Medicaid Eligibility Fact Sheet
Bridges to Health Home and Community Based Medicaid Waiver (B2H)
Medicaid Eligibility Determination for B2H Children Discharged from Foster Care
Children who are in the care and custody of a Local Social Services (LDSS) Commissioner or the Commissioner of the New York State Office of Children and Family Services are categorically eligible for Medicaid, as long as they are United States citizens or meet satisfactory immigration status and are otherwise eligible.
Once children are discharged form foster care and are no longer in the care and custody of a LDSS or OCFS Commissioner, a separate Medicaid eligibility determination must be made for the child based on general eligibility requirements and the B2H budgeting methodology specified below.
General eligibility requirements for Medicaid specify verification and documentation of:
- New York State residency
- US Citizenship or appropriate immigration status
- Age (if appropriate)
- Social security number (SSN), documentation that a SSN has been “applied for”, or proof that a SSN was applied for and was denied.
The Medicaid budgeting methodology for a B2H waiver participant discharged from foster care is as follows:
- Use a household size of one and Budget Type 01 (ADC-related) or 04 (SSI-related)—whichever methodology is most beneficial to the child.
- Disregard parental income and resources.
- Budget the child's own income and resources.
- Apply appropriate income and resource disregards for either the ADC-related or SSI-related eligibility category.
- Compare the child's income and resources to the Medically Needy level.
- If the child's income and resources are at or below the Medically Needy level, the child is fully eligible for Medicaid.
- If the child's income and/or resources exceed the Medically Needy level, the child may spenddown to the Medically Needy level.
Please Note: It is only necessary to do a disability determination if SSI-related budgeting methodology is used to determine the child's B2H eligibility.
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