Qualifications for Medicaid in New York

New York Medicaid eligibility requirements have expanded to accommodate a variety of patients, totaling more than 6 million covered in June 2016, alone. Thanks to Medicaid benefits eligibility expansion, uninsured rates in NY have significantly fallen. Adults with incomes up to 138 percent of the Federal Poverty Level (FPL) are encouraged to review how to qualify for Medicaid. But, exactly what are the requirements for Medicaid in New York?

In order to understand who is eligible for Medicaid in New York, review the below topics, which are covered in detail:

  • Who is eligible for New York Medicaid?

  • What are the income requirements for Medicaid?

  • What are the Medicaid eligibility requirements in New York?

  • What are the Medicaid application guidelines?

Who is eligible for New York Medicaid?

New York Medicaid eligibility determination is based on several factors developed by the state department. Medicaid benefits eligibility applies to those who cannot pay their medical bills, those who currently receive Supplemental Security Income (SSI) and those who meet the Medicaid income requirements in New York.

Before Medicaid requirements can be met, Medicaid-eligible applicants must first fall into one of the two following categories:

  1. Adults with an income that is no more than 138 percent of the Federal Poverty Level (FPL)

  2. Infants and pregnant women with an income that is no more than 218 percent of the FPL

To decide on if you are eligible for Medicaid in New York, the state strictly adheres to a specific system. The Modified Adjusted Gross Income (MAGI) is the sole strategy in reading if you qualify for Medicaid in New York or not. A simple way to understand Medicaid qualifications in NY, MAGI is utilized for the calculation of a single set of income eligibility rules across the entire health care Marketplace.

What are the income requirements for Medicaid?

Medicaid income requirements are based on resource levels in the state. Income requirements for Medicaid differ for those whole are blind, disabled or above age 65, in comparison to single individuals and couples without children. In addition, your assets are taken into account. When it comes to bypassing the financial Medicaid requirements, you can only report more money than the state allows if you are a child, disabled or blind, above 65 or pregnant.

Some patients who want to be accepted for Medicaid benefits eligibility in NY will already have a pre-existing condition or a disability. The Medicaid Buy-In Program was designed for people in New York with incomes higher than the standard threshold who are still in employment. Vital healthcare insurance coverage can be retained when a person learns how to qualify for Medicaid in this program. In order to qualify into the Medicaid Buy-In Program, you must be a New York state resident, be at least 16 years old, have a gross income of $60,420 to $81,132, be employed on a part-time or full-time basis and have a Social Security Administration-defined disability.

What are the requirements for Medicaid in New York for the disabled? Disabilities must be confirmed by the Social Security Administration (SSA) and depending on income, a premium might be necessary. Getting in touch with the local Department of Social Services in New York is the best way to find out how to qualify for NY Medicaid Buy-In benefits.

What are the Medicaid eligibility requirements in New York?

When reviewing how to qualify for Medicaid in New York, there are factors beyond your income and the size of your household that are considered. And, these Medicaid qualifications are non-negotiable with the state. To qualify for Medicaid in NY, you must have several required items. You will need to have handy: proofs of United States citizenship and New York state residency, support of your current living arrangements, information regarding your marital status (such as marriage license), if applicable and your Social Security Number (SSN).

What are the Medicaid application guidelines?

Application guidelines for Medicaid in New York differ from other states, as you must adhere to specific instructions when submitting your paperwork. Since the qualifying criteria is spread into two groups – MAGI eligibility groups and non-MAGI eligibility groups, you must follow suit depending on the category in which you fall. Now that you understand income requirements for Medicaid, you can familiarize yourself with both eligibility groups.

What are the Medicaid application guidelines in NY for the MAGI groups? Categorized into the first group are foster care children, infants and children under 19, pregnant women, relatives of parents or caretakers, and beneficiaries in the Family Planning Benefit Program (FPBP).

A new adult group also falls into the MAGI eligibility groups. This group contains those eligible for Medicaid who are adults without dependents, including beneficiaries that:

  • Are age 19 to 64

  • Are not pregnant

  • Are potentially certified disabled

  • Lack Medicare and therefore require Medicaid

If you belong to any of the above groups, the state department requests that you apply for Medicaid through the New York State Department of Health Marketplace, when the time comes.

Non-MAGI eligibility requirements for Medicaid include recipients of:

  • Medicare Savings Program (MSP)

  • ADC-related Medically Needy

  • Social Security Income (SSI)

  • AIDS Health Insurance Program (AHIP)

  • Medicaid Cancer Treatment Program (MCTP)

Those who belong to non-MAGI groups should proceed with Medicaid application procedures at their Local Department of Social Services offices.

To learn more about Medicaid application guidelines and procedures, review the “How to Apply for Medicaid in New York” page.



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