Medicaid is federally and state-subsidized health insurance for eligible, low-income adults, children and pregnant woman, as well as elderly adults and people with disabilities. It is administered by each state according to federal requirements. New York’s Medicaid, believe it or not, provides some of the broadest coverage to individuals compared to other states, and in 2023, the updated budget will continue to recognize New Yorkers’ need to retain more assets and income while still benefiting from some public assistance for health benefits through Medicaid. The following are some highlights of benefits that will further expand for NY Medicaid effective January 1, 2023[1]:
- Increased Income[2] Levels – We will see a raise in the allowable amounts for Medicaid income eligibility level from 100% to 138% of the Federal Poverty Level Income:
- Individuals – Will increase from $934.00 monthly in 2022 to an estimated $1,563.00 monthly allowance in 2023.
- Couples – Will increase from $1,367.00 monthly in 2022 to an estimated $2,106.00 monthly allowance in 2023.
- Increased Asset[3] Limits – Allowable asset maximum limits will increase for Community Medicaid Long Term Care recipients by 50% in 2023:
- Individuals – From $16,800.00 in 2022 to an estimated $28,134.00 in 2023.
- Couples – From $24,600.00 (combined) in 2022 to an estimated $37,908.00 (combined).
Additionally, since the country’s Public Health Emergency status currently continues through at least April 15, 2023, federal laws continue to prohibit any changes to current Medicaid beneficiaries’ benefits[4]. This means the ban on terminating or reducing Medicaid continues through (at least) April 2023. In sum, NYS’ attempted implementation of a “lookback” for community Medicaid benefits that was supposed to become effective January 1, 2021, has now been postponed until March 31, 2024, at the earliest.[5] With every benefit generally comes a challenge or two. For NYS’ Community Medicaid, this has been the newly implemented changes to medical eligibility determinations, following the assets and income eligibility determinations. Applicants now must complete two (instead of one) medical assessments through the NY Independent Assessor contractor (formerly Maximus) in addition to long term care insurance company assessments. These new assessments have tended to ultimately result in concerningly reduced care hour awards for community Medicaid recipients without advocacy support.
If your eyes have glazed over trying to fully digest all in this update, the take-away we encourage is this: do not try to independently navigate the complex and constantly changing arena of Medicaid eligibility on your own. If you or your loved one wants to plan ahead for or immediately needs financial assistance to planning or paying immediately for needed nursing or home care, call Kiley, Kiley & Kiley to help you. Associate Attorney, Mary Beth Heiskell can’t wait to help you address your unique needs and goals around Medicaid eligibility, and our firms’ over 30 years of estates and trusts planning is also here to further assist. Just call us!
Citations:
[1] This move to expand Medicaid eligibility is a result of the NYS Legislature and Governor reaching an agreement on the 2023 Fiscal Budget on April 8, 2022.
[2] Sources of income generally include social security, retirement account distributions, pension, income payable from a trust, and rental income.
[3] Assets generally include checking and savings accounts (including CD’s), non-qualified annuities, individual stocks, real estate (excepting one’s primary residence), and cash surrender value of life insurance. Tax-deferred retirement accounts, and traditional IRAs and 401ks, in payout status are generally not included as assets.
[4] See: https://health.ny.gov/health_care/medicaid/redesign/mrt2/proposals/30-month_lookback-final.htm. See also: Maintenance of Effort requirements under Section 6008(b)(1) of the Families First Coronavirus Response Act (FFCRA), and the requirements for Home and Community Based Services under the American Rescue Plan Act.
[5] Note: Nursing Home Medicaid continues to have a 60-month (or 5-year) lookback of all gifted asset transfers.