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Individuals with special needs in a caring environment

Medicaid Frequently Asked Questions

What is Medicaid?

It is a health insurance program that pays for medical and OPWDD services.

How do I qualify for Medicaid?

Medicaid is a needs-based program with income and resource limits but not all income “counts”. Medicaid is automatic for SSI recipients in NYS.

What are the Medicaid income and resource limits?

Income limits (monthly):

  • Independent living:  $1,677
  • Individualized Residential Alternative (IRA): $1,319/$1,349.00
  • Family Care Home: $1,142.48/$1,180.48

Resource limit:  $30,182.00

How do you determine what income counts?

Calculating countable income: Total income (earned & unearned) – income exemptions = countable income

For example:

Calculating Income

Unearned Income

  • Social Security Disability Insurance $500.00
  • General income disregard ‐ 20.00
  • Countable unearned income $480.00

Earned Income

  • Wages $2,000.00
  • Earned income disregard – 65.00
  • Earned income exclusion (1/2 remainder) ÷ 2
  • Countable earned income $967.50

Total Countable Monthly Income $1,447.50

 

Can I still qualify for Medicaid if I’m over the Medicaid income limit?

There may be other Medicaid programs or continuing eligibility categories that you may qualify for such as Medicaid Surplus pay-in program (Medicaid Spend down), The Medicaid Buy-in for Working People with Disabilities (MBI-WPD), DAC or PICKLE continuing Medicaid eligibility category.  Each of these Medicaid programs and continuing eligibility categories have additional eligibility requirements.

What if I lose SSI eligibility because of my wages?

You may qualify for continuing SSI in a non-pay status known as 1619B which will provide you with continuing Medicaid coverage.

What other programs does Medicaid offer?

There’s also the Medicare Savings program which is a Medicaid-administered program that can assist people with limited income in paying for their Medicare premiums.  You may be eligible as a Qualified Medicare Beneficiary (QMB) or as a Qualifying Individual (QI).  Please note that if you are eligible as a Qualifying Individual then you cannot be eligible for Medicaid as well.

How do you determine if you’re eligible for the Medicare Savings program?

There are income limits for this program.  The income limits are below:

Qualified Medicare Beneficiary (QMB) Income Limit

  • Individual $1,677
  • Couple $2,268

Qualified Individual (QI) Program Income Limit

  • Individual $2,260
  • Couple $3,057