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us-ny/guidance/doh/gis · Axiom

(26-ma-05)GIS 26 MA/05: 2026 Federal Poverty Levels#

(26-ma-05)(attachment-1)GIS 26 MA/05 Attachment 1: New York State Income and Resource Standards for Non-MAGI Population, Effective January 1, 2026#

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Household Size Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual HH Size One 15,960 1,330 22,025 1,836 23,940 1,995 29,526 2,461 29,686 2,474 31,920 2,660 39,900 3,325 33,038 One Two 21,640 1,804 29,864 2,489 32,460 2,705 40,034 3,337 40,251 3,355 43,280 3,607 54,100 4,509 44,796 Two Three 27,320 2,277 37,702 3,142 40,980 3,415 50,542 4,212 54,640 4,554 Four 33,000 2,750 45,540 3,795 49,500 4,125 61,050 5,088 66,000 5,500 Five 38,680 3,224 53,379 4,449 58,020 4,835 71,558 5,964 77,360 6,447 Six 44,360 3,697 61,217 5,102 66,540 5,545 82,066 6,839 88,720 7,394 Seven 50,040 4,170 69,056 5,755 75,060 6,255 92,574 7,715 100,080 8,340 Eight 55,720 4,644 76,894 6,408 83,580 6,965 103,082 8,591 111,440 9,287 Nine 61,400 5,117 84,732 7,061 92,100 7,675 113,590 9,466 122,800 10,234 Ten 67,080 5,590 92,571 7,715 100,620 8,385 124,098 10,342 134,160 11,180 Each Add'l 5,680 474 7,839 654 8,520 710 10,508 876 11,360 947 + Person Amount Amount Amount Central $439 Northeastern $567 Northern Metropolitan $1,380 Rochester $505 Long Island $1,828 Western $402 New York City $2,104 Spousal Impoverishment Income Resources Special Standards for Housing Expenses Community Spouse $4,066.50 $162,660 Region Region Region New York State Income and Resource Standards for Non-MAGI Population Effective January 1, 2026 138% FPL Medicaid Income 100% FPL 150% FPL 185% FPL 250% FPL Resources 186% FPL 200% FPL *In determining the community spouse resource allowance on and after January 1, 2026, the community spouse is permitted to retain resources in an amount equal to the greater of the following $74,820 or the amount of the spousal share up to $162,660. The spousal share is the amount equal to one-half of the total value of the countable resources of the couple as of the beginning of the most recent continuous period of institutionalization of the institutionalized spouse on or after September 30, 1989. $50 $33,038 Family Member Allowance $2,705 (150% of FPL for 2) is used in the FMA formula the maximum allowance is $902 N/A Institutionalized Spouse

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(26-ma-05)GIS 26 MA/05: 2026 Federal Poverty Levels#

(26-ma-05)(attachment-1)GIS 26 MA/05 Attachment 1: New York State Income and Resource Standards for Non-MAGI Population, Effective January 1, 2026#

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1 2 1 2 Presumptive Eligibility for Pregnant Consumers 223% FPL N/A 4,022 Qualified provider makes the presumptive eligibility determination. Cannot spenddown to become eligible for presumptive eligibility. Pregnant Consumers 223% FPL N/A 4,022 A woman determined eligible for Medicaid for any time during her pregnancy remains eligible for Medicaid coverage until the last day of the month in which the 60th day from the date the pregnancy ends occurs, regardless of any change in income or household size composition. If the income is above 223% FPL the A/R must spenddown to the Medicaid Income level. The baby will have guaranteed eligibility for one year. Children Under One 223% FPL 2,966 4,022 If the income is above 223% FPL the A/R may apply for CHPlus or spenddown to the Medicaid Income level. One year guaranteed eligibility if mother is in receipt of Medicaid on delivery. Eligibility can be determined in the 3 months retro to obtain the one year extension. Children Age 1 through 5 154% FPL 2,049 2,778 If income is above 154% FPL the A/R may apply for CHPlus or if chooses to spenddown, must spenddown to the Medicaid Income level. 110% FPL 1,463 1,984 154% FPL 2,049 2,778 Parents/Caretaker Relatives 138% FPL 1,836 2,489 If income is above 138% FPL the A/R may apply for Advanced Premium Tax Credit (APTC) or Essential Plan (EP) if chooses to spenddown, must spenddown to the Medicaid Level. 138% FPL 1,836 2,489 155% FPL 2,062 2,796 100% FPL 1,330 1,804 138% FPL 1,836 2,489 Family Planning Program 223% FPL 2,966 4,022 Eligibility determined using only applicant's income. Rev. 02.05.2026 No Resource Test 19 and 20 Year Olds, Living with Parents If income is above 155% FPL the A/R can apply for APTC or EP or if chooses to spenddown, must spenddown to Medicaid Income level. Single/Childless Couples and 19 and 20 Year Olds, Living Alone Single/Childless Couples (S/CCs) cannot spenddown, but can apply for APTC or EP; 19 and 20 year olds if income over 138% may apply for APTC or EP if chooses to spenddown, must spenddown to the Medicaid Income level. No Resource Test No Resource Test No Resource Test No Resource Test No Resource Test MAGI POPULATION Category Income Compared to: Household Size Resource Level Special Notes No Resource Test No Resource Test Children Age 6 through 18 If income is above 154% FPL the A/R may apply for CHPlus or if chooses to spenddown, must spenddown to the Medicaid Income level. No Resource Test No Resource Test No Resource Test No Resource Test

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If SSI was terminated during this period: Multiply 2026 Social Security income by: If SSI was terminated during this period: Multiply 2026 Social Security income by: If SSI was terminated during this period: Multiply 2026 Social Security income by: May – June 1977 0.181 Jan. 1992 – Dec. 1992 0.425 Jan. 2007 – Dec. 2007 0.627 July 1977 – June 1978 0.192 Jan. 1993 – Dec. 1993 0.437 Jan. 2008 – Dec. 2008 0.641 July 1978 – June 1979 0.204 Jan. 1994 – Dec. 1994 0.449 Jan. 2009 – Dec. 2011 0.678 July 1979 – June 1980 0.224 Jan. 1995 – Dec. 1995 0.461 Jan. 2012 – Dec. 2012 0.703 July 1980 – June 1981 0.256 Jan. 1996 – Dec. 1996 0.473 Jan. 2013 – Dec. 2013 0.715 July 1981 – June 1982 0.285 Jan. 1997 – Dec. 1997 0.487 Jan. 2014 – Dec. 2014 0.726 July 1982 – Dec. 1983 0.306 Jan. 1998 – Dec. 1998 0.497 Jan. 2015 – Dec. 2016 0.738 Jan. 1984 – Dec. 1984 0.317 Jan. 1999 – Dec. 1999 0.504 Jan. 2017 – Dec. 2017 0.740 Jan. 1985 – Dec. 1985 0.328 Jan. 2000 – Dec. 2000 0.516 Jan. 2018 – Dec. 2018 0.755 Jan. 1986 – Dec. 1986 0.338 Jan. 2001 – Dec. 2001 0.534 Jan. 2019 – Dec. 2019 0.776 Jan. 1987 – Dec. 1987 0.342 Jan. 2002 – Dec. 2002 0.548 Jan. 2020 – Dec. 2020 0.788 Jan. 1988 – Dec. 1988 0.357 Jan. 2003 – Dec. 2003 0.556 Jan. 2021 – Dec. 2021 0.799 Jan. 1989 – Dec. 1989 0.371 Jan. 2004 – Dec. 2004 0.568 Jan. 2022 – Dec. 2022 0.846 Jan. 1990 – Dec. 1990 0.388 Jan. 2005 – Dec. 2005 0.583 Jan. 2023 – Dec. 2023 0.920 Jan. 1991 – Dec. 1991 0.409 Jan. 2006 – Dec. 2006 0.607 Jan. 2024 – Dec. 2024 0.949 Jan. 2025 – Dec. 2025 0.973 Rev. 12.18.2025 Pickle Section 503 of Public Law 94-566, referred to as the Pickle Amendment, protects Medicaid eligibility for all recipients of Retirement Survivors and Disability Insurance (RSDI) who were previously eligible for SSI benefits concurrently. These recipients are individuals who would be eligible for SSI, if all RSDI Cost of Living Allowances (COLAs) received since they were last eligible for and receiving RSDI and SSI benefits concurrently, were deducted from their countable income. (See 85 ADM-35 for further information). The reduction factors in the chart below, "REDUCTION FACTORS FOR CALCULATING MEDICAID ELIGIBILITY UNDER THE PICKLE AMENDMENT", should be used when determining Medicaid eligibility for individuals who are entitled to a reduction to their countable SSI Income. Note: This updates the Reduction Factors included in the Medicaid Reference Guide (MRG). The MRG table should no longer be used.

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WGIUPD GENERAL INFORMATION SYSTEM DIVISION: Office of Health Insurance Programs 2/13/2026 PAGE 1 GIS 26 MA/05

The purpose of this General Information System (GIS) message is to inform local departments of social services (LDSS) of the revised federal poverty levels (FPLs). The revised FPLs are effective January 1, 2026, as published in the Federal Register.

The new FPLs should be used for all transactions with a Medicaid Budget Logic (MBL) eligibility “From” date of January 1, 2026, or later. The updated levels will be available in MBL on February 17, 2026. For all new and pending applications, income must be compared to the 2026 FPLs. All redeterminations effective January 1, 2026 or later, must be re-budgeted retroactive to January 1, 2026, using the Medically Needy Income Level (MNIL) based on the 2026 FPLs. As a result of the increase in the MNIL, the personal needs allowance amount for certain waiver participants and Managed Long Term Care enrollees who are subject to spousal impoverishment budgeting increases to $653 effective January 1, 2026.

Neither Phase 1 or Phase 2 of Mass Re-Budgeting (MRB), including the systematic update of the 2.8 percent (%) Cost of Living Adjustment (COLA) was run. Districts will be informed of any additional updates regarding MRB. Due to the increase in the FPLs, some Qualifying Individuals (QI) may be income eligible for the Qualified Medicare Beneficiary (QMB) benefit. In such cases, staff must complete a 99-change transaction on the eMedNY Buy-in span, with the effective date of January 1, 2026, and change the Medicare Savings Program (MSP) code appropriately. For NYC, the change in MSP level can be transmitted via an undercare case transaction. Medicare Part B Premium In 2026, there is a COLA of 2.8% for Social Security benefits. Under a “hold-harmless” provision of federal law, a beneficiary’s Medicare Part B premiums in any year cannot rise higher than that year’s COLA. In 2026, most beneficiaries will pay the full Part B premium as the 2.8% COLA will generate enough increased income for them to pay $202.90 without reducing their net Social Security benefits. TO: Local District Commissioners, Medicaid Directors FROM: Gabrielle Armenia, Director Division of Eligibility and Marketplace Integration SUBJECT: 2026 Federal Poverty Levels ATTACHMENT: 2026 FPL Chart EFFECTIVE DATE: January 1, 2026 CONTACT PERSON: Local District Support Unit Rest of State (ROS) (518) 474-8887 NYC (212) 417-4500

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WGIUPD GENERAL INFORMATION SYSTEM DIVISION: Office of Health Insurance Programs 2/13/2026 PAGE 2 GIS 26 MA/05

If an individual’s Social Security benefit does not increase enough for them to pay the $202.90 without their benefit decreasing, the “hold harmless” provision will limit the Part B premium increase to the amount of their 2026 Social Security benefit increase. The “hold-harmless” provision does not apply to all beneficiaries. The Medicare Part B premium for individuals in the following categories will increase to $202.90 (or higher) in 2026:

● Individuals whose income is above $109,000, or a married individual when the couple’s combined income is over $218,000, will pay the standard premium and an Income Related Monthly Adjustment Amount (IRMAA);

● New Medicare Part B beneficiaries since these individuals did not pay the Medicare Part B premium in 2025; and ● Individuals who do not have the Medicare Part B premium deducted from their Social Security benefit, including individuals who are enrolled in the Medicare Savings Program. These individuals will not be directly affected as the increased premium will be paid by Medicaid. If an individual has chosen to pay the Medicare Part B premium to reduce a spenddown obligation, the actual premium that is paid must be used in calculating the individual’s budget.

Family Member Allowance As a result of the increase in the FPLs, the amount used in the Family Member Allowance (FMA) formula increased to $2,705.00 and the maximum monthly FMA increased to $902. All spousal impoverishment cases involving a family member entitled to the family member allowance, with a budget effective date of January 1, 2026 or later and which were budgeted using the 2025 Family Member Allowance, must be re-budgeted using the 2026 Family Member Allowance. If a district determines that a previously budgeted case with a “From” date of January 1, 2026 or greater, has been negatively affected due to use of 2025 FPL, or if a case is brought to the district’s attention, the case should be re-budgeted using the revised FPLs. If eligible, covered medical expenses paid by an individual as a result of an improper calculation must be reimbursed pursuant to 10 OHIP/ADM-9, “Reimbursement of Paid Medical Expenses Under 18 NYCRR §360-7.5(a).” Congregate Care Medicaid eligibility for SSI-related consumers is determined by comparing income, after appropriate deductions, to the MNIL or the Medicaid Standard (and MBL Living Arrangement Chart as appropriate), and applying whichever income level is most beneficial. Special Income Standard for Housing Expenses

The special income standard for housing expenses that is available to certain individuals who enroll in the Managed Long-Term Care program (See 12 OHIP/ADM-5 and GIS 14 MA/017 for further information) varies by region. The 2026 amounts for each region have been updated based on the FPLs for 2026.

(26-ma-05)GIS 26 MA/05: 2026 Federal Poverty Levels#

(26-ma-05)(attachment-1)GIS 26 MA/05 Attachment 1: New York State Income and Resource Standards for Non-MAGI Population, Effective January 1, 2026#

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(26-ma-05)GIS 26 MA/05: 2026 Federal Poverty Levels#

(26-ma-05)(attachment-1)GIS 26 MA/05 Attachment 1: New York State Income and Resource Standards for Non-MAGI Population, Effective January 1, 2026#

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