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Medicaid Income Limits NY 2023

Posted on October 2, 2023


For many Long Island residents, Medicaid serves as a critical safety net, providing access to quality healthcare services they might not otherwise afford. Medicaid is especially beneficial for low-income families, the elderly, pregnant women, individuals with disabilities, and other New York residents who would not be able to afford long-term care once they reach an advanced age. However, getting eligibility for Medicaid can be difficult for individuals who exceed the income limits and have no other means of availing necessary care.

To safeguard your access to quality healthcare services and protect your financial well-being, take proactive steps to familiarize yourself with the updated Medicaid income limits for 2023. Understanding the changes and how they affect you can help you make informed decisions about your healthcare planning and explore potential eligibility options. Seeking professional guidance from a qualified Long Island Medicaid planning attorney from Schlessel Law PLLC can help maximize your chances of qualifying for Medicaid coverage. Our team can help you navigate Medicaid’s application system and safeguard your assets against potential complications that can prevent your access to medical care.

Remember, staying well-informed about the changes in Medicaid income limits empowers you to take control of your healthcare and financial future. Schedule a consultation at (516) 574-9630 today to ensure you’re on the right path toward accessing the healthcare support you deserve.

What is Medicaid?

Medicaid is a means-tested program that offers health coverage to eligible individuals and families with limited financial resources. It covers a wide range of medical services, including hospital stays, doctor visits, prescription medications, long-term care, and more. The program aims to improve access to healthcare for vulnerable populations and promote better health outcomes.

New York’s Medicaid program follows the guidelines set by the federal government but also has state-specific variations and requirements. This means that eligibility criteria and income limits may differ from other states. Understanding these nuances is essential for Long Island residents seeking Medicaid benefits.

Exploring Medicaid Income Limits in New York for 2023

Medicaid income limits refer to the maximum amount of income an individual or family can earn to qualify for Medicaid in New York. The income limits determine eligibility for Medicaid benefits, and they vary based on household size and composition. These limits are based on a percentage of the Federal Poverty Level (FPL) and are updated annually to account for changes in the cost of living and other economic factors. It’s important to note that Medicaid is a means-tested program, which means that only individuals and families with limited financial resources can qualify. For 2023, the New York Medicaid Limits have been raised to 138% of the Federal Poverty Level.

Medicaid Income Limits for Different Household Sizes in 2023

Medicaid income limits vary based on the size and composition of the household. In New York, the income thresholds differ for individual applicants, married couples, and families with dependents.

Starting January 1, 2023, New York State’s 2023 Fiscal budget is broadening Medicaid coverage eligibility for disabled individuals, individuals aged 65 and above, or blind individuals (also known as DAB). The same income limits also apply to applicants for Institutional/Nursing Home Medicaid and Medicaid Home and Community Based Services.

Individual Applicants

For individual applicants in New York, the income limit in 2023 is now $1,677 monthly or $20,121 annually. 

Married Couples

Married couples applying for Medicaid have a different income limit than individual applicants. The income limits for married couples in New York in 2023 are $2.268 monthly or $27,214 annually for the applicant spouse. 

In cases where only one spouse of a married couple applies for Nursing Home Medicaid or an HCBS Waiver, the income of the non-applicant spouse, often referred to as the community spouse, is not taken into consideration. To protect the non-applicant spouse from impoverishment, a minimum monthly income allowance known as the Community Spouse Monthly Income Allowance (CSMIA) is provided.

As of 2023, the CSMIA in New York is set at $3,715.50 per month. If the non-applicant spouse’s monthly income falls below this amount, they are entitled to receive a supplement from the applicant spouse to reach the CSMIA threshold. On the other hand, if the non-applicant spouse’s monthly income is already equal to or exceeds $3,715.50, they will not receive a CSMIA. Additionally, Medicaid may request that 25% of any income exceeding $3,715.50 per month be allocated towards the applicant spouse’s care costs. In such cases, the applicant spouse has the option to institute Spousal Refusal.

Families with Dependents

Families with dependents, such as children or other qualifying individuals, have their income limits calculated based on their household size. The income limits for families generally depend on the number of household members, accounting for the additional financial responsibilities of caring for dependents.

Long Island residents need to be aware of these income limits and how they apply to their specific household size. Medicaid eligibility is determined by comparing the household’s income to the relevant income limit for that size. If the household’s income falls below the income limit, they may qualify for Medicaid coverage. Aside from income limits, applicants must also be aware of Medicaid’s asset limits that could affect their eligibility.

Understanding Countable Income

Countable income is a critical factor in determining Medicaid eligibility in New York. It represents the portion of an individual or family’s income that is considered when evaluating their qualification for Medicaid benefits. Knowing what income is included and excluded in the countable income calculation is essential for Long Island residents applying for Medicaid.

Inclusions in Countable Income

In New York, countable income includes various sources of earned and unearned income. Some examples of income inclusions are:

  • Wages and Salaries: Income earned from employment, including part-time and full-time jobs.
  • Self-Employment Income: Profits generated from a business or freelance work.
  • Pension and Retirement Income: Payments received from pensions, annuities, and retirement accounts.
  • Social Security Benefits: Retirement benefits, survivor benefits, and disability payments.
  • Unemployment Benefits: Income received from state or federal unemployment insurance programs.
  • Interest and Dividends: Earnings from investments and savings accounts.
  • Rental Income: Income generated from renting out properties.

Exclusions from Countable Income

Certain types of income are excluded from the countable income calculation, meaning they do not impact Medicaid eligibility. Some common exclusions are:

  • Supplemental Security Income (SSI): SSI payments are not considered as countable income for Medicaid eligibility purposes.
  • Temporary Assistance for Needy Families (TANF): TANF benefits, also known as cash assistance, are typically excluded from countable income.
  • Child Support Payments: Income received from child support is often excluded from the calculation.
  • Earned Income Tax Credit (EITC): EITC payments are typically not included in countable income.

Properly identifying countable income can make a significant difference in whether an applicant qualifies for Medicaid benefits or not.

Non-Financial Eligibility Requirements

Beyond income limits, New York’s Medicaid program has non-financial eligibility requirements that applicants must meet to qualify for coverage.

Citizenship and Immigration Status

To be eligible for Medicaid in New York, applicants must be U.S. citizens, U.S. nationals, or qualified immigrants. Individuals with specific immigration statuses, such as lawful permanent residents and refugees, may qualify for Medicaid benefits.

New York State Residency Requirements

Applicants must also be residents of New York State to be eligible for Medicaid. Proof of residency, such as a valid New York driver’s license or utility bills, may be required during the application process.

Social Security Number Requirement

In most cases, individuals applying for Medicaid must have a valid Social Security number unless they have religious objections to getting an SSN. This requirement applies to primary applicants as well as any dependents included in the application.

As Medicaid income limits and rules can be complex, Long Island residents seeking Medicaid benefits should consider consulting with experienced Medicaid planning attorneys. These professionals can provide guidance on how to accurately calculate income, understand countable income, and navigate the application process effectively. Individuals and families can increase their chances of qualifying for Medicaid and accessing vital healthcare services in New York by getting professional assistance from a qualified attorney.

Changes to Medicaid Income Limits for 2023

Medicaid income limits are subject to annual updates to reflect changes in the cost of living and economic conditions. These updates are necessary to ensure that the program continues to assist those in need and adapt to fluctuations in living expenses. Applicants need to be aware of the current income limits to determine their eligibility accurately.

Impact of Cost of Living Adjustments (COLA)

Cost of Living Adjustments (COLA) is a mechanism used to account for inflation and adjust benefit amounts accordingly. Concerning Medicaid income limits, COLA can have an impact on the income thresholds that determine eligibility. If the cost of living increases, income limits may be adjusted higher, potentially expanding eligibility for certain individuals and families.

Changes in Supplemental Security Income (SSI) Limits

Supplemental Security Income (SSI) is a federal program that provides financial assistance to individuals with disabilities and seniors with limited income. Changes to SSI benefit amounts can influence Medicaid eligibility, as some states, including New York, use the SSI income limits as a basis for determining Medicaid income thresholds. Therefore, any changes in SSI limits can directly affect Medicaid qualification in New York.

State and Federal Poverty Guidelines

Poverty guidelines are used as a reference for determining eligibility for various government assistance programs, including Medicaid. Both the state and federal governments set poverty guidelines, and New York often adopts the federal poverty guidelines (FPL) as a basis for determining Medicaid income limits. These guidelines take into account household size and are updated annually. Understanding how the poverty guidelines interact with Medicaid income limits is crucial for Long Island residents applying for Medicaid benefits.

It is important to note that changes to Medicaid income limits can impact eligibility for both new applicants and current beneficiaries. Long Island residents seeking Medicaid coverage should stay informed about any updates to income limits and guidelines for 2023. Consulting with a Medicaid planning attorney can also be beneficial in navigating these changes and ensuring accurate eligibility assessments during the application process.

Strategies for Qualifying for Medicaid with Excess Income

For Long Island residents who have income slightly above the Medicaid income limits, it is still possible to maintain eligibility. There are strategies available to help qualify for Medicaid through the Excess Income Program, commonly known as the Medicaid “spend down.” This program allows individuals to “spend down” their excess income on medical expenses to meet the income eligibility requirements for Medicaid.

Medicaid Spend Down (Excess Income Program)

Excess income refers to the amount of income that exceeds the Medicaid income limits. When a medically-needy individual has excess income, they are required to pay a portion of their medical expenses, known as the “share of cost,” before Medicaid coverage begins. The share of cost works similarly to a deductible, where the individual is responsible for paying a certain amount of medical expenses out of pocket each month.

Calculating Share of Cost

The share of cost is calculated based on the difference between an individual’s income and the Medicaid income limits for their household size. The specific formula varies by state, including New York, and is subject to change annually. Understanding how to calculate the share of cost accurately is crucial for individuals hoping to qualify for Medicaid through the Excess Income Program.

Utilizing Medical Expenses to Meet Share of Cost

One of the key strategies for qualifying for Medicaid with excess income is to strategically use medical expenses to meet the share of cost. By paying for medical services and expenses out of pocket, individuals can effectively reduce their countable income, bringing it below the Medicaid income limits.

Some eligible medical expenses that can be used to meet the share of cost include doctor’s visits, prescription medications, hospital stays, and long-term care services. Additionally, certain home care services and medical equipment may also be used to offset the share of cost.

It’s essential for Long Island residents considering the Excess Income Program to keep detailed records of their medical expenses and consult with a Medicaid planning attorney. A legal professional can help individuals navigate the complex process, maximize the use of eligible medical expenses, and ensure compliance with New York’s Medicaid regulations.

Strategically utilizing the Excess Income Program can help individuals with slightly higher incomes to still qualify for Medicaid coverage and gain access to the vital healthcare services they need. However, it’s crucial to understand the rules and seek professional guidance to ensure a smooth and successful application process.

Pooled Income Trusts

Pooled Income Trusts are valuable financial tools that can assist Long Island residents in meeting Medicaid’s income requirements while still accessing essential benefits. These trusts are designed to help individuals with excess income, who would otherwise be ineligible for Medicaid due to income limits, become eligible by “pooling” their income with that of other trust participants.

Under the structure of a Pooled Income Trust, a non-profit organization acts as the trustee. The individual (the trust “grantor”) deposits their excess income into the trust account. The trustee then manages and combines these funds with the contributions of other trust beneficiaries.

Benefits and Considerations

The main benefits of Pooled Income Trusts include:

  • Medicaid Eligibility: By placing excess income into the trust, individuals can reduce their countable income, potentially meeting Medicaid’s income limits and qualifying for benefits.
  • Protection of Funds: Pooled Income Trusts are managed by professional trustees, providing an added layer of protection for the grantor’s funds.
  • Community Medicaid: Pooled Income Trusts are especially useful for individuals seeking Medicaid coverage for home and community-based services, as the excess income reduction allows them to qualify for Community Medicaid.

However, there are some considerations to keep in mind:

  • Medicaid Estate Recovery: After the grantor’s passing, any remaining funds in the trust may be used to reimburse Medicaid for the cost of care received during their lifetime. 
  • Joining Fees and Administrative Costs: Pooled Income Trusts may charge fees for joining and administering the trust, which can vary depending on the organization.

Qualified Income Trusts (Miller Trusts)

Qualified Income Trusts, commonly known as Miller Trusts, are another essential tool for Long Island residents to qualify for Medicaid when their income exceeds the Medicaid income limits. They are specifically designed for individuals who require nursing home care or other long-term care services.

The primary purpose of a Miller Trust is to act as a “filter” for the individual’s income. Instead of the income being paid directly to the nursing home or care facility, it is deposited into the trust account. Once the funds are in the trust, they are no longer counted as income for Medicaid eligibility purposes.

Establishing a Miller Trust

To establish a Miller Trust, the individual must work with a qualified attorney to create the trust document and select a trustee. The trustee can be a family member, a friend, or a professional trustee. Once the trust is set up, the individual’s income is deposited into the trust account each month.

The funds in the trust are then used to pay for the individual’s share of cost (discussed under the Excess Income Program) and other allowed expenses. By effectively reducing the individual’s countable income, Miller Trusts can help them qualify for Medicaid coverage for long-term care services.

It’s important to note that Miller Trusts must comply with strict legal requirements, and any remaining funds in the trust after the individual’s passing may be subject to Medicaid payback.

Seeking guidance from a Medicaid planning attorney is crucial when considering Pooled Income Trusts or Miller Trusts. These professionals can help individuals understand the intricacies of each trust, choose the most appropriate option for their situation, and navigate the legal complexities to ensure compliance with New York’s Medicaid rules.

Planning for Medicaid Long-Term Care

When it comes to Medicaid long-term care in New York, strategic planning is essential to ensure that individuals can access the necessary services while protecting their assets and financial well-being. There are two main approaches to Medicaid planning: proactive Medicaid planning and crisis planning.

Medicaid Planning vs. Crisis Planning

Medicaid planning involves taking proactive steps to structure assets and income in a way that meets Medicaid eligibility requirements while preserving assets for the individual and their family. This approach is best implemented well in advance of needing long-term care services. By engaging in Medicaid planning early on, individuals can strategically reorganize their finances and investments to maximize eligibility for Medicaid benefits.

Crisis planning, on the other hand, occurs when an individual or their family is confronted with an immediate need for long-term care and has not engaged in prior Medicaid planning. This often arises when a loved one requires urgent nursing home care, and the cost of care threatens to deplete their savings. Crisis planning involves taking swift action to protect as many assets as legally possible while ensuring the individual can qualify for Medicaid benefits as quickly as possible.

Asset Protection Strategies

Asset protection strategies play a significant role in Medicaid long-term care planning, whether through proactive Medicaid planning or crisis planning. These strategies aim to safeguard assets from being fully spent on long-term care expenses, allowing individuals to maintain a level of financial security for themselves and their families.

Exempt vs. Non-Exempt Assets

Understanding the distinction between exempt and non-exempt assets is crucial in asset protection planning for Medicaid long-term care.

  • Exempt Assets: Certain assets are considered exempt for Medicaid eligibility purposes. They are not counted towards the individual’s countable assets when determining Medicaid eligibility. Examples of exempt assets may include the individual’s primary residence, household items, one vehicle, and specific burial arrangements.
  • Non-Exempt Assets: Non-exempt assets are those that are countable and may affect Medicaid eligibility. This includes cash, investments, additional real estate properties, and other valuable assets.

Proactive Medicaid planning involves structuring non-exempt assets strategically to reduce countable assets and qualify for Medicaid coverage.

Transfers of Assets and Look-Back Period

Asset transfers and the associated look-back period are significant considerations in Medicaid long-term care planning.

  • Transfers of Assets: Transferring assets, such as gifting assets to family members or setting up trusts, can be a viable strategy in Medicaid planning. However, Medicaid rules impose restrictions on the timing and value of such transfers to prevent individuals from giving away assets solely to qualify for Medicaid.
  • Look-Back Period: Medicaid imposes a “look-back” period, which is a specific duration during which asset transfers are reviewed. In New York, the look-back period is typically five years. Any asset transfers made within this period may result in a penalty period during which the individual is ineligible for Medicaid.

Long-Term Care Insurance Options

Long-term care insurance is a valuable option for Long Island residents seeking to plan for their future healthcare needs. This type of insurance provides coverage for a range of long-term care services, including nursing home care, assisted living, and home care. Understanding the available long-term care insurance options can help individuals make informed decisions about their healthcare planning.

There are various long-term care insurance policies with different coverage levels, benefit periods, and premium costs. When considering long-term care insurance, individuals should carefully review the policy details, including coverage limits, waiting periods, and any restrictions or exclusions. Working with an experienced insurance agent can be beneficial in finding a policy that suits individual needs and financial capabilities.

Investing in long-term care insurance can provide financial security and peace of mind, knowing that potential long-term care expenses are covered, allowing individuals to maintain control over their assets and avoid significant financial strain in the event of needing long-term care services.

Common Mistakes to Avoid in Medicaid Applications

Applying for Medicaid can be a complex process, and even minor errors can lead to significant delays or denials of benefits. To increase the chances of a successful Medicaid application, Long Island residents should be aware of common mistakes to avoid.

Incomplete or Inaccurate Information

One of the most critical mistakes applicants can make is submitting incomplete or inaccurate information on their Medicaid application. Missing or providing incorrect details about income, assets, or personal information can lead to delays in processing the application or even result in a denial of benefits. It is essential to thoroughly review the application and ensure that all required information is provided accurately.

Improper Asset Transfers

Transferring assets improperly or without considering the Medicaid look-back period can have serious consequences for Medicaid eligibility. Medicaid rules have strict guidelines regarding asset transfers, and gifting assets or transferring them at undervalued prices to qualify for Medicaid is not allowed. Such transfers can trigger penalty periods during which the applicant will be ineligible for Medicaid coverage.

Failure to Consider Look-Back Period

The Medicaid look-back period is a critical factor that applicants must consider before applying for benefits. This period, which is typically five years in New York, reviews any asset transfers made during that time. If improper transfers are identified, the applicant may face a penalty period, delaying their eligibility for Medicaid. Proper planning for the look-back period is essential to avoid such penalties.

Not Seeking Professional Guidance

Applying for Medicaid can be overwhelming, especially for those unfamiliar with the process and eligibility requirements. Not seeking professional guidance from Medicaid planning attorneys can lead to mistakes and oversights that could impact the application’s success. Consulting with an experienced attorney can help applicants understand eligibility criteria, navigate complex rules, and ensure that their application is well-prepared and compliant.

Missing Application Deadlines

Medicaid applications have specific deadlines that must be adhered to for successful submission. Missing application deadlines can lead to delays in benefits or the need to reapply altogether. Applicants must be aware of the application deadlines and submit all required documents promptly.

Long Island residents can streamline the Medicaid application process and improve their chances of qualifying for essential healthcare coverage by avoiding these common mistakes and seeking professional assistance. Medicaid planning attorneys can guide applicants through the complexities of the application, help with asset protection strategies, and ensure that all necessary information is provided accurately and on time.

Common Mistakes to Avoid in Medicaid Applications Description
Incomplete or Inaccurate Information Submitting incomplete or inaccurate information on the application can lead to delays or denials of benefits. Review thoroughly.
Improper Asset Transfers Improperly transferring assets or ignoring the look-back period can affect eligibility. Avoid gifting assets to qualify for Medicaid.
Failure to Consider Look-Back Period Not accounting for the look-back period may lead to penalty periods. Plan accordingly.
Not Seeking Professional Guidance Seek help from Medicaid planning attorneys to navigate complex rules and ensure compliance.
Missing Application Deadlines Adhere to application deadlines to avoid delays or the need to reapply. Submit all documents promptly.

Working with a Medicaid Planning Attorney

Navigating Medicaid rules and planning for long-term care can be complex and overwhelming for many individuals and families. Working with a Medicaid planning attorney can be instrumental in creating a comprehensive and effective Medicaid plan that aligns with individual circumstances and goals.

At Schlessel Law PLLC, experienced Long Island Medicaid planning attorney Seth Schlessel has helped Long Island residents have the confidence that their long-term care and Medicaid planning are well-structured, legally sound, and aligned with their best interests. We can assist you in maintaining Medicaid eligibility by conducting a comprehensive evaluation of your circumstances and providing options to effectively protect your assets, access essential healthcare services, and secure your financial future. Schedule a consultation with skilled Long Island attorney Seth Schlessel today. Contact us at (516) 574-9630 to explore your Medicaid planning options.

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