Medicaid Income Limits in New York in 2024 (Updated)

To qualify for Medicaid, your income must be at or below certain Federal Poverty Level (FPL) percentages. The exact percentage depends on the specific Medicaid program you are applying for and varies by state. For most adults under the age of 65, the income limit is set at 138% of the FPL. However, states have flexibility and may set higher income limits for certain groups like pregnant women, children, or people in need of long-term care.

There are two categories of Medicaid eligibility

MAGI stands for Modified Adjusted Gross Income Category, it matters because depending on which category you're in, your income limit will differ.

Most people fall under the Modified Adjusted Gross Income (MAGI) category when determining Medicaid eligibility. MAGI is used for most non-disabled adults and children under the age of 65. Non-MAGI typically applies to individuals who are 65+, disabled, blind, or who need long-term care. Different income limits and calculation methods apply to each category.

1. You are MAGI if:

• Singles/Childless couples ages 19 through 64 who are not entitled to or enrolled in Medicare.
• You are pregnant
• Dependent children under the age of 19
• Parents/caretaker relatives of children under 19

2. You are Non-MAGI if: 

• You are 65 or older and you are disabled or blind
• You need or receive long-term care services

3. You are neither if:

• You make more than the maximum income threshold.
• You are on Medicare and you are not disabled.
• You are not a U.S. citizen or legal immigrant.
• You are not a NY state resident (then you need to get Medicaid in your state)

If you are not eligible for Medicaid and find options on the exchange unaffordable, Mira could make a good fit at $45/month.

2024 Medicaid Income Limits in New York

For MAGI (most people)

The income limit for a single person to qualify for Medicaid in NY in 2024 is $20,121 a year or $1,677 a month. For a family of two (couple), the annual income limit is $27,214 or $2,268 a month. This is a significant increase from 2023. 

There is also a resource threshold levels that are $30,182 for an individual and a $40,821 for a family of two. 

For non-MAGI

Notice the non-MAGI income threshold is higher than that of MAGI, this is because certain programs may aim to provide coverage for individuals with higher incomes who are elderly or have a disability.

The year 2024 holds promising prospects for Medicaid beneficiaries in New York. Anticipated data from the New York State Department of Health and Medicaid.gov project potential upswings in the income limits. Although the exact figures are yet to be ratified, these changes, given the precedent set in 2023, have the potential to continue expanding healthcare access for numerous families and individuals.

With these projected higher income limits, a larger population segment could benefit from the Medicaid program in New York. However, these changes, according to the New York State Department of Health and Health Affairs Journal, will also influence the program's beneficiaries. With higher income limits, more low-income families and individuals would become eligible, making healthcare more accessible for them. However, an influx of new beneficiaries might present more significant logistical challenges, including managing the larger beneficiary pool and maintaining the quality of healthcare services.

What To Do if My Income Exceeds Medicaid Limits?

If your income exceeds the Medicaid threshold, there are several strategies you could use:

1. Spend-Down Program: In some states, you may be eligible for the Medicaid "spend-down" or "surplus income" program. This program allows individuals with incomes higher than the Medicaid limit to "spend down," or subtract, their medical expenses from their income, potentially bringing them below the eligibility limit.
2. Medicaid Planning: Consult with a Medicaid planner or elder law attorney. They may be able to help you legally restructure your finances to qualify for Medicaid.
3. Insurance Deductibles: Large healthcare costs such as deductibles or copays could potentially be deducted from your income, reducing the countable income.
4. Use an Income Trust: In some states, a Miller Trust or Qualified Income Trust can be used to qualify for Medicaid. Excess income is deposited into the trust and can be used to pay for medical expenses.
5. Increase Household Size: In some cases, adding a dependent might increase the income limit for qualification.
6. Apply for Waivers: Check if your state has Medicaid waivers or programs that have higher income limits.
7. Consider Spousal Impoverishment Rules: If you're married and one spouse requires care, the "spousal impoverishment" provisions might allow you to divert some income to the non-Medicaid spouse, potentially making the other spouse qualified for Medicaid.
    

What is Medicaid Spend-down and How Does It Affect You?

Medicaid Spend-down, also known as income surplus, is a process that allows individuals with income levels above typical Medicaid eligibility standards to still qualify for Medicaid benefits. This often applies to elderly, blind, or disabled individuals.

To better understand, let's consider an example:

Let’s say for a person aged 65+, the income limit for Medicaid eligibility in New York is $934 per month in 2021. 

Thomas, a 70-year-old retiree, receives $1400 monthly from social security and a small pension. Based on his income, Thomas doesn't initially qualify for Medicaid benefits. However, if Thomas has high medical expenses, he might still be eligible through the Medicaid Spend-down program.

Here's how it works: Thomas' income is $466 over the Medicaid limit ($1400 - $934). That overage amount forms his spend-down or income surplus. If Thomas has medical bills, premiums, or healthcare costs that equal or exceed $466 each month, he can "spend down" his excess income on these expenses.

In effect, Thomas is using his surplus income to pay off his medical costs, which brings his countable income down to the Medicaid eligibility level, hence the term "spend down." As a result, Thomas could still qualify for Medicaid, despite initially making too much.

Medicaid Spend-down or income surplus provisions can be beneficial to those with high healthcare costs and who otherwise can't afford long-term care or other services. However, it's essential to understand the specific regulations and guidelines in your state, as Medicaid rules can vary. Working with a benefits advisor can help ensure you maximize your benefits while staying within the legal guidelines.

Frequently Asked Questions

Can I qualify for Medicaid if I have a job?

Yes, you can still qualify for Medicaid if you have a job. What matters is your income level, not your employment status. If your income is at or below your state's Medicaid eligibility limit, you may qualify.

I have children. Will they be covered under my Medicaid?

Depending on the specific rules in your state, your children may be covered under your Medicaid. Some states have separate programs for children, such as the Children's Health Insurance Program (CHIP). I recommend contacting your state's Medicaid office for specific information.

I'm a student. Can I qualify for Medicaid?

Yes, students can qualify for Medicaid. Again, it largely depends on your income. If your income falls within the income limit in your state, you could qualify for Medicaid.

Can I apply for Medicaid if I already have health insurance?

Yes, it's possible to apply for Medicaid even if you already have health insurance. The specifics will depend on the rules in your state, as well as your income and family size. If you're eligible for Medicaid, it can work together with your other insurance to cover your healthcare costs.

Are prescription medications covered by Medicaid?

Yes, prescription medications are generally covered by Medicaid. However, the exact medications that are covered can vary from state to state and may depend on things like your age, your specific Medicaid plan, and the specifics of your prescription.

How often do I need to reapply for Medicaid?

Typically, you need to renew your Medicaid coverage once a year. However, this can vary by state. It's crucial to keep all your information up to date to ensure continuous coverage. If your income or family size changes, for instance, you should immediately report these changes to your state Medicaid office.

How much does Medicaid cost?

Medicaid costs, including co-pays and premiums, vary by state. Some people may qualify for free Medicaid care, while others may have to pay small monthly premiums or co-pays for certain medical services. Also, some groups, such as children, pregnant women, and low-income adults, may be exempt from most out-of-pocket costs.