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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