Medicaid for Permanent Residents in New York

Permanent residents may apply for New York Medicaid for as long as they are legal residents of New York and otherwise qualify based on Medicaid income and asset requirements and other Medicaid regulations. With the promulgation of Aliessa v. Novello, 96 N.Y.2d 418 (Ct App 2001), Medicaid has become available to all permanent residents, even those who have been living in the US for less than five years.

Undocumented immigrants, however, can only qualify for emergency Medicaid services. These emergency services are limited to treatment for emergency medical conditions that are necessary to stablize a person's condition. An exception to this rule are undocumented immigrants aged 65 and older. As of January 1, 2024, this category of undocumented immigrants are eligible for full Medicaid in New York State as part of an expansion of health coverage.

Application Process

The application process for Medicaid in New York requires several documents, including proof of income, such as pay stubs, tax returns, or self-employment records; identification documents, including driver's license, state ID, or passport; Social Security cards for all household members applying for coverage; proof of residency, such as a utility bill or lease agreement; citizenship or immigration status documentation, like birth certificates or green cards; medical records or disability determination, if applicable; pregnancy verification, if applying as a pregnant woman; and asset documentation, such as bank statements or vehicle registration, if required by the state.

Applicants may need to provide additional information or documentation during the review process. If approved, coverage may be retroactive to the date of application or the first day of the month of application. If denied, applicants have the right to appeal the decision and request a fair hearing. Once approved, beneficiaries will receive a Medicaid card and information about covered services and providers, as well as regular communication from the Medicaid agency regarding renewals, changes, or additional requirements.

Challenges in Applying for Medicaid

Navigating the Medicaid application process in New York can be a daunting and lengthy endeavor, posing various obstacles for those seeking coverage. A significant challenge lies in meeting the stringent income and asset limits set by New York Medicaid.

For individuals whose financial resources exceed these thresholds, legal avenues exist to strategically reduce income and assets, thereby increasing the likelihood of qualifying for Medicaid benefits. As experienced Medicaid estate planning attorneys, we possess the expertise to guide you through this intricate process and help you create a comprehensive plan for your future well-being.

Should you need assistance in planning your estate, the Law Offices of Albert Goodwin is here for you. You can call us at 212-233-1233 or send us an email at [email protected]. We are located in Midtown Manhattan, New York.

Background: How Aliessa Changed New York Medicaid

For many years, federal law restricted Medicaid eligibility for permanent residents during their first five years of residency. The federal welfare reform of 1996 included this five-year bar as a cost-saving measure. The result was a category of permanent residents — legally in the United States, paying taxes, working — who could not access Medicaid for routine care during their first five years.

In Aliessa v. Novello, the New York Court of Appeals held that the federal five-year bar did not apply to New York State Medicaid because New York's state constitution requires the state to provide aid to the needy. The court found that excluding permanent residents from Medicaid violated the equal protection clauses of both the federal and state constitutions. The result is that New York provides Medicaid to permanent residents who meet other eligibility requirements, regardless of how long they have been in the country.

This makes New York more generous than many other states. A permanent resident who would not qualify for Medicaid in another state during the first five years of residency can qualify in New York if other eligibility requirements are met.

Income and Asset Eligibility

The income and asset limits for Medicaid are the same for permanent residents as for U.S. citizens. The exact limits depend on the category of Medicaid — MAGI-based Medicaid (used for most working-age adults and families), non-MAGI Medicaid (used for the aged, blind, and disabled), and various waiver programs.

MAGI-based Medicaid uses Modified Adjusted Gross Income from federal tax returns. The income limit is set as a percentage of the Federal Poverty Level and varies by household size. There is no asset test for MAGI Medicaid.

Non-MAGI Medicaid uses both income and asset tests. The income limits are based on the Federal Poverty Level. The asset limits in 2024 were $30,182 for a single individual and $40,821 for a couple for Community Medicaid, with higher exemptions for primary residence, household goods, vehicles, and certain other assets. Institutional Medicaid has separate (typically lower) asset limits for the institutionalized individual, with a higher Community Spouse Resource Allowance for the spouse remaining at home.

Documentation Required for Permanent Residents

Permanent residents applying for Medicaid in New York must document their immigration status. Acceptable documentation includes:

• Permanent Resident Card (Form I-551, "green card").
• Foreign passport with a current I-551 stamp.
• I-94 Arrival/Departure record with appropriate stamps.
• Documentation of asylum, refugee status, or other qualifying immigration categories.

The Medicaid agency verifies immigration status with the Department of Homeland Security through the SAVE program. The verification process is automated for most applicants and should not produce delays.

Mixed-Status Families

Many families have members with different immigration statuses — a U.S. citizen child, a permanent resident parent, an undocumented grandparent. Medicaid eligibility is determined individually for each family member based on their own status. The presence of undocumented family members does not affect the eligibility of qualifying family members.

Public charge concerns sometimes deter immigrant families from applying for Medicaid. The public charge rules have evolved significantly in recent years. Under current rules (as of 2024), receipt of Medicaid (other than long-term institutional care) does not generally count against the public charge determination for most categories of immigrants. Applicants concerned about public charge implications should consult both an immigration attorney and an elder law attorney before applying.

Emergency Medicaid for Undocumented Immigrants

Undocumented immigrants in New York are eligible for Emergency Medicaid, which covers treatment of emergency medical conditions. Emergency conditions include sudden onset of illness with severe symptoms (acute pain, traumatic injury, severe bleeding) that, without treatment, could be expected to seriously impair health. Childbirth is included.

Emergency Medicaid does not cover routine or ongoing care. It does not cover preventive medicine, primary care, prescription medications outside of the emergency event, or long-term care. Undocumented individuals needing routine care must pay out of pocket or seek subsidized care through community health centers and other sliding-scale providers.

Expanded Coverage for Older Undocumented Immigrants

Starting January 1, 2024, New York expanded full Medicaid coverage to undocumented immigrants aged 65 and older. This expansion was driven by recognition that older undocumented immigrants face significant health needs and that emergency-only coverage was inadequate for their situation. The expansion does not cover working-age undocumented immigrants, who remain eligible only for Emergency Medicaid.

Medicaid Planning for Immigrant Families

Many of the same Medicaid planning techniques used for U.S. citizens apply to permanent residents. These include:

• Irrevocable Medicaid Asset Protection Trusts to hold the home and other assets outside countable resources.
• Spousal refusal and spousal asset protection for married couples.
• Pooled income trusts to shelter excess monthly income.
• Caregiver contracts to compensate family members providing care.
• Coordinated planning with the family's broader estate plan.

Immigration status adds complexity in some of these techniques. A permanent resident transferring assets to a non-resident family member, for example, may face additional reporting and tax issues. We work with families to navigate these issues and develop plans that meet both Medicaid and immigration requirements.

The Fair Hearing Process for Denied Applications

If a Medicaid application is denied, the applicant has the right to a fair hearing within 60 days of the notice. The hearing is held by an administrative law judge from the New York State Office of Temporary and Disability Assistance. The applicant can be represented by an attorney, can introduce evidence, and can cross-examine the agency's witnesses.

For permanent residents, denials often involve documentation issues or misclassification of immigration status. These can usually be resolved through the fair hearing process with proper preparation.