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Income and Resource Limits for New York State Public Health Insurance Programs
INTRODUCTION AND NEWS ALERTS Feb. 13, 2026 UPDATE - NYS DOH announced the 2026 limits are in effect for Medicaid GIS 26 MA/05 - 2026 Federal Poverty Levels (PDF) GIS 26 MA/05 - 2026 Federal Poverty Levels Chart Since Jan. 1, 2023, the income limit for the Aged, Blind and...
KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind
This Fact Sheet (updated 03/12/2026 with 2026 figures) explains Medicaid financial eligibility for New Yorkers who are age 65+ or who have disabilities. This category is also called "Non-MAGI" Medicaid, as opposed to "MAGI MEDICAID" which is for children and adults under 65 who do not have...
Know Your Rights: NYLAG Trainings on Medicare, Medicaid, and Home Care
The Evelyn Frank Legal Resources Program (EFLRP) regularly hosts trainings (via webinars and other presentations) that provide tools for the public to understand and navigate the complex world of Medicare and Medicaid in New York. Some of these trainings are via the NYLAG webinar account, and...
How to use funeral planning to become eligible for Medicaid (updated fact sheet - 2015)
Download Fact Sheet on Pre-Paid Funeral Planning as Method to Qualify for Medicaid in New York State BACKGROUND: One common reason why people are ineligible for Medicaid or SSI is if their assets are over the resource limit. Rather than give money away to make yourself eligible, which can cause...
Medicaid Spend-Down
Because Medicaid is a health insurance program for the poor, one must have income and assets below a certain limit to be eligible. For a single elderly or disabled person in New York State in 2026, the income limit is $1836/mo. of income. (after subtracting $20/mo disregard) (The income limits for...
What You Need to Know About Medicaid Spenddowns
By the Legal Aid Society A Medicaid spenddown is when your monthly income is more than the income limit for Medicaid. The difference between your income and the Medicaid limit is called a “spenddown” or a “surplus.” You also might be told you are “over-income” for Medicaid or have “excess...
Medicaid Spend-down: NYC Medicaid Now Accepts FAXED Medical Bills
In May 2009, the NYC Medicaid Program announced a pilot program that allows consumers who must "spend down" to qualify for Medicaid to fax their medical bills each month to the Medicaid Centralized Surplus Unit. See announcement. You can download the official Spend-down fax cover sheet with the...
The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) expands eligibility for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. The income...
Special Medicaid Income Rules That May Eliminate "Spend-down" or "Surplus Income" for Age 65+, Disabled or Blind
Introduction Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting used for people age 65+,...
Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan
A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...
Spousal Impoverishment Protections for Married Couples - If One Spouse is in MLTC, Waiver or Immediate Need - Can use Pooled Trust
In this Article KNOW YOUR RIGHTS: Download Consumer Fact Sheet on Tips for Keeping More Income, including Spousal Impoverishment Protections.: What are Spousal Impoverishment Rules? Which Married couples can Use Spousal Impoverishment Protections? Spousal Impoverishment...
2026 UPDATE: Elimination of Requirement to Apply for Social Security and Maximize Other Benefits for Medicaid & MSP
As of December 23, 2025, Medicaid and Medicare Savings Program (MSP) applicants and recipients are no longer required to pursue potentially available income, including Social Security and IRA distributions, as a condition of receiving Medicaid and MSP. This is from an amendment to federal Medicaid...
Maintaining Community Medicaid Budgeting and SSI Benefits During Temporary Nursing Home Stays
Many Medicaid recipients are admitted to nursing homes but plan to return to their homes in their community. Financially, they need to maintain income so that they can continue to pay rent, utility, and other living expenses to preserve their apartment or home for their return. However, both...
Medicaid Renewals/Recertifications in NYC- Medicaid can be DISCONTINUED if RENEWAL not returned - Starting April 2025
INTRODUCTION and NEWS UPDATES This article explains the annual procedure to RENEW MEDICAID for people whose Medicaid is administered by the NYC Human Resources Administration (HRA). For those living in different NYS counties outside NYC, whose Medicaid is administered by the Local Department of...
Medicare Insurance Premium Payment Program (MIPP)
Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $202.90 in 2026. MIPP is for some groups who...
Holocaust or Nazi Victim Reparations -- Effect on Medicaid, SSI and other Federally Funded and New York State Benefits
Under a 1994 federal law, (h.r. 1873 or public law 103-286), known as the Victims of Nazi Persecution Act of 1994, Holocaust compensation payments made to individuals based on their status as victims of Nazi persecution are excluded from being counted as income and resources in determining both...
Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections
Medicaid rules are different for people living in the "community" than people living in institutions. For this article, the word "institution" means nursing home care. If you live in your home, someone else's home, or an Assisted Living Program, you are considered to live in the "community." ...
New York Medicaid Expansion 2023 - Increased Income Limits for Aged, Blind & Disabled
Know Your Rights: What You Need to Know About NYS Medicaid Expansion in 2023 This year’s Health Budget makes significant changes to New York’s Medicaid program – expanding eligibility to 138% of the federal poverty law (FPL) and changing budgeting rules and enrollment processes for Medicaid and...
Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
The Deficit Reduction Act of 2005 (DRA, enacted in 2006, made major changes to the transfer penalty rules for eligibility for Medicaid to pay for nursing home care. At the time, and until now, nursing home care was the only Medicaid service that had a lookback and transfer penalty.See GIS 06...
Advocacy to Improve the Medicaid Spend-down Program in New York State
In May 2009, the New York State Health Foundation issued a report titled Streamlining New York's Excess Income Program, written by Manatt Health Solutions. The report presents a clear picture of the daunting complexity of the Excess Income or “spend-down” program. This program makes Medicaid...
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