Bill > A5472

Introduced Session

This bill increases income threshold limits for certain Medicaid eligibility groups. Specifically, the bill increases the income eligibility for the Aged, Blind, and Disabled (ABD) eligibility group from 100 percent of the federal poverty level to 138 percent of the federal poverty level, which, in 2025, would increase the income threshold from $15,650 per year to $21,597 per year for an individual. In doing so, the bill provides for an identical income threshold under Medicaid for the ABD population as is currently used for individuals under 65 years of age without disabilities. The Medicaid ABD pathway provides medical coverage to individuals who are age 65 years or older as well as individuals determined blind or disabled by the federal Social Security Administration or by the State. The bill also increases the medically needy income limit, which allows an income ineligible applicant for ABD benefits to deduct certain medical expenses from the applicant's income in order to become eligible for Medicaid. Under the bill, this threshold would also be 138 percent of the federal poverty level. In 2025, the State's medically needy Income Limit is $367 per month for an individual, which would increase to $1,800 under the bill. Finally, the bill increases the income limit for the Qualified Medicare Beneficiary (QMB) Program from 100 percent of the federal poverty level to 138 percent of the federal poverty level. Generally, QMB is a Medicare savings program. These programs are federal programs administered by each individual state Medicaid agency that provide people with limited income and resources assistance in paying their Medicare cost sharing obligations. The QMB program is the most generous program and pays for eligible individuals Medicare Part A and B premiums, copayments, coinsurances, and deductibles. The other Medicare Savings Programs, which currently have income thresholds higher than QMB but that do not exceed 135 percent of the federal poverty level, are the Specified Low-Income Medicare Beneficiary (SLMB) Program and the Qualifying Individual (QI) Program. The SLMB and QI programs only pay for eligible individuals Medicare Part B premiums. In raising the income threshold for QMB and not the other two programs, the bill in effect is eliminating the least generous Medicare Savings Programs and funneling all eligible individuals to the program that provides the most comprehensive support. Under the bill, the Commissioner of Human Services is to apply for such State plan amendments or waivers as may be necessary: to implement the provisions of this act; to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program; and to reduce the administrative burden on, and simplify the redetermination process implemented by, the department regarding the Medicaid eligibility groups affected by this act.

Committee Categories

Reginald Atkins (D)*,  Shanique Speight (D)*,  Sterley Stanley (D)*, 

Reported and Referred to Assembly Health Committee (on 05/08/2025)

Official Document