NYSDOH Takes Steps to End Disparity in Access to Medicaid for SSI-Related Individuals and Couples

August 1, 2007

Legal Services Offices with significant numbers of elderly or disabled clients have likely noticed that households of two on Medicaid have been struggling with increases in their spenddown amounts.  In fact, beginning on January 1, 2006, the New York State Department of Health (NYSDOH) lowered, and capped, the Medicaid income eligibility level for households of two at a level below New York’s SSI program.

This year, although a household of two receiving SSI qualifies for Medicaid with monthly income of $1,038, an SSI-related couple will need to spend their monthly income down to $900 before Medicaid will be available.

In December of 2006, Empire Justice Center and Legal Services of Central New York filed a class action complaint in Monroe County State Supreme Court on behalf of SSI-related individuals and couples in need of Medicaid services.  The case,    Blair v. Novello,  Index No.15486-06, challenges the lower eligibility level under both Article XVII of the New York State Constitution, which prohibits the state from denying assistance or care to individuals it has classified as needy, and state and federal due process protections.  Pleadings are available on the Online Resources Center.

A Long and Tortuous Process

According to documents filed by NYSDOH in Blair, the reduction in eligibility levels was a result of conversations between NYSDOH and the Centers for Medicare and Medicaid Services (CMS) during former Governor Pataki’s administration.  Concerns about the potential loss of federal matching dollars led to a technical amendment during the 2005 legislative session that triggered the reduction in program eligibility for SSI-related individuals and couples.  Empire Justice began conversations with NYSDOH in 2005 about a different strategy for retaining federal dollars – a disregard strategy that could gain approval from CMS without penalizing SSI related individuals and couples.

Protracted discussions with NYSDOH finally gained momentum following the Blair filing and after Governor Spitzer took office.  In January of 2007, NSYDOH submitted language for another legislative amendment, which was approved as part of the 2007 budget and provided the Department with the authority to bring the eligibility level for SSI-related Medicaid recipients up to the same level as that for SSI recipients.  On June 28, of 2007 NYSDOH submitted its proposal for raising the Medicaid income level to CMS for approval.

The End May be Near

Unless CMS stops the clock by submitting questions, federal approval or disapproval will issue in late September.  Meanwhile, Empire Justice and Legal Services of Central New York have made significant progress toward the terms of a final settlement of the Blair case, which would end the disparity in access to Medicaid for SSI related individuals and couples.  If you have SSI-related clients who are struggling with spenddown amounts, please contact Trilby de Jung in the Rochester office of Empire Justice (1-800-724-0490, X 5722), for further information.