NYS DOH Issues Administrative Directive on Medicaid Eligibility Changes Under the ACA

The Department of Health (DOH) has released an administrative directive to local social services districts explaining changes in Medicaid eligibility rules and processes as a result of the Affordable Care Act (13 OHIP/ADM-03).  Effective Jan. 1, 2014, these changes include an expansion of eligibility for childless adults under age 65 who are not entitled to Medicare, known as the "new adult" Medicaid eligibility group.  Applicants in the new adult group will be eligible for Medicaid, if their income does not exceed 138 percent of the federal poverty level.  Eligibility of new adult group applicants and applicants in other eligibility groups, such as parents, pregnant women and children, will be determined based on Modified Adjusted Gross Income (MAGI) budgeting rules and a five percent income disregard.  There is no asset test under MAGI budgeting.   

Medicaid beneficiaries in the new adult group will generally be eligible for “benchmark coverage,” which includes managed care coverage of all Medicaid benefits, except long term nursing home care.  However, new adult group beneficiaries who are “medically-frail” will be eligible for long term nursing home care as well.  They will not be required to undergo a disability review to qualify.  There will be no asset test and no asset transfer look-back period.  These beneficiaries will, nevertheless, be subject to post-eligiblity income rules (i.e. determination of the NAMI).

For more information about MAGI budgeting and benchmark coverage, see this LeadingAge NY memo.  

Contact:  Karen Lipson, klipson@leadingageny.org, 518-867-8383, ext. 124