2025 Medicaid Guidelines
Emics Elder Care: New York Medicaid Planners
Income levels & other figures used to determine Medicaid
Navigating the complexities of Medicaid eligibility is crucial for individuals seeking long-term care services in New York. Below are the updated 2025 Medicaid Income and Resource Levels effective January 1, 2025.
Medicaid Income Eligibility Levels
The income thresholds for Medicaid eligibility vary based on household size and specific program requirements. For 2025, the income limits are as follows:
Household Size | 100% FPL | 138% FPL | 150% FPL | 185% FPL | 200% FPL | 250% FPL |
1 | $14,580 | $20,120 | $21,870 | $26,955 | $29,160 | $36,450 |
2 | $19,720 | $27,214 | $29,580 | $36,482 | $39,440 | $49,300 |
3 | $24,860 | $34,307 | $37,290 | $46,009 | $49,720 | $62,150 |
4 | $30,000 | $41,400 | $45,000 | $55,535 | $60,000 | $75,000 |
5 | $35,140 | $48,493 | $52,710 | $65,062 | $70,280 | $87,850 |
6 | $40,280 | $55,586 | $60,420 | $74,589 | $80,560 | $100,700 |
7 | $45,420 | $62,680 | $68,130 | $84,116 | $90,840 | $113,550 |
8 | $50,560 | $69,773 | $75,840 | $93,642 | $101,120 | $126,400 |
Each additional person | Add $5,140 | Add $7,093 | Add $7,710 | Add $9,527 | Add $10,280 | Add $12,850 |
*Note: These figures are subject to annual adjustments based on the Federal Poverty Level (FPL).
Medically Needy Income and Resource Levels
For individuals with income exceeding the standard Medicaid eligibility limits, New York offers the Medically Needy program, allowing qualification through a “spend-down” process on medical expenses. The 2025 levels are:
Monthly Income Level:
Individual: $1,820
Couple: $2,453
Resource Limit:
Individual: $32,396
Couple: $43,781
*These figures are effective as of January 1, 2025.*
Special Income Standard for Housing Expenses
New York provides a Special Income Standard for Housing Expenses to assist individuals transitioning from nursing homes back into the community. This standard offers additional income allowances to cover housing costs for eligible individuals enrolled in Managed Long-Term Care (MLTC) plans. The allowances are based on the U.S. Department of Housing and Urban Development (HUD) Fair Market Rent (FMR) values for a one-bedroom apartment in each region, adjusted by subtracting 30% of the Medicaid Income Level for a one-person household. The specific amounts vary by region and are detailed in the New York State Department of Health’s Administrative Directive.
Spousal Impoverishment Standards
To protect spouses of individuals requiring long-term care from financial hardship, New York has established spousal impoverishment standards:
- Community Spouse Resource Allowance (CSRA): The community spouse is permitted to retain resources equal to the greater of $74,820 or the amount of the spousal share up to $157,920. The spousal share is defined as one-half of the total value of the couple’s countable resources as of the beginning of the most recent continuous period of institutionalization of the institutionalized spouse on or after September 30, 1989.
- Minimum Monthly Maintenance Needs Allowance (MMMNA): The community spouse may retain income up to $3,926.50 per month.
- Asset Transfers: Transferring assets shortly before applying for Medicaid can trigger a penalty period, making the applicant temporarily ineligible. It’s advisable to consult with an elder law attorney to understand state-specific rules and protect assets legally.
- Home Equity Limit: Applicants with home equity above a certain limit may be ineligible for Medicaid coverage for long-term care services. This limit is subject to annual adjustments.
*Please note that Medicaid eligibility criteria, including income and resource limits, can vary by state and are subject to change. For the most accurate and up-to-date information, it’s advisable to consult your state’s Medicaid office or official publications.