Medicaid income limits raised for seniors and disabled

Summary#

S-4841, titled “Increases income and resource threshold limit for certain Medicaid eligibility groups,” would amend New Jersey’s Medical Assistance and Health Services Act and add rules for some Medicaid eligibility groups. Its stated goal is to raise income and resource limits so more people in those groups can qualify; the bill is introduced and is not law.

  • For medically needy applicants, it would set the income limit at 138% of the federal poverty level and set resource limits at $40,000 for one person, $60,000 for two, and $20,000 more for each additional person.
  • For the aged, blind, and disabled eligibility group, it would raise the income limit from 100% to 138% of the poverty level and link its resource limit to the medically needy limits.
  • It would set the same resource limits for applicants and beneficiaries in Medicaid Managed Long-Term Services and Supports (MLTSS) and for applicants to three Medicare Savings Programs.
  • The Commissioner of Human Services must seek federal approvals needed to carry out the bill and must adopt implementing rules.

What it means for you#

  • People who are 65 or older, blind, or disabled: If the bill takes effect and applies to you, you could qualify with income up to 138% of the poverty level and resources up to the new limits. The bill does not specify which assets count as resources.
  • People who may qualify as medically needy: The new 138% income standard would apply to the groups listed in the bill, including pregnant women, dependent children under 21, and people who are 65 or older, blind, or disabled. People with income above the limit may still qualify by incurring medical expenses that reduce their income to the limit. The bill keeps a six-month period for determining medically needy eligibility.
  • People seeking MLTSS or Medicare Savings Program help: The bill would raise the resource limits for those programs to the same amounts. It does not otherwise change the services or help those programs provide.
  • Other Medicaid applicants: The bill does not change every Medicaid income or resource limit. For example, the text leaves several other eligibility thresholds unchanged.
  • State and county agencies: The state commissioner must seek federal approvals and adopt rules. The bill does not set application steps, decision timelines, or appeal rules.

Money#

No publicly available information on the bill’s estimated cost.

  • The bill does not appropriate a specific amount of money. It directs the commissioner to seek federal approvals to secure federal funding for state Medicaid spending.
  • Raising eligibility limits could increase the number of people who qualify and Medicaid spending; the bill materials do not estimate that effect.
  • The bill’s statement lists existing resource limits of $4,000 for the aged, blind, and disabled and medically needy groups, $2,000 for MLTSS, and $9,090 for Medicare Savings Programs. It gives the medically needy income limit as $367 per month for one person in 2024. These are figures in the bill’s statement, not a verified account of current limits.

What is unclear#

  • The parent Act was not supplied, so the bill’s description of current law and its changes could not be checked against the current Act.
  • The bill does not say which assets count toward the resource limits or how particular assets would be treated.
  • The bill requires federal applications and makes the medically needy resource limits subject to federal approval. It is unclear which provisions would need approval before they could operate.
  • The bill does not estimate how many people might newly qualify or what the added state and federal costs might be.
  • The bill’s title refers to P.L.1968, c.412, while the operative amendment refers to P.L.1968, c.413.
  • The bill says it takes effect immediately, but it does not explain how that timing relates to federal approval and the rules the commissioner must adopt.

Case for#

  • The bill appears intended to let people keep more resources and have more income while qualifying for Medicaid help.
  • A possible argument for the bill is that higher limits may make coverage and long-term care support available to people who are currently just over the eligibility thresholds.
  • The bill sets the same resource limits for medically needy, MLTSS, and Medicare Savings Program eligibility, which could make those limits more consistent.

Case against#

  • One concern is that broader eligibility could increase Medicaid spending, but the bill provides no cost estimate or forecast.
  • The bill does not define which assets count or explain how eligibility decisions would work under the higher limits.
  • It is unclear when federal approval is needed and whether any of the new limits could be delayed or changed because of that approval.
  • The bill raises limits for selected groups, not all Medicaid applicants, so people in other eligibility categories would not necessarily benefit.