Medicare-Medicaid Pay-Down of Assets
State law and regulations impose income and asset limits on persons applying for Medicaid.
The income limit for the institutional Medicaid program and certain home and community-based waiver programs is determined by the New York State Department of Health – Medicaid Division. To qualify for Medicaid through SSI the income limit for an aged, blind or disabled individual cannot exceed $1,800 per month or $2,433 for a couple.
New York also offers a Medicaid Excess Income program also referred to as the Spenddown program” or the “Surplus Income program”. If an individual’s monthly income is over the Medicaid level, he or she may still be able to get help with his or her medical bills. The amount an individual’s income is over the Medicaid level is called excess income. If he or she is eligible for Medicaid except for having excess income and can show that he or she has medical bills equal to their excess income in a particular month, Medicaid will pay the additional medical bills beyond that for the rest of that month. This includes outpatient care, doctor and dental visits, lab tests, prescription drugs, and long-term care in the community such as home care and assisted living. Individuals can spenddown to the Medicaid level in one of two ways:
1. Outpatient Care and Services (One Month Eligibility)
If an individual needs outpatient care in a hospital, clinic or doctor’s office, prescription drugs or medical supplies, he or she may be able to get help with these bills. If he or she has medical bills that are equal to or more than their monthly excess income, they can get Medicaid outpatient services for one month at a time. To do so, the individual must bring in, send or fax the medical bills to the local department of social services when they are at least equal to the excess income amount. These bills can be paid or unpaid. Additionally, an individual may be able to get long-term care services like adult day health care, personal care services and the Assisted Living Program.
2. Inpatient/Hospital Care and Services (Six Months Eligibility)
If an individual needs hospital care or need help paying hospital bills, he or she may be able to get Medicaid inpatient services, in addition to the outpatient care described above. He or she must have medical bills that are at least equal to the monthly excess income amount for six months. These bills can be paid or unpaid. They can also be for medical services other than hospital care. Once the individual’s medical bills are at least equal to the excess income amount for six months, he or she must bring or send these bills to the local department of social services and will then receive Medicaid for six months.
When determining eligibility, all income and resources shall be indicated on the application form and evaluated as to their immediate and/or potential availability to remove or reduce need for assistance and utilized for such purpose in accordance with applicable regulations of the department. When a clear, consistent statement of financial need and resources cannot be obtained, a full field investigation by the validation staff shall be made. Whenever investigation indicates that a person applying for AABD has transferred or assigned his property, real or personal, prior to application, the reason for such transfer or assignment shall be sought and a determination made as to whether such transfer or assignment was made for the purpose of qualifying for assistance.
(1) A transfer of property made within one year prior to the date of the person’s application for such assistance shall be presumed to have been made for the purpose of qualifying for such assistance.
(2) If it is determined that there was no intent to defraud the agency and that the action which the applicant took at the time the property was conveyed was a normal transaction, not taken for the purpose of qualifying for assistance, such transfer or assignment shall not constitute a basis for denial.
(3) If transfer or assignment is found to have been made for the purpose of qualifying for AABD, the agency shall determine whether the property is available for return to the applicant or assignment to the agency. When not available for return or assignment, the application for assistance shall be denied.
New York State Department of Health – Medicaid Division
18 N.Y. Comp. Codes R. & Regs. 368.4
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Medicaid Buy-In Program for Working People with Disabilities
2024 SSI and SSP Maximum Monthly Benefit Levels Chart