The New York State Department of Health (DOH) has issued additional directives  outlining the new procedures for Medicaid applications and renewals under the Affordable Care Act, effective in 2014.

For newest directives scroll to the bottom of this page.

1.     13 ADM-04 – Medicaid Application and Renewal Processing for Modified Adjusted Gross Income (MAGI) Eligibility Groups  (Dec. 4, 2013)  PDF  

  • Links to the appendix (which is just a list of the attachments) and ten attachments that accompany it available a:

  • “This ADM advises local districts of the referral process for applicants in a Modified Adjusted Gross Income (MAGI) eligibility group to New York State of Health (NYSOH), New York’s Health Insurance Marketplace, and the requirements for determining or renewing Medicaid eligibility for certain individuals using MAGI-like budgeting rules. This directive also informs districts of the actions the State will take to transition Family Health Plus (FHPlus) Single Individuals and Childless Couples to coverage under the Affordable Care Act (ACA) effective January 1, 2014, and advises districts of special instructions for processing Medicaid referrals from NYSOH for coverage/payment of medical bills in the three-month retroactive period.”

  •  NYC HRA has also issued a directive re applications procedures – see Important Changes in Medicaid Application Submissions -MAGI and Non-MAGI (Dec. 24, 2013)

2.     13 ADM-03 – Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010  (PDF) 

  • This directive outlines the changes to Medicaid eligibility that become effective January 1, 2014 under the ACA.   

13 ADM-03 describes “expanded Medicaid coverage under the ACA, a new method for counting household income based on modified adjusted gross income (MAGI), Medicaid benefits under the ACA and Medicaid enrollment in New York’s Health Benefit Exchange.”

The directive contains several attachments, including these desk aids explaining

MAGI Eligibility Groups and Income Levels (Attachment 1)

MAGI and Non-MAGI Eligibility Groups  (Attachment 2) and

the notice to households whose applications are being referred to the local district for non-MAGI processing. (Attachment 3)

3.    GIS 13 MA/021 Renewal Processing for MAGI Eligibility Groups Beginning January 2014 (PDF) (11/15/2013)

4.    GIS 13/MA/022 2014 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards

  • PDF
  • Attachment 1  – Annual and monthly income and resource limits for “non-MAGI” population –
  • Attachment 2   – Explains what income limits — usually a percentage of the Federal Poverty Level — apply to different categories of people, for use with Attachment 1 of same GIS.

5.    GIS 14/MA-007   Update on Self-Employment Policy for MAGI-like Budgeting  (3/21/2014)

6.   GIS 14 MA/016: Long Term Care Eligibility Rules and Estate Recovery Provisions for MAGI Individuals

7.   GIS 14 MA/022 – Medicaid Eligibility for Pregnant Minors   PDF  (7/1/2014)

8.     2014 LCM-02 – Medicaid Recipients Transferred at Renewal from New York State of Health to Local Departments of Social Services   (Dec. 1, 2014)

9.  GIS 15 MA/008 – Treatment of Income of Dependents Under MAGI-like Rules  (4/9/2015)

Child’s Social Security or other income may be disregarded from household income, depending on amount and type of income.  UPDATED 2018 – click here

10.  GIS 15 MA/022 – Continuous Coverage for MAGI Individuals  (12/23/15)   PDF 

  • Attachment 1
  • Announces that beginning January 1, 2016, 12-month continuous coverage protections will no longer be extended to MAGI recipients who turn 65.

Clarifies that “MAGI-like” category — those who fall into a MAGI category but are getting their Medicaid coverage through their LDSS or HRA — are entitled to the same 12-month continuous coverage protections as MAGIs (people who fall into a MAGI category and are getting their coverage through the Marketplace).  Some people must get coverage through their LDSS because they need long term care such as home care, a waiver program, or nursing home care.  They are eligible for these services with MAGI eligibility- see GIS 14 MA/016 above- but need eligibility processed by the local district.

11.  GIS 15 MA/020 – IRS Tax Form 1095-B Guidance   PDF  

  • Attachment 1   
  • Attachment 2 
  • Explains form sent to MAGI Medicaid recipients to prove they are enrolled in Medicaid so they are not charged with a tax penalty charged to those who did not enroll in a health insurance plan – under the ACA

12.  2016 LCM-01 – Transitioning MAGI Consumers from WMS to NY State of Health – attachments at this link

13.    16 ADM-01 – Transitioning Essential Plan Consumers from WMS to NY State of Health  PDF  — read more about the Essential Plan here

14.   GIS 16 MA/004 -Referrals from NY State of Health to Local Departments of Social Services for Individuals who Turn Age 65 and Instructions for Referrals for Essential Plan Consumers  (PDF) —  read more about the Essential Plan here

15.  GIS 17 MA/011: Treatment of Federal Income Tax Refunds and Advanced Payments  PDF

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NYS Directives on Medicaid changes under the Affordable Care Act