Many Medicaid recipients who are 65+, and/or who have a disability and receive Medicare, will now be able to have higher income and more resources while still qualifying for Medicaid.
Medicaid recipients who are 65 and over, and/or who have a disability and receive Medicare, receive Medicaid through the Local District of Social Services (LDSS). In New York City the LDSS is the New York City Human Resources Administration (NYC HRA). This population is also referred to as DAB (Disabled, Aged, and Blind), ABD (Aged, Blind, and Disabled), non-MAGI, SSI-related, or Medically-Needy. Until now, many Medicaid recipients became ineligible for Medicaid once they began to receive Medicare because they suddenly had different income eligibility requirements and new resource limits. Now, with these changes, their resource limits have been raised, and the income eligibility limit is equal across most groups of Medicaid recipients, including those under and over 65, as well as those with or without Medicare.
In addition, many Medicaid recipients who now have a spenddown, or Excess Income, will no longer have a spenddown or will have a much lower one. The spenddown program means that you need to pay-in to get Medicaid or submit bills to activate your Medicaid.
Medicaid recipients can now receive more income. Starting January 1, 2023, the income limit for the DAB population will increase from $924 to $1,563 for an individual, and from $1,367 to $2,106 for a couple. These levels are expected to get a little higher again in March 2023.
Medicaid recipients can have more resources. Starting January 1, 2023, the resource limit for the DAB population will increase from $16,800 to $28,133 for an individual, and $24,600 to 37,902 for a couple.
Starting January 1, 2023, the resource limit for the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) population will increase from $20,000 to $28,133 for an individual and $30,000 to $37,902 for a couple. The monthly income limits for this program remain the same ($2,832 for an individual and $3,815 for a couple). These income limits are already higher than the regular Medicaid income limits.
The Medicare Savings Program, a state-run Medicaid program that pays the Part B Medicare premiums and sometimes other costs for low-income individuals, will also see improvement. Starting January 1, there will only be two MSP programs, Qualified Medicare Beneficiary (QMB) and Qualifying Individuals (QI). There will no longer be a Specified Low-Income Medicare Beneficiary (SLMB) program. SLMB recipients will now be included in the QMB program. QMB is a more generous program – it will pay for a recipient’s Part B premium and will also provide coverage for all Medicare cost-sharing such as co-pays, deductibles, and co-insurance.
MSP recipients can now receive more income. Starting January 1, 2023, the income eligibility limit for QMB will increase from $1,153 to $1,563 for an individual and $1,546 to $2,106 for a couple. The income limit for QI will increase from $1,549 to $2,107 for an individual and $2,080 to $2,839 for a couple. These levels are expected to get a little higher again in March 2023.
If you are a current Medicaid recipient and have a spenddown you should have received a letter in December 2022 from the Department of Health letting you know that you may now qualify for Medicaid without a spenddown or with a smaller spenddown. If you live in NYC and your Medicaid is administered through HRA, you will also receive a letter from HRA.
If you want your spenddown to decrease as soon as possible, you can ask your LDSS (HRA in NYC) to review your budget after January 1, 2023. You will need to provide your current gross income and any deductions you may have (such as for health insurance premiums, etc.). HRA will be mailing an attestation form directly to spenddown recipients where they can include this information. No proof of income is necessary. Forms should be sent back with the pre-addressed envelopes provided by HRA. Mailing back the pre-addressed envelope is the best way to have your budget reviewed. But, if you misplace this envelope, you can still send in the form. If you do not receive home care, you can fax the documents to 917-639-0645 or bring it to a community office. If you do receive home care, you should mail the form to: HRA/HCSP, 785 Atlantic Ave., 7th Floor. Brooklyn, NY 11238 or drop it off at Window 16 at 785 Atlantic Ave., Brooklyn.
*For those in New York City, the best way to have your budget adjusted is to fill out the form that HRA sends and mail it back right away.
Otherwise, if you do nothing, your Medicaid budget will be adjusted during your normal renewal period. Since we are still in the federal Public Health Emergency and Medicaid cases are being automatically extended, we do not know when renewals will restart and when that budget adjustment will take place.
*Now is a good time to make sure HRA has your updated mailing address and contact information. You can do this by calling 718-557-1399 or updating your ACCESS HRA profile.
If you are not a Medicaid recipient, but think you may now be eligible submit a Medicaid application, along with a Supplement A form, to be considered for Medicaid. As of January, these will be processed using the new income and resource limits.
The spenddown program will still exist for those with “excess income” above the new income limits.
Supplemental Needs Trusts (SNTs)
Pooled trusts are still an option for those with income above the new limits who will be told they have a spenddown. If your spenddown decreased due to the new income limits, you can alert your trust to the decrease, and arrange to contribute less each month.
What if you no longer have a spenddown and want to stop contributing to your pooled trust?
You can stop contributing to a pooled trust at any time. If you have remaining funds in the trust you can continue to spend them down. However, the pooled trust will remain in existence even if you do not make any future contributions. Pooled trusts terminate when the beneficiary dies. We advise you to call your trust organization if you intend to stop contributing to see what best practices they recommend.
If you are a current MSP recipient who is in SLMB or QI you will receive a letter in December 2022 from the Department of Health letting you know that you may now qualify for the QMB MSP program, as well as Medicaid.
If you want to benefit from these changes as soon as possible, you must submit a new MSP application that will be processed using the new eligibility guidelines. You may also submit a Medicaid application, along with a Supplement A form, if you also want to be considered for Medicaid. As of January, these will be processed using the new income and resource limits.
Otherwise, if you do nothing, your MSP budget will be adjusted during your normal renewal period. Since we are still in the federal Public Health Emergency and MSP cases are being automatically extended, we do not know when renewals will restart and when that budget adjustment will take place.
You may now be eligible for both MSP and Medicaid, even if you were not in the past. We encourage you to apply for both Medicaid (including the Supplement A form) and the MSP program.
For more information, or for assistance with your individual case, you may call The Legal Aid Society’s Access to Benefits helpline at 888-663-6880.
The information in this document has been prepared by The Legal Aid Society for informational purposes only and is not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. You should not act upon any information without retaining professional legal counsel.
Last Updated: 23 December 2022
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