What is Medicaid?

What is Medicaid?

Medicaid is a program for New Yorkers who can’t afford to pay for medical care. It pays for a full range of healthcare services, including many not covered by Medicare (such as home care, unlimited nursing home care, dentistry, eyeglasses, hearing aids and others).

How do I know if I qualify for Medicaid?

You may be covered by Medicaid if:

  • You have high medical bills.
  • You receive Supplemental Security Income (SSI).
  • You meet certain financial requirements

For more information about Medicaid, please visit https://www.health.ny.gov/health_care/medicaid/#definition.

Who is eligible for Medicaid? 
Age: No age requirement; if you are under 65, you may qualify if you are receiving SSI (Supplemental Security Income) or if you are disabled.
Income: There are detailed formulas that specify how much income you can receive in a month and still qualify for Medicaid. These limits depend on the number of people who live with you, and are re-calculated each year. To qualify in 2020, the income level for individuals who are blind, disabled, or age 65+  is $875 per month ($10,500 per year); for single individuals without disability it is $1,468 per month ($17,609 per year) and for couples without children it is $1,983 per month ($23,790 per year).
Exceptions: In general, if you have surplus income above these limits, you must “spend down” the surplus in order to keep your Medicaid active. However, the Medicaid Excess Income program provides for exceptions to these income limits for pregnant women, children, the disabled, and others with high medical bills. Individuals with income above these limits may qualify for Community Medicaid (which includes home health care) if they have medical bills equal to their “surplus income.” Disabled individuals may deposit their surplus income into a Supplemental Needs Trust, and have the Trust pay for necessities and extras.
Resources: If you are blind, disabled or over 65, you are permitted to retain some resources and still qualify for Medicaid. The amounts depend on the number of people living with you, and are re-calculated each year. In 2020, a single individual is allowed to retain $15,750.
Exemptions from limits on resources include: Not counted as resources are: a $1,500 burial fund per person, or irrevocable prepaid funeral arrangement in any amount; for life insurance with face value of more than $1,500, the first $1,500 is counted toward the burial fund and the remaining balance is counted as a resource; a home with a value up to $893,000, personal effects and a car. 
Transfer of Assets: There are complex rules governing the transfer of assets or resources by people who want to qualify for Medicaid. You should not transfer ownership of a home, an investment or any other resources without consulting an elder law attorney.
Last updated 5/7/2020