New York Medicaid Changes 2022-2023 | Urgent Medicaid News

URGENT NEWS NY Medicaid 2022-23 Changes

Medicaid is a joint federal and state run program that gives a wide variety of medical and health benefits, prominently long-term care for those who are chronically ill, are in cognitive or physical decline, injured/disabled, and are in need of constant medical care. Laws regarding Medicaid are constantly changing, so it’s important to stay informed on the recent and upcoming changes in order to make sure you’re still eligible to receive benefits. Below are some changes that recently came in effect and some that are upcoming.

Medical insurance and Medicaid

Upcoming Changes to Medicaid in 2022:

  • Independent Assessor for Home Care → In Effect May 1, 2022

Starting May 1, 2022, Medicaid applicants over the age of 18 who are applying for Personal Care or Consumer Directed Personal Assistance Program (CDPAP) services will need to go through nurse assessments conducted by New York Independent Assessor (NYIA). Also, the NYIA will also conduct nursing assessments for “Immediate Need” applicants and others who apply to the local Department of Social Services, which is the Human Resource Administration (HRA) in NYC for personal care or CDPAP.

The NYIA will not only be conducting a nurse assessment but also a clinical assessment by either a doctor, physician’s assistant, or nurse practitioner. With those assessments, the NYIA will be able to determine whether or not the applicant is eligible for personal care or CDPAP and send the applicant a written notice. If the applicant’s eligibility is denied, they have Fair Hearing rights, which means that you can appeal their decision.

If the NYIA finds the applicant eligible for benefits and services, the applicant is referred back to their local Medicaid office. The nurse and clinical assessment will then be used to determine how many hours of personal care or CDPAP should be authorized to the applicant. If you are approved for over 12 hours of personalcare a day, the Medicaid Office or plan must refer the case back to the Independent Assessor for a third assessment, which is known as an Independent  Medical Review (IMR). The purpose of the IMR is to determine whether the proposed plan of care is safe and can maintain the health of the applicant when they are home.

  • Increases in Medicaid Eligibility of Applicants 65+ and Blind/Disabled Individuals → In Effect January 1, 2023

NY Governor Hochul and State Legislature passed four increases in Medicaid eligibility for New Yorkers who are 65+, blind, or disabled in the NYS budget. These are the four changes that will go into effect January 1, 2023:

    • Medicaid Asset Limit has increased by nearly 50%
    • Medicaid Income Limit has increased to the same amount used for Modified Adjusted Gross Income (MAGI) Medicaid for younger people (138% Federal Poverty Line or “FPL”).
    • Medicare Savings Program: Qualified Medicare Beneficiary limit increased from 100% to 138% FPL. Individuals with higher incomes not exceeding 186% FPL will be eligible for QI-1.
    • Undocumented Immigrants Age 65+ will not be elidgible for full Medicaid benefitsas opposed to only “emergency” Medicaid.

New Medicaid Limits in 2023 for 65+, Blind, & Disabled

Benefit Federal Poverty Line % SINGLES COUPLES
2022 2023 2022 2023 2022 2023
Income Limit Per Month
Medicaid 82% 138% $934 $1,563 $1,367 $2,106
QMB 100% 138% $1,133 $1,563 $1,526 $2,106
QI-1 135% 186% $1,529 $2,107 $2,060 $2,838
Medicaid Asset Limit $16,800 $28,134 $24,600 $37,908
  • Public Health Emergency→ Extended Through July 2022

President Biden and his administration extended the COVID-19 Public Health Emergency on April 13, 2022 for 90 days. This means that protections that prohibit the government from discontinuing Medicaid or increasing the “spend down” for any recipient of Medicaid will continue through July 2022, so long as they primarily reside in NYS.

What does this mean? Restrictions on eligibility may not be implemented before October 1, 2022, which would include the 30 month “lookback” that will disqualify applicants from obtaining home care benefits, or the require applicants from needing physical assistance with 3 activities of daily living or two if diagnosed with dementia in order to qualify for CDPAP.

For more information on the Medicaid changes coming soon and how you can qualify for Medicaid, call a medicaid planning attorney at the Law Office of Inna Fershteyn at 718-333-2394.