In New York, over 7.3 million people rely on Medicaid for health insurance and coverage for home care services, time spent in a nursing home, and much more. That means there are many documents and information for Medicaid agencies to keep track of!
To ensure an applicant or beneficiary’s financial status matches what they’ve reported, Medicaid offices verify assets and income levels using bank account balances and other key metrics.
But how often do Medicaid agencies get to look at your financial information, and what happens if what they find doesn’t match what they expect?
Key Takeaways
- Medicaid agencies can check your account balances for bank accounts at any financial institution you’ve used in the past five years. They will check when you submit an application and on an annual basis, but checks can occur at any time.
- While agencies can look at account balances, they can’t view your personal bank statements. Other information used to determine Medicaid eligibility often comes from public records.
- New York Medicaid eligibility is determined by your yearly income. However, qualifying for coverage while making more than the income limit is still possible, particularly for adults over 65.
- Withholding information, whether intentionally or not, can cause a Medicaid recipient to lose their benefits, be prosecuted, and be expected to repay the bills for the services they received while ineligible.
Does Medicaid Check Your Bank Account?
Medicaid agencies can check your account balances at any financial institutions you use during the month you apply or during a 60-month look-back period.
In this context, a look-back period is the time before your application during which the Medicaid agency administering benefits reviews all financial transactions and asset transfers.
In other words, it’s the timeframe that Medicaid considers to determine your overall financial status to assess your eligibility.
So, if you’re submitting a Medicaid application, the agency you’re sending it to can check your bank account — but that doesn’t mean it has unlimited access to all your financial information.
It makes sense that a Medicaid agency would need to verify your account balance. After all, Medicaid is a need-based program with financial eligibility requirements.
Verifying that you have as much money as you claim is an essential part of the process. Once you’ve been approved for Medicaid coverage, you take on some of the responsibility of maintaining your eligibility and reporting anything that changes it.
Medicaid agencies make annual checks to account balances to ensure a Medicaid recipient still meets the right requirements. Still, beyond that, it’s up to you to notify your agency if something affects your eligibility.
For instance, if you receive an inheritance or another unexpected source of income that puts you over the Medicaid asset limit, you’re expected to report it, not wait for Medicaid to discover it during a yearly check.
What Information Can Medicaid Access About Your Finances?
Medicaid agencies can and will look at your balance from any bank account you’ve had in the last five years. They may also conduct property checks using public records like deeds.
To keep track of all of this information and consistently update and confirm it, New York’s Medicaid program uses an Asset Verification System (AVS). The AVS is able to:
- Confirm information about an applicant or their spouse’s bank accounts held in financial institutions during the month of application and the 60-month look-back period
- View balances for accounts closed during the month of application or look-back period
- View information about other assets, like retirement accounts, life insurance policies, etc.
- Run searches on real property owned by an applicant or their spouse
- Identify potential transfers of assets that might need to be verified by the benefit recipient with some form of paper documentation
The goal of the AVS is not to fully automate the process but to help Medicaid offices identify changes that are worth investigating.
It’s the benefit recipient’s job to confirm the information the AVS finds. If that can’t be or isn’t done, the Medicaid agency will rely on the details mined by the AVS.
Agencies can request bank account information at any time and may do so to compare paper documentation to the AVS.
So, is there anything that Medicaid agencies can’t access? Though they can view account balances, agencies cannot view your personal bank statements. They can’t see your spending patterns, and they can’t track all of your expenses.
What Is the Highest Income to Qualify for Medicaid in New York?
New York State of Health, which handles most Medicaid applications, uses Modified Adjusted Gross Income (MAGI) Rules to determine income eligibility.
However, individuals over 65 may still be eligible for Medicaid services even if they earn or hold more than the asset limit.
Individuals who are aged 65 or older, blind, or disabled can earn up to $31,175 a year in a one-person household and $42,312 in a two-person household while still qualifying for Medicaid.
Since some older adults can have more countable resources or income than this without losing their eligibility, the best way to see which health insurance options are available to you is to visit the State of Health’s Marketplace.
Below is a breakdown of the income eligibility requirements for Medicaid in New York as of January 1, 2024. Use these income limits to see whether you might be eligible before you get too deep into the application process.
| New York Medicaid Income Eligibility Levels (2024) Source: New York State of Health | |||
Family Size | Net income for families and individuals who are blind, disabled, or age 65+ | Individuals who are blind, disabled, or age 65+ ONLY) | |
| Annual | Monthly | ||
| 1 | $20,783 | $1,732 | $31,175 |
| 2 | $28,208 | $2,351 | $42,312 |
| 3 | $35,632 | $2,970 | |
| 4 | $43,056 | $3,588 | |
| 5 | $50,481 | $4,207 | |
| 6 | $57,905 | $4,826 | |
| 7 | $63,330 | $5,445 | |
| 8 | $72,754 | $6,063 | |
| 9 | $80,178 | $6,682 | |
| 10 | $87,603 | $7,301 | |
| For each additional person, add: | $7,425 | $619 | |
What Happens If You Withhold Information from Medicaid?
Withholding information from a Medicaid agency is never a good idea.
Agencies have plenty of ways to verify your income and assets, even if they can’t see your bank statements or peer into your personal life.
Whether intentional or not, withholding information can quickly land you in hot water. If you don’t provide Medicaid with accurate and updated information about your finances, you may:
- Lose your Medicaid benefits and have your eligibility withdrawn
- Be responsible for reimbursement or repayment of all the services and benefits you received while ineligible
- Be prosecuted under the law
- Be disqualified from receiving certain benefits in the future
Not everyone withholds information on purpose or for their own gain. Some people might be worried about losing the money they worked for or having little to leave their children or families. Others might have bills — like a mortgage — to keep up with and rely on Medicaid benefits.
It’s also possible to simply forget or fail to realize you need to update your agency on your financial situation. No matter why information gets withheld, you can still face consequences that put your insurance coverage at risk.
If you’re not sure when or how to report information to your Medicaid agency, the best thing you can do is speak up.
Ask questions early, and make note of the times you’ll need to provide updated documentation. A small slip-up might not cause any issues, but repeated or large-scale inaccuracies should definitely be avoided.
