NY State proposed healthcare changes

[jim584672]

Some changes to NY's laws proposed by Governor Hochul.

The biggest one is removing the asset test for aged, disabled, and blind Medicaid
beneficiaries, and increasing the eligibility level. They would be treated the
same as ACA MAGI Medicaid beneficiaries are currently. Increasing the Essential plan up to 250% FPL. Removing the $9 premium for CHIP coverage on certain groups.


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https://www.governor.ny.gov/sites/default/files/2022-01/2022StateoftheStateBook.pdf
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"Under current Medicaid coverage rules, income eligibility plunges from 138 percent
of the federal poverty level ($17,775 annually for an individual and $24,040
annually for a couple) to roughly 87 percent ($10,600 annually for an individual and
$15,600 annually for a couple) when a person turns 65 and becomes eligible for
Medicare, forcing many seniors to lose Medicaid coverage. Others lose access to full
Medicaid coverage if they become disabled.

To address this concern, New York will expand Medicaid eligibility so that low-
income New Yorkers age 65 and up, as well as those with disabilities, are able to
maintain Medicaid eligibility after they become eligible for Medicare. This coverage
expansion will eliminate the resource eligibility test and raise the income level to
138 percent of the federal poverty level for these populations for these populations."
---
"Governor Hochul will expand Essential Plan eligibility for New Yorkers, raising the
threshold from 200 percent of federal poverty line to at least 250 percent subject to
federal approval. "
---
"Governor Hochul will eliminate the $9 premium for families between 160
and 222 percent of the federal poverty level ($27,876 and $38,676 for a household
of two and between $42,408 and $58,836 for a household of four)."

 

[Irishgirlyc58]

Good! People don’t typically understand that there are 2 sets of rules for Medicaid eligibility depending on if you are eligible for Medicaid classic or the expansion Medicaid due to ACA.
Keeping these separate rules is confusing to the public and makes eligibility determinations more difficult. There is no reason for it.

 

[jim584672]

Good! People don’t typically understand that there are 2 sets of rules for Medicaid eligibility depending on if you are eligible for Medicaid classic or the expansion Medicaid due to ACA.
Keeping these separate rules is confusing to the public and makes eligibility determinations more difficult. There is no reason for it.

Yes. With traditional Medicaid they need all assets and bank account statements and it is very complex. MAGI is just income, and that is easy to verify. Long overdue, elderly and disabled should not handled worse than others. NY will still pursue estate recovery for nursing home costs.

 

[Irishgirlyc58]

Yes. With traditional Medicaid they need all assets and bank account statements and it is very complex. MAGI is just income, and that is easy to verify. Long overdue, elderly and disabled should not handled worse than others. NY will still pursue estate recovery for nursing home costs.

If I’m remembering correctly the estate recovery is a federal requirement.
I wonder if NY is getting the asset income rules changed under a waiver program.

I agree-MAGI is much more efficient which should mean we don’t spend as much money in the eligibility/administration side and can actually use it for services.
What a concept.

 

[jim584672]

Just a followup on this. The budget is finally done and these are the changes for 2023...

Age 65+, Blind, or Disabled ("Non-MAGI" Medicaid)
Income limits increased to 138% FPL to match the MAGI group
Singles - $1563/mo (a big increase from $934/mo)
Couples - $2106/mo (a big increase from $1367/mo)
Asset limits increased 50%.
Single increase from $16,800 to $28,134
Couples increase from $24,600 to $37,908.

Medicare Savings Programs
QMB limit increased from 100% FPL to 138% FPL
QI-1 income limit increase from 135% to 186% FPL.
No asset limit on MSPs.
Automatically qualifies you for Social Security Full Extra Help, the Medicare Part D prescription drug subsidy and pays the Part B premium.

The NYSOH Essential Plan income limit increased from 200% FPL to 250% FPL.

 

[Irishgirlyc58]

So they only removed the asset test for the QMB and Q-1 cases?

 

[jim584672]

So they only removed the asset test for the QMB and Q-1 cases?

MSPs in NY don't have an asset test, so nothing changed for them. The asset test removal on Medicaid didn't get adopted. QMB basically covers all out of pocket costs and is like MAGI Medicaid, both are at 138% FPL. QMB doesn't cover full nursing home costs.

 

[GenXguy]

Just a followup on this. The budget is finally done and these are the changes for 2023...

Age 65+, Blind, or Disabled ("Non-MAGI" Medicaid)
Income limits increased to 138% FPL to match the MAGI group
Singles - $1563/mo (a big increase from $934/mo)
Couples - $2106/mo (a big increase from $1367/mo)
Asset limits increased 50%.
Single increase from $16,800 to $28,134
Couples increase from $24,600 to $37,908.

I was going to say this sounded like a good thing, but that says asset limits for 65+ were merely increased, not eliminated as the first post stated. If those changes to Medicaid for 65+ were made in my state, I know people that would benefit if the asset test was eliminated (they have well over $100K assets not counting home residence). But as it is, even the NY law wouldn't help them. And if you don't have enough work history to get it for free, Medicare part A is about $500/mo for one person, and you could be spending over $1000/mo for one person when you add B, D, and supplemental before you even get to the deductibles, which applies to some people I know. These people seem to be left out.

But having said all that, those limits are certainly better than my state.

 

[jim584672]

I was going to say this sounded like a good thing, but that says asset limits for 65+ were merely increased, not eliminated as the first post stated. If those changes to Medicaid for 65+ were made in my state, I know people that would benefit if the asset test was eliminated (they have well over $100K assets not counting home residence). But as it is, even the NY law wouldn't help them. And if you don't have enough work history to get it for free, Medicare part A is about $500/mo for one person, and you could be spending over $1000/mo for one person when you add B, D, and supplemental before you even get to the deductibles, which applies to some people I know.


But having said all that, those limits are certainly better than my state.

The first post was the initial proposal, so it looked like a good chance of it going through, but the sausage making process made it come out different. QMB covers all out of pocket for Medicare, no supplemental Medigap needed or Part D. No asset test for QMB, and no Estate Recovery either. So it is like MAGI Medicaid. The big cost is nursing home (like $14K a month) and for that it seems fair that people draw down assets before Medicaid comes in.

 

[mpeirce]

Wow, so much jargon. I have ho idea what’s being discussed.

 

[GenXguy]

The first post was the initial proposal, so it looked like a good chance of it going through, but the sausage making process made it come out different. QMB covers all out of pocket for Medicare, no supplemental Medigap needed or Part D. No asset test for QMB, and no Estate Recovery either. So it is like MAGI Medicaid. The big cost is nursing home (like $14K a month) and for that it seems fair that people draw down assets before Medicaid comes in.

OK. So, they might qualify under NY's QMB since it has no asset test, although borderline on the income limit. QMB has an ~$8K asset limit for a single person in my state, and even the income limit is definitely too low for these people, at around ~$1K for one person. So NY is certainly an improvement, although the income limit may still be too restrictive for them, not that it matters since they don't live in NY.

 

[jim584672]

OK. So, they might qualify under NY's QMB since it has no asset test, although borderline on the income limit. QMB has an ~$8K asset limit for a single person in my state, and even the income limit is definitely too low for these people, at around ~$1K for one person. So NY is certainly an improvement, although the income limit may still be too restrictive.

NY matched the MAGI Medicaid FPL level for QMB which is $18,754 for a 1 person house.

 

[GenXguy]

NY matched the MAGI Medicaid FPL level for QMB which is $18,754 for a 1 person house.

Exactly - that's the borderline figure I was referring to in regard to a couple different people I know.

 

[jim584672]

Wow, so much jargon. I have ho idea what’s being discussed.

Medicare / Medicaid is an advanced course in complexity.

 

[jim584672]

Exactly - that's the borderline figure I was referring to in regard to a couple different people I know.

QI-1 at 186% FPL $25,277 gets Part B paid for and Part D through Extra Help

 

[Irishgirlyc58]

The first post was the initial proposal, so it looked like a good chance of it going through, but the sausage making process made it come out different. .

Or in other words-politicians wimped out. [emoji12]

 

[jim584672]

California is phasing out the asset test for elderly Medicaid by mid 2024. Unless they rework the look back rules people would be able to move there, give away all their assets and qualify for full nursing home with no delay penalty.

 

[Irishgirlyc58]

California is moving toward a single payer health care system. We will get there if politicians don’t wimp out.

This is our first big step:

https://www.dhcs.ca.gov/CalAIM/Pages/calaim.aspx