Medicaid provides health coverage to over 7.3 million low-income New Yorkers. The program covers a wide range of services, depending on your age, income, and family situation. In this article, we take a closer look at income-based Medicaid eligibility and how to apply when you’re above the income limit.
What Is Medicaid?
New York Medicaid, or Medicaid Managed Care, is a needs-based benefit for low-income individuals and families who can’t afford to pay for medical care. The program is jointly funded by the federal government and the state of New York. Medicaid recipients in all 62 counties are mandated to receive a full range of health services through a managed care plan, including:
- Doctor and clinic visits
- Medication and medical supplies
- Regular medical checkups and follow-up care
- Laboratory tests
- X-ray services
- Emergency care
- Home health care
- Nursing home care
- Long term care
- Emergency ambulance transportation
- Non-emergency transportation
- Hospital stays
- Dental care
- Prescription drug coverage
- Family planning services.
For a complete list of benefits, please consult the New York Medicaid website.
To qualify for Medicaid in New York State, applicants must meet several eligibility criteria. Read more about these criteria in the section below.
Who Is Eligible for New York Medicaid?
To be eligible for New York Medicaid, you must be:
- A resident of New York State
- A US national, citizen, permanent resident, or legal alien
- In need of assistance when it comes to medical care or insurance coverage
- In a financial situation that can be considered as low income or very low income.
In addition to the above prerequisites, you must also fall into one of the following categories:
- Be pregnant
- Be responsible for a child 18 years old or younger
- Be diagnosed as blind
- Have a disability
- Have a family member in your household with a disability
- Be 65 years of age or older.
The Affordable Care Act defines the above categories as Modified Adjusted Gross Income (MAGI) or non-MAGI.
MAGI Medicaid determines benefit eligibility based on gross income and provides all Medicaid benefits except for long-term care. It is available for:
- Pregnant women
- Children under the age of 19
- Children in foster care
- Childless adults aged 19-64 who could be certified disabled
- Parents or caretaker relatives
- Individuals who are on a family planning benefit program.
Non-MAGI Medicaid covers essential health benefits for the following groups:
- Individuals over the age of 65 who are not a parent or caretaker relative
- People who are diagnosed blind or disabled but who don’t meet the MAGI eligibility criteria.
The following groups are automatically eligible for Medicaid:
- Supplemental Security Income (SSI) recipients
- Cash Assistance recipients
- Children in foster care
- Juvenile delinquents in the care of New York’s Office of Children and Family Services (OFCS).
Because Medicaid is a program designed specifically for low- and very low-income New York residents, you have to meet certain income and asset requirements to qualify.
2022 New York Medicaid Long Term Care Eligibility for Seniors
|Type of Medicaid||Single||Married both spouses applying||Married one spouse applying|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$934 / month||$16,800||Nursing Home||$1,367 / month||$24,600||Nursing Home||$934 / month for the applicant||$16,800 for applicant $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$934 / month||$16,800||Nursing Home||$1,367 / month||$24,600||Nursing Home||$934 / month for the applicant||$16,800 for applicant $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$934 / month||$16,800||Help with Activities of Daily Living (ADLs)||$1,367 / month||$24,600||Help with Activities of Daily Living (ADLs)||$1,367 / month||$24,600||Help with Activities of Daily Living (ADLs)|
* Source: American Council on Aging
Eligibility Based on Income
New York Medicaid sets income and asset limits depending on different factors, such as the size of the beneficiary’s household, medical needs, and age. Income and resource levels are subject to yearly adjustments.
Income before taxes for single individuals, couples without children, and families
Net income and resource limits for blind, disabled, and 65+ individuals
*Resource limits only apply to Medicaid adult recipients who fall into the disability and elderly categories. Medicaid has no resource limits for children, low income families, and non-disabled individuals.
But what happens if you meet all the other eligibility factors, but not the income limit requirements? The good news is that there are several ways you can still qualify for Medicaid.
Can You Apply for Medicaid in New York if You Are above the Income Limit?
In some cases, you can qualify for New York Medicaid even if you earn more than the income limit or if you have more assets than the program normally allows.
You can gain eligibility through the following options:
- Medicaid excess income program
- Exempt assets
- Asset spend downs
Medicaid excess income program
When your monthly income exceeds the Medicaid level—the amount known as excess income—and at the same time you fulfill other eligibility requirements, you might still receive Medicaid assistance.
Here’s how it works.
If your medical bills equal the monthly excess income, Medicaid will pay your remaining bills for the rest of the month. These bills can include expenses such as outpatient care, doctor and dental visits, laboratory tests, prescription drugs, as well as long-term care, such as home care and assisted living.
Medicaid distinguishes between two kinds of assets:
- Countable assets, such as checking and investment accounts, cash, real property (other than your home), boats, etc.
- Non-countable or exempt assets, for example, your primary residence, one vehicle, household goods, life insurance policies, and prepaid burial expenses.
The exempt assets are not counted towards Medicaid’s asset limit. Even if their amount exceeds the eligibility requirements, you can still qualify for Medicaid.
Asset spend down
If your income or countable assets exceed Medicaid’s financial limits, you can become eligible by “spending down” the income or assets until they reach the limit of financial eligibility.
Asset spend down for New York seniors is known as the “medically needy pathway.” The asset limit for 2022 is $16,800 for a single elderly applicant, which is relatively high compared to other states.
Medicaid imposes specific rules on how you can spend down your excess income. While you are not allowed to use your extra resources to pay bills or expenses, you can spend them on one of the following:
- Paying past-due medical bills (within the last six years)
- Paying off mortgage or credit card debt
- Paying for in-home care
- Paying off debt or purchasing an annuity
- Repairing or purchasing a vehicle
- Making repairs and improvements to your primary residence, for example, installing wheelchair ramps or stairlifts
- Purchasing medical devices that are not covered by insurance, such as dentures, eyeglasses, and hearing aids
- Purchasing life insurance policies with a combined face value of $1,500 or less
- Prepaying funeral expenses.