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Qualifications for Medicaid in NYS

Medicaid is a federal program administered by the states. It provides care for low-income individuals. Each state can customize its own eligibility requirements. New York State Medicaid delivers access to quality, comprehensive health insurance to fourteen percent of New York State's population at little to no cost to the consumer.

  1. Income Eligibility

    • Income eligibility guidelines are based on various categories. In 2010, adults, couples without children and low- income families must have a monthly income less than $707 if single or $883 if married. The net income for families, the elderly, disabled and blind is slightly higher. Their 2010 monthly income must fall below $767 if single or $1,117 if married. For any additional people in the household, such as dependents, the income limit increases.

      Some groups can qualify with higher incomes, including pregnant women, children and the disabled. In 2010, pregnant women with infants qualify with income up to $1,805 monthly in a one-person home. Additional household members will increase the income limit.

    Resource Eligibility

    • The elderly, disabled and blind must meet resource eligibility requirements. Resources include such things as money in bank accounts, cars and investments. As of 2010, single applicants may have no more than $13,800 in resources. A two-person household may have no more than $20,100 in resources.

    Medically Needy Eligibility

    • Certain applicants with income above these limits may still qualify for Medicaid. In New York State, pregnant women, the elderly, blind, disabled, and children can qualify through the Medicaid spend-down program. In this case, an applicant submits current medical bills. These medical bills are subtracted from the applicant's income in order to make him Medicaid eligible. Eligible medical bills include health insurance costs, doctor bills, prescription drug costs, over-the-counter drug costs, dental costs and the cost of eyeglasses. Medically needy applicants can also buy in to Medicare by paying a monthly premium instead of submitting medical bills. The monthly premium is equal to the spend-down amount.

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