Medicaid Frequently Asked Questions
It is a health insurance program that pays for medical and OPWDD services.
Medicaid is a needs-based program with income and resource limits but not all income “counts”. Medicaid is automatic for SSI recipients in NYS.
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
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
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.
You may qualify for continuing SSI in a non-pay status known as 1619B which will provide you with continuing Medicaid coverage.
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.
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