New York Medicaid Eligibility and Enrollment

Older adults who struggle to pay for medical expenses may be eligible for Medicaid in New York. As of August 2020, New York has more than 7.8 million people enrolled in Medicaid and CHIP who are receiving assistance with their health care costs. The programs help a wide range of people, including children, pregnant women, disabled people and older adults. People aged 65 or older can access a range of programs designed to assist them as they age. 

What Is New York Medicaid?

Medicaid in New York is a joint state and federal program designed to help low-income residents receive medical care. New York has regular Medicaid, which covers general medical expenses and provides long-term care and support to qualified individuals. Through waivers and specific programs, older adults can get assistance paying for nursing home care, assisted living and a variety of services to help them age in place.

What Does New York Medicaid Cover?

New York Medicaid beneficiaries have coverage for a full range of health services. Eligible people can use Medicaid for regular medical checkup and follow-ups, emergency care, emergency ambulance transport and hospital stays. Other benefits include dental and eye care, lab tests and X-rays. New York Medicaid can also help pay for prescription medicine, medical supplies and medical equipment, such as wheelchairs. 

Older adults may be eligible for additional benefits, depending on their circumstances. These can include personal care, home health care, nursing home care and home or vehicle modifications. New York’s Assisted Living Program also helps beneficiaries pay for care in an assisted living facility. 

Who Is Eligible for Medicaid in New York?

New York Medicaid is available to help a wide range of adults access health care. To be eligible for the program, applicants must meet certain eligibility criteria, based around their finances, residency and citizenship status. Some programs, such waiver programs, may have additional criteria. For example, applicants may need to be assessed as requiring a certain level of care.

Financial Eligibility

The financial eligibility criteria for New York Medicaid are the same, whether an individual is applying for regular Medicaid, waivers or nursing home Medicaid. For single applicants, the income limit is $18,984 annually and the asset limit is $15,750. For married couples, the income limit rises to $25,636 per year and the asset limit is $23,100. 

When just one spouse of a married couple is applying for regular Medicaid, the income and asset limits are the same as any other married couple. However, when only one spouse is applying for a waiver or nursing home coverage, the income limit reverts to $1,677 and the asset limit is $30,182. Both of these figures are for the applicant, and the non-applicant spouse can retain $148,620 worth of assets. 

The income limit includes all income the applicant receives, including Social Security income; however, some assets are not included in calculations. Countable assets, also called resources, include stocks, cash, investments and vacation properties. Belongings not counted as part of the asset limit include burial funds, household furnishings and a vehicle. A house is not counted as an asset if it’s the applicant's primary place of residence or if their spouse still lives there. 

As indicated above, the non-applicant spouse can keep some assets to ensure they have enough resources to live on. This is known as the Community Spouse Resource Allowance (CRSA), and it allows the non-applicant spouse to keep half the couple’s joint assets, up to $148,620. If the couple has limited assets, CRSA allows the non-applicant spouse to keep all of the joint assets up to $74,820. 

New York residents may still be eligible for Medicaid, even if they have an income that’s higher than the limit. In particular, New York has the Medicaid Excess Income Program, which helps people with high medical expenses access Medicaid. In this program, excess income is used to pay for medical expenses such as prescription drugs and doctor’s visits. Once their income reaches the Medicaid eligibility limit, they’re eligible for Medicaid for the rest of the month. 

This program doesn’t help applicants meet the asset limit, but there are ways of spending this down as well. Excess assets may be spent on specific expenses, including past due medical bills, home modifications or a mortgage. It’s best to discuss these options with the Medicaid office or a Medicaid planner to ensure no rules are broken. 

Older adults should also be aware that Medicaid may recover the costs of their care. The department is able to take the costs from assets in a person's estate upon their death. The extent of costs that can be recovered differs based on the exact program a person is enrolled in.

Other Eligibility Criteria

People aged 65 and older are able to access the Aged, Blind and Disabled program. There are no further eligibility criteria for this program besides the age and income limits. People applying for nursing home assistance must be assessed as requiring a nursing home level of care. 

Older adults applying for Medicaid waiver programs have to require a certain level of care. There may be slight differences between each program, but in general, the benchmark is that they require assistance with at least two activities of daily living. Some of these waivers may have additional requirements; for example, the Community First Choice Option requires that beneficiaries still be living at home or in the home of a relative. 

How Do I Enroll in Medicaid in New York?

Older adults can apply for Medicaid in New York by writing, phoning or visiting their local department of social services. In addition, residents of New York City can contact the Human Resources administration at (718) 557-1399 to apply. Generally, applications take around 45 days to process. It may take longer for people who need to have their medical needs assessed, such as those seeking nursing home coverage. 

Contact Information for New York Medicaid

The best way for older adults to get more information about Medicaid in New York and their eligibility is through their local department of social services. Alternatively, the number of the Medicaid Helpline is 1-800-541-2831.