2009 Changes to Medicaid Eligibility

August 13, 2009

Author: Trilby de Jung

A year ago we took stock of significant gains in the advocacy campaign to expand access to Medicaid coverage in New York State. This year, we would be remiss if we didn’t once again catalogue legislative action that promises to streamline, simplify and expand eligibility even further. We are thrilled that many of the health initiatives on Empire Justice Center’s legislative agenda were introduced in the Governor’s budget and approved by the legislature. 

However, changes in policy always necessitate monitoring of implementation. So, just as last year, when we urged advocates to monitor eligibility determinations for their clients; we are sounding the same message, perhaps even more loudly, this year.  Although the legislature has approved important program improvements, timely implementation of the changes will be a big job at a time when the New York State Health Department (NYSDOH) and local districts are seriously under-staffed. 

Please let us know if your county is struggling with the new Medicaid rules, or unaware of their existence so that we can do our best to bring state resources, as well as our own tools of persuasion, to bear.

The 2009 changes to Medicaid eligibility in New York include:

Elimination of the Resource Test for Some Categories of Medicaid Applicants/Recipients

Legislation passed in 2009 removes the asset test for certain categories of Medicaid applicants and all applicants to the Family Health Plus program.  L. 2009, c. 58, pt. C, §§ 58 to 59-a. 

Effective October 1, 2009, the following Medicaid applicants/recipients are no longer subject to a  resource test:

• Parents and caretakers
• 19 and 20 year olds
• Single adults and childless couples

Resource tests will still apply to aged, blind and disabled applicants and recipients, although this group’s eligibility should be evaluated according to the relatively new, higher resource levels for regular Medicaid, passed in 2008. 

Elimination of the Face to Face Interview Requirement

New York has required applicants for Medicaid to complete a face to face interview with either a county eligibility worker or a qualified facilitated enroller in order to complete the application process. Legislation passed in 2009 removes this administrative requirement effective April 1, 2010.  L. 2009, c. 58, pt. C, § 60.  

Implementation of this change promises to be particularly tricky, as many districts, and some advocates fear that some applicants who need help with the process will not receive it.  It will be important to ensure that help is there for those who want it even without the requirement for a face to face interview. 

In addition, NYSDOH may be looking at a major retooling of the Medicaid application in preparation for elimination of the face to face interview requirement. Such an investment may be premature, however, in view of the significant changes to public health insurance that may be announced on the federal level in the very near future. 

Elimination of the Fingerprinting Requirement

Although it was not uniformly enforced, New York has also required Medicaid applicants for whom photo-identification is required to submit to finger imaging. Legislation passed in 2009 removed this administrative requirement effective July 1, 2009.  L. 2009, c. 58, pt. C, § 62. 

Consolidated Category for Children’s Medicaid

Legislation passed in 2009 took a significant step toward simplifying income eligibility rules for children’s Medicaid by consolidating age groups 1-18 and applying one income level to all. This change becomes effective April 1, 2010.  Eligibility will be set at 160% of the federal poverty level (FPL) if approved by the federal government, and 133% of FPL without federal approval.  L. 2009, c. 58, pt. C, §§ 63 to 65-d.

In addition, distinctions between19 and 20 year olds based on whether applicants live with parents or on their own will be dropped, further simplifying the eligibility rules.  Id.

Elimination of the Waiting Period for Child Health Plus (CHP)

This change in CHP is actually a result of legislative action in 2008 approving an expansion to New York’ CHP program to 400% of poverty with state only dollars. The new levels became effective on September 1, 2008.  N.Y. Pub. Health L. §2511, as amended by L. 2008, c. 58. 

It wasn’t until June of 2009 that the federal government approved this expansion of New York’s CHP program.  The long awaited federal approval not only provides significant funding for the program, but also allows New York State to eliminate the six month waiting period previously imposed on children leaving employer-based insurance and applying for CHPlus.

Family Health Plus Expansion (FHPlus)

Legislation passed in 2009 increases the FHPlus income eligibility level to 160% of FPL for single adults, childless couples, and 19 and 20 year olds, effective April 1, 2010. The legislation also restores FHPlus eligibility for public employees, reversing a restriction to the program that was implemented under Governor Pataki.  L. 2009, c. 58, pt. C, § 67 & 68.  Public employees are eligible for FHPlus again beginning October 1, 2009.    

The 2009 legislation also authorizes an increase in the FHPlus income eligibility level for parents and caretakers, to 200% of FPL.  However, this increase is dependent upon federal approval of an agreement for redirection of public funds to finance the expansion.  This increase will not become effective until agreement is reached with the federal government.   L. 2009, c. 58, pt. C, §§ 67-a & 67-b.