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.
1. 13 ADM-04 - Medicaid Application and Renewal Processing for Modified Adjusted Gross Income (MAGI) Eligibility Groups (Dec. 4, 2013) PDF
Links to the appendix (which is just a list of the attachments) and ten attachments that accompany it available a: http://www.health.ny.gov/health_care/medicaid/publications/pub2013adm.htm
Attachment IV was revised in GIS 19 MA/11 -- See Attachment to that GIS - list of non-taxable income under MAGI - replaces Attachment IV
"This ADM advises local districts of the referral process for applicants in a Modified Adjusted Gross Income (MAGI) eligibility group to New York State of Health (NYSOH), New York’s Health Insurance Marketplace, and the requirements for determining or renewing Medicaid eligibility for certain individuals using MAGI-like budgeting rules. This directive also informs districts of the actions the State will take to transition Family Health Plus (FHPlus) Single Individuals and Childless Couples to coverage under the Affordable Care Act (ACA) effective January 1, 2014, and advises districts of special instructions for processing Medicaid referrals from NYSOH for coverage/payment of medical bills in the three-month retroactive period.”
NYC HRA has also issued a directive re applications procedures - see Important Changes in Medicaid Application Submissions -MAGI and Non-MAGI (Dec. 24, 2013)
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
Announces that beginning January 1, 2016, 12-month continuous coverage protections will no longer be extended to MAGI recipients who turn 65.
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
Alimony changes - how treated under MAGI rules:
Alimony received under a divorce or separation agreement finalized AFTER 12/31/2018 NOT countable as income; if finalized BEFORE that date it IS countable as income.
Alimony PAID under agreement finalized before 12/31/18 is deductible from income; if paid under agreement finalized after that date, it IS NOT deductible from income.
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.
Attachment (PDF) List of Non-Taxable Income Sources Excluded from Gross Income for MAGI
Budgeting," (corrects and amends attachmentpreviously distributed as Attachment IV to 13 ADM-04)
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.
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.
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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