live or work in the setting of their choice, which may include the individual's home, a worksite, or a provider-owned or controlled residential setting."   It is unclear whether these long term care services are the same as those covered by Medicaid.

Unfortunately, this expansion will not include undocumented immigrants. 

II.  Timing - When Will This Happen in 2023 - and What Can You Do? 

New applications for Medicaid or MSP filed after Jan. 1, 2023 should be assessed under the new limits.  We do not yet know about applications filed in 2022 but approved in 2023, but we believe they should also be assessed under the 2023 limits.  

What about the hundreds of thousands of Medicaid recipients who:

• now have a Medicaid spend-down, and want it reduced under the new income limits in 2023?  Or
• those who have QI-1 or SLIMB Medicare Savings Program, and want to "upgrade" to QMB or full Medicaid?  

This is not so simple. See materials from NYLAG 1/18/23 webinar, including sample forms, link to view recording, and other resources - links at the top of this article. 

Unfortunately, the NYS Dept. of Health told advocates that because of the antiquated computer sytem, they cannot automatically recalculate the spend-down for everyone in January 2023 under the new limits.  Consumers will have two choices:

1. Wait Until the Medicaid Renewal -  Since March 2020,  Medicaid renewals normally done every year were suspended because of the Public Health Emergency (PHE).  Under special COVID Maintenance of Effort rules,  Medicaid could not be discontinued and the spend-down could not be increased since March 2020, even if income or assets increased or if the renewal was not completed. Therefore, there was no point for local agencies to process the renewals.  (Adding confusion, NYC recipients have still received the renewal packages, but if they did not return them, Medicaid could not be discontinued).  See more in article on Medicaid renewals. 

However, once the PHE is declared over, which might be in April 2023, renewals will be sent to all Medicaid recipients over the course of a full year, going into 2024.  When processing these renewals, the Medicaid offices will recalculate eligibility under the new income limits. Most people should see their spend-down go down – or be eliminated altogether.  Many people will newly qualify for a Medicare Savings Program (MSP). 

Until the renewal is processed based on actual current income, the spend-down, if any, will remain the same.  It cannot be increased by the Medicaid office. 

2. Those who don't want to wait for the renewal, starting in January 2023, may ask their local Medicaid agency to rebudget their income - and reduce their spend-down, and those with an MSP only may ask to upgrade to full Medicaid or QMB.    SEE NOTE FOR New York City Recipients below.

Beginning December 10, 2022,  over 2 weeks, the NYS Dept. of Health will send out 2 notices to 2 groups of consumers.

1. Group 1 - Spend-down - This notice will be sent to consumers who have a Medicaid spend-down saying that starting Jan. 2023, they may ask their local Medicaid office to rebudget their spend-down and enroll them in QMB if they were not enrolled. (This is an attachment to GIS 22 MA/11 posted here.

   • NYC recipients with a Medicaid spend-down will receive an additional notice from the NYC Medicaid program that will be mailed around January 30, 2023.   The UPDATED NYC MAP-3190 form that will be mailed out  is attached to the NYC Medicaid Alert dated 2022-12-22 -- Increase in Medically Needy Income and Asset Levels in 2023 and Sample Form MAP-3190 2023 Budget Review Request Form. (the download has the updated MAP-3190 notice). This will be  in addition to this notice they receive from NYS Medicaid in Dec. 2022. 

   • The NYC notice will include a bar-coded MAP-3190 FORM for the recipient to complete and return in a self-addressed pre-paid return envelope.  On the form, the recipient will state and attest to their current 2023 income and 2023 deductions, including pooled trust deposits.   No documentation will be required.  NYC HRA will rebudget their Medicaid and MSP back to Jan. 1, 2023.   See the 12/22/22 HRA Medicaid Alert for instructions on where to mail, fax, or deliver the completed MAP-3190 form. 

   • NYC HRA urges consumers to wait until they receive this form and return it in the bar-coded envelope, to ensure that it goes to the proper department for processing.  

2. Group 2 - Medicare Savings Program -ONLY  -This notice will be sent to all those in a Medicare Savings Program  who do not also have Medicaid. (Notice is an attachment to GIS 22 MA/10).   This includes those in QMB, SLIMB, and QI-1.  They may either submit:

   1. a Medicaid application with  Supplement A  (DOH 5178A) to upgrade coverage to Medicaid, if their assets are under the new Medicaid asset limits. OR 

   2. an MSP application (DOH-4328) if they only want QMB MSP but not full Medicaid.   

   • NYC residents who have MSP-only and not Medicaid will not receive any additional notice other than this one from NYS DOH.   Stay tuned for suggestions on how to submit Medicaid/MSP applications to upgrade coverage. 

3. Advocates are concerned that HRA and the county Medicaid offices lack the capacity to field thousands of requests to recalculate the spend-down.  This may delay help for those with the most urgent need to have their case rebudgeted.

4. NYLAG recommends that advocates triage these requests to prioritize those for whom rebudgeting is more urgent.  Also, see above form that NYC Spend-down recipients will receive. Suggested priorities are:

HIGH PRIORITY --

• People using the Pay-In program or who meet their spend-down by submitting medical bills to the Medicaid office.  

• Those who are in the QI-1, SLIMB or QMB MSP who do not have Medicaid and would like to upgrade to full QMB and/or Medicaid.

LOW PRIORITY -- 

• Those who have been determined to have a ZERO ($0) SPEND-DOWN based on depositing income into a Pooled Income Trust  or if under age 65, into an individual Supplental Needs Trust (SNT).  They have the lowest priority since they already have full Medicaid without being billed for a spend-down, and hopefully also have QMB MSP.  However, these consumers may still want to reduce how much they deposit into the trust. 

  • STRATEGY TIP:  Advocates who are knowledgeable about Medicaid budgeting can estimate the consumer's spend-down for 2023. (Use 2023 income and 2022 FPL until the 2023 FPL is announced and see Non-MAGI Budgeting Tips here). 

  • The consumer may reduce their contribution to the Pooled Trust in Jan. 2023 or soon after to the amount determined by an experienced advocate. 

  • The consumer may now qualify for Medicaid and QMB without using a pooled trust or SNT at all!  If so, they may stop their trust deposits, spend down the balance of their trust account, and notify the trust that they want to close their account.  The monthly trust fee will likely be charged until the account is closed.  

  • Then, when the consumer responds to the Medicaid renewal later in 2023 or 2024 after the PHE ends, they will include a Verification of Deposits to the trust.   If the estimate of their 2023 spend-down was correct, the trust deposits should offset their new spend-down, so that the spend-down will remain at ZERO once the renewal is processed.   

  • TIP:   Estimate the 2023 spend-down conservatively - better to put too much than too little into the pooled trust or individual SNT. 

See links at top of this article for materials from NYLAG webinar on the strategies outlined below and how to help clients benefit from the new eligibility limits, held January 18, 2023

III.  Background on Campaign to Expand Medicaid & MSP for Older New Yorkers and People with Disabilities

Background:  In August 2021, over 50 organizations sent a  letter  to Governor Hochul asking her to expand Medicaid eligibility for older adults and people with disabilities in the 2022-23 Executive Budget.  These groups were left out of Medicaid expansion under the Affordable Care Act (ACA). Lead organizations on the letter included  New York Legal Assistance Group, along with Medicaid Matters New York, and other organizations.  The letter to Gov. Hochul urged her to expand the income limits for the Medicare Savings Program or "MSP."

• NYLAG and the coalition sent a follow up letter  to the Governor in December 14, 2021.

The Governor heard our message and in her State of the State message and then her proposed Budget proposed o align rules for INCOME and ASSETS for Medicaid for people age 65 and disabilities  with  Medicaid for younger people under the Affordable Care Act   "so that low-income New Yorkers age 65 and up, as well as those with disabilities, are able to maintain Medicaid eligibility after they become eligible for Medicare. These changes would be effective January 1, 2023.    See more here.  Her State of the State message stated,  "This coverage expansion will eliminate the resource eligibility test and raise the income level to 138 percent of the federal poverty level for these populations for these populations. These changes will enable extremely low-income seniors and individuals with disabilities to easily maintain secondary Medicaid coverage when their Medicare eligibility begins — significantly reducing health disparities across the State, reducing unnecessary eligibility redeterminations, and increase administrative efficiencies."  Plan at page 35.

Though the Governor's proposed budget and both one-house bills of the NYS Senate and Assembly all proposed to repeal the asset test. The final NYS SFY 2022-23 budget increased but did not repeal the asset limit.  Final enacted  bill at A9006-C - See Part AAA Sections 2-4, p. 259 et seq.

See Justice in Aging's issue brief on the national movement to expand eligibilty for Medicaid and reduce racial disparities in health care access.

View this webinar held May 11, 2022, discussing this national trend sponsored by Justice in Aging, with participation by Valerie Bogart, NYLAG. 

WHAT'S NEXT:   In Nov. 2022, advocates renewed their request to Gov. Hochul to repeal, or at least expand the asset limit in the SFY 2023-24 Budget.  

• See all of NYLAG's Health Priorities for NYS Budget SFY 22-23 here

• READ NYLAG's Memo in Support of the MSP Expansion here. 

• Read NYLAG's statement applauding the Governor's momentous position here.  

• In the Press -- NY Times article For Older Americans, Some Positive Health News, online Feb. 28, 2022; NY Focus article Jan. 7, 2022 - Hochul Proposes Medicaid Expansion for Seniors and Disabled, Marking a Shift From Past Governors

THANK YOU GOVERNOR HOCHUL and STATE LEGISLATURE FOR RECOGNIZING THAT NOW MORE THAN EVER ACCESS TO HEALTH CARE IS CRITICAL!!!