Does Spouse Qualify for Family in Essentials Plan 1 in Nys

NYS updated the non-MAGI Medicaid levels for 2022 with GIS 21 MA/25  and Attachment I  on Dec. 28, 2021.

Because the Federal Poverty Levels for 2022 have not been appear,  the 2021 FPL limits will still be used for MAGI, the Medicare Savings Programs, MBI-WPD and other Medicaid programs that use the FPLs.  See  GIS 21 MA/06 -with the  2021 Federal Poverty Levels  (Apr 2021)

• Zipper I ( MAGI & non-MAGI limits  for Aged, Blind & Disabled - not-MAGI)
• Attachment II   non-MAGI levels  (this is now partly replaced by the 2022 GIS)
• Attachment 3 (PDF)   MAGI levels for 2021
• Zipper IV  (PDF) MAGI levels for 2021

• Zipper Five (PDF)  PICKLE reduction factors - come across more about Pickle hither

The 2022HRA Income and Resources Level Chart   is now updated for 2022 but it still has 2021 Federal Poverty Levels

	Non-MAGI  - 2022 Disabled, 65+ or  Bullheaded  ("DAB" or SSI-Related) and take Medicare		MAGI (2021)* (< 65, Does not have Medicare)(OR has Medicare and has dependent kid < 18 or < xix in school) 138% FPL*** Children < 5 and pregnant women have College LIMITS than shown			ESSENTIAL Program (2021)* For MAGI-eligible people over MAGI income limit up to 200% FPL No long term intendance. See info here
	1	two	1	ii	3	1	2
Income	$934 (up from $884 in 2021) add together $20 for standard deduction	$1367 (up from $1,300 in 2021) add $xx for standard deduction	$1,482	$2,004	$2,526	$2,146	$2,903
Resources	$xvi,800(upwardly from $15,900 in 2021)	$24,600 (up from $23,400 in 2020)	NO LIMIT**			NO LIMIT

* MAGI and ESSENTIAL program levels are based on Federal Poverty Levels, which are non released until afterwards in 2022.  2021 levels are used until then.

COVID-nineteen Annotation -Because of the ongoing Public Health Emergency, current Medicaid recipients will accept eligibility connected nether their electric current budgets.  Though income for many volition increase in 2022 with the 5.nine% COLA for Social Security, their spend-downwards will non be increased at this time.  Still, when the Public Health Emergency is declared over, probably in 2022, the next renewals will redetermine their elibibility using 2022 income and limits.  See this commodity for tips on renewals.  Note that the 2022  increase in the Medicare Role B premium (($170.10/mo increased from $148.l in 2021 ) will beginning some of the increased Social Security income.

Simply for new applications filed or canonical in 2022, the 2022 limits will be used for non-MAGI.

NEED TO KNOW By MEDICAID INCOME AND RESOURCE LEVELS?

• See income levels for by years from 2001  through 2020 here.

WHAT IS THE HOUSEHOLD SIZE? Encounter rules here.

HOW TO READ THE  HRA Medicaid Levels chart -

• Boxes 1 and 2 are Not-MAGI Income and Resource levels -- Age 65+, Bullheaded or Disabled and other adults who need to use "spend-downwards" because they are over the MAGI income levels.
• Box ten on page three are the MAGI income levels -- The Affordable Intendance Act  changed the rules for Medicaid income eligibility for many BUT Not ALL New Yorkers.  People in the "MAGI" category - those Non on Medicare -- acceptexpanded eligibilityup to 138% of theFederal Poverty Line, then may now authorize for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down."   They take NO resource limit.
• Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Intendance & Nursing Homes and Box 8 has the Transfer Punishment rates for nursing home eligibility
• Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65  (still 2017 levels til April 2018)
• Box vi are Medicare Savings Program levels  (will be updated in April 2018)

MAGI INCOME LEVEL of 138% FPL applies to virtually adults who are non disabled and who do not take Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.  42 C.F.R. § 435.four.

  Certain populations have an even college income limit -

• 224% FPL for pregnant women and babies < age i,
• 154% FPL for children age 1 - 19.

• See all income limits on MAPDR-01 HRA income limits chart.

Caution: What is counted every bit income may not be what y'all think.

For the NON-MagazineI Disabled/Anile 65+/Blind, income will however be adamant by the same rules as earlier, explained in this outline  and these charts on income disregards.    However, for the MAGI population  - which is nigh everyone under age 65 who is not on Medicare - their income volition at present be determined under new rules, based on federal income tax concepts - chosen "Modifed Adjusted Gross Income" (MAGI).   In that location are good changes and bad changes.

GOOD: Veteran'south benefits, Workers bounty, and gifts from family or others no longer count as income.

BAD:  There is no more "spousal" or parental refusal for this population (but there however is for the Disabled/Aged/Bullheaded.) and some other rules.  For all of the rules see:

• State's directive xiii ADM-03 - Medicaid Eligibility Changes nether the Affordable Care Act (ACA) of 2010   (PDF)   ,
• PowerPoint by NYLAG on MAGI Budgeting
• Grooming materials by Empire Justice Middle
• Grooming materials by Legal Aid Society
• National Health Police PlanAdvocates Guide to MAGI

Likewise SEE 2018 Transmission on Lump Sums and Affect on Public Benefits - with resource rules 

HOW TO Make up one's mind SIZE OF HOUSEHOLD TO IDENTIFY WHICH INCOME LIMIT APPLIES

The income limits increment with the "household size."  In other words, the income limit for a family of 5 may be higher than the income limit for a single person.  Yet, Medicaid rules most how to calculate the household size are not intuitive or fifty-fifty logical.  There are different rules depending on the "category" of the person seeking Medicaid.     Hither are the 2 basic categories and the rules for calculating their household size.

1. People who are Disabled, Anile 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - Come across this nautical chart for their household size.   These same rules apply to the Medicare Savings Programme, with some exceptions explained in this article.

2. Everyone else -- MAGI - All children and adults under age 65, including  people with disabilities who are not withal on Medicare -- this is the new "MAGI" population.  Their household size volition be adamant using federal income tax rules, which are very complicated.

New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Deed (ACA) of 2010   (PDF)  pp. 8-10 of the PDF,   This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.  See slides 28-49. Also see Legal Help Order and Empire Justice Heart materials

Erstwhile RULE used until end of 2013 --  Count the person(s) applying for Medicaid who live together, plus whatsoever  of their legally responsible relatives who do non receive SNA, ADC, or SSI and reside with an applicant/recipient.   Spouses or legally responsible for ane another, and parents are legally responsible for their children nether age 21  (though if the kid is disabled, use the dominion in the 1st "DAB" category.    Under this rule, a kid may be excluded from the household if that child'due south income causes other family members to lose Medicaid eligibility.    See xviii NYCRR 360-4.ii,  MRG p. 573,  NYS GIS 2000 MA-007

• Circumspection:   Unlike people in the same household may be in different "categories" and hence accept dissimilar household sizes AND  Medicaid income and resources limits.  If a man is historic period 67 and has Medicare and his married woman is historic period 62 and not disabled or bullheaded, the husband's household size for Medicaid is determined nether Category 1/ Non-MAGI above and his married woman'southward is under Category two/MAGI.

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:

• Prenatal Care Assist Program (PCAP) was Medicaid  for pregnant women and children nether age 19, with higher income limits for significant woman and infants under one twelvemonth (200% FPL for pregnant women receiving perinatal coverage only not total Medicaid) than for children ages 1-xviii (133% FPL).

• Medicaid for adults betwixt ages 21-65 who are not disabled and without children nether 21 in the household. Information technology was sometimes known as "Due south/CC" category for Singles and Childless Couples.  This category had lower income limits than DAB/ADC-related, merely had no nugget limits.  It did not allow "spend down" of excess income.  This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.

• Family Health Plus - this was an expansion of Medicaid to families with income upwards to 150% FPL and for childless adults upwards to 100% FPL.  This has now been folded into the new MAGI adult group whose limit is 138% FPL.  For applicants betwixt 138%-150% FPL, they volition be eligible for a new program where Medicaid volition subsidize their purchase of Qualified Wellness Plans on the Exchange.

Past INCOME & Resources LEVELS --

By Medicaid income and resource levels in NYS are shown on these old NYC HRA  charts for 2001 through 2019, in chronological order.    These include Medicaid levels for MAGI and non-MAGI populations, Kid Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS.

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This article was authored by the Evelyn Frank Legal Resources Programme of New York Legal Assistance Grouping.

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Source: http://www.wnylc.com/health/entry/15/

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