Expansion of Medicaid Benefits for Medicare Beneficiaries in New York State

Em Balkan; Laura M Keohane; Momotazur Rahman; Jaclyn M W Hughto; David J Meyers

doi:10.1001/jamahealthforum.2026.2394

. 2026 Aug 7;7(8):e262394. doi: 10.1001/jamahealthforum.2026.2394

Expansion of Medicaid Benefits for Medicare Beneficiaries in New York State

Em Balkan ^1,^✉, Laura M Keohane ², Momotazur Rahman ¹, Jaclyn M W Hughto ^3,⁴, David J Meyers ¹

¹Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island

²Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee

³Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island

⁴Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island

Accepted for Publication: May 26, 2026.

Published: August 7, 2026. doi:10.1001/jamahealthforum.2026.2394

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License, which does not permit alteration or commercial use, including those for text and data mining, AI training, and similar technologies. © 2026 Balkan E et al. JAMA Health Forum.

^✉

Corresponding Author: Em Balkan, MSW, Brown University, 121 S Main St, Providence, RI 02903 (em_balkan@brown.edu).

Author Contributions: Mx Balkan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Balkan, Meyers.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Balkan, Rahman.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Balkan, Keohane.

Administrative, technical, or material support: Rahman, Hughto, Meyers.

Supervision: Rahman, Hughto, Meyers.

Conflict of Interest Disclosures: Dr Keohane reported personal fees from Health Affairs Forefront, grants from National Institute on Aging, and grants from Blood Cancer United outside the submitted work. Dr Rahman reported grants from the National Institutes of Health during the conduct of the study. Dr Meyers reported grants from Arnold Ventures, grants from National Institute on Aging, and personal fees from Oak Ridge Affiliated Universities as a paid senior advisor to the Center for Medicare and Medicaid innovation outside the submitted work. No other disclosures were reported.

Disclaimer: This work does not necessarily reflect the views of the Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, or the federal government.

Data Sharing Statement: See Supplement 2.

Additional Contributions: We thank and acknowledge Derek Ayeh, MS, Sarah Murdoch, MSW, Frederic Riccardi, MSW, and Beth Shyken-Rothbart, JD, of the Medicare Rights Center for their support, which included discussions about our findings to help frame our conclusions. No Medicare Rights Center staff were compensated for these discussions.

^✉

Corresponding author.

PMCID: PMC13451982 PMID: 42566205

Abstract

This cross-sectional study uses Medicare data to examine outcomes associated with the New York 2023 Medicaid and Medicare Savings Program eligibility expansion in the number and characteristics of dually enrolled beneficiaries.

Introduction

Although Medicare is designed to provide health insurance to those with adequate work history, its costs can hinder access to health care. Out-of-pocket health care spending accounted for nearly 40% of the average Medicare beneficiary’s Social Security income in 2022.¹ Medicaid and the Medicare Savings Program (MSP)—benefits administered by state Medicaid programs—assist with health care costs for those eligible. States can choose to expand eligibility criteria for both benefits beyond federal guidelines.

Effective January 2023, New York increased the income limits for 2 MSPs: the Qualifying Individual (QI) and Qualified Medicare Beneficiary (QMB) programs.² The income limit for QI increased from 135% to 186% of the federal poverty level (FPL).² The QMB income limit increased from 100% to 138% of the FPL.² Both programs cover the Medicare Part B premium,^2,3 and QMB covers Medicare cost-sharing (eg, deductibles, coinsurance).^2,3

New York concurrently increased the Medicaid income limit from approximately 82% to 138% of the FPL⁴ and the asset limit by over 50%⁵ for adults who are older and/or disabled (the eTable in Supplement 1 presents MSP and Medicaid eligibility criteria). Those with incomes above 138% FPL can qualify for Medicaid through the spenddown program. This requires submitting proof of medical expenses to Medicaid, which reduce the person’s countable income.^4,5

In this cross-sectional study, we use Medicare data to examine the outcomes associated with the New York 2023 Medicaid and MSP eligibility expansion in terms of the number and characteristics of dually enrolled beneficiaries.

Methods

The Institutional Review Board of Brown University determined this study was exempt from ethics review because of the use of secondary data. This study followed the STROBE reporting guideline. We used the Medicare Master Beneficiary Summary File from 2021 to 2023 as our primary source of enrollment information and beneficiary characteristics. We identified MSP and Medicaid enrollment using the monthly Medicare-Medicaid dual indicator. We regressed pre-2023-monthly MSP and Medicaid enrollment data on a linear time trend to estimate expected enrollment shares in 2023 in lieu of a policy change.

We examined enrollee characteristics prepolicy and postpolicy change (ie, 2022 vs 2023). We defined newly enrolled individuals as those who were not covered by the MSP or Medicaid at the start of our study period (January 2021) and gained either or both benefits between February 2021 and December 2023. We also examined those who transitioned from receipt of either Medicaid or the MSP to both. Analyses were conducted using STATA 18 (StataCorp) from October 2025 to January 2026.

Results

MSP and Medicaid actualized enrollment were higher than projected enrollment (Figure, A). By December 2023, 751 134 (64.8%) of nearly 1 200 000 dually enrolled beneficiaries received both benefits (Figure, B).

Two-panel chart of enrollment over time and enrollee counts, 2021 to 2023. Two vertically stacked panels labeled A and B. Panel A title at upper left: Rates of enrollment. Vertical axis label: Enrollment, percent, with tick marks from 2 to 20. Horizontal axis labeled by months Jan, Mar, May, Jul, Sep, Nov repeated across years 2021, 2022, 2023. Legend in upper left lists six series: Medicaid without M S P in solid light green; M S P without Medicaid in solid orange; Medicaid and M S P in solid blue gray; projected versions of each as dotted lines in matching colors. Solid light green Medicaid without M S P rises from about 7 point 2 percent in early 2021 to about 8 point 1 percent by late 2021, then to about 8 point 9 percent by late 2022, followed by a sharp drop near Jan 2023 to about 6 point 9 percent and a gradual decline to about 6 point 5 percent by Nov 2023. Solid orange M S P without Medicaid stays near 3 point 8 to 4 point 0 percent through 2021 and 2022, then edges down to about 3 point 7 to 3 point 8 percent by late 2023. Solid blue gray Medicaid and M S P stays near 13 point 7 to 14 point 2 percent through 2021 and 2022, then jumps around Jan 2023 to about 16 point 5 percent and increases to about 18 point 7 percent by Nov 2023. Dotted projected lines remain smooth: projected Medicaid without M S P increases from about 7 point 3 to about 9 point 5 percent by late 2023; projected M S P without Medicaid stays near 3 point 9 to 4 point 0 percent; projected Medicaid and M S P stays near 13 point 8 to 14 point 4 percent. Panel B title at upper left: Number of enrollees. Vertical axis label: Enrollees, No., thousands, ranging from 0 to 1400. Horizontal axis uses the same month and year layout as panel A. A stacked area chart uses the same three solid colors as panel A, with legend at upper left: Medicaid and M S P in blue gray at the top of the stack, M S P without Medicaid in orange in the middle, Medicaid without M S P in light green at the bottom. Total stacked height increases from roughly 960 thousand in early 2021 to about 1060 thousand by late 2022, rises to about 1090 thousand around Jan 2023, then continues upward to about 1160 thousand by Nov 2023. The light green base increases to roughly 350 thousand by late 2022, drops near Jan 2023 to about 270 thousand, then trends down toward about 250 thousand by late 2023; the orange band remains near 140 to 160 thousand with a brief rise near late 2022; the blue gray top band expands notably after Jan 2023. — A, Regression of pre-2023 monthly MSP and Medicaid enrollment data on a linear time trend to estimate the expected enrollment shares and numbers in 2023 in lieu of a policy change. B, The increase of beneficiaries with both Medicaid and the MSP included those with dual enrollment being reassessed after the policy change took effect.

There were 52 640 more new dually enrolled individuals (127 226 vs 179 866) and 143 327 more individuals who transitioned from either Medicaid or the MSP to both (29 964 vs 173 291) in 2023 compared with 2022 (Table). Groups differed by all observed characteristics. New dually enrolled individuals (41.7% vs 45.6%) and beneficiaries who transitioned from one to both programs (29.1% vs 45.6%) had higher proportions of non-Hispanic White beneficiaries in 2023 compared with 2022. While new dually enrolled individuals in 2023 were older compared with those in 2022 (mean [SD] age, 68.1 [12.7] years vs 66.0 [13.0] years), Medicare beneficiaries who transitioned from one to both programs had a higher proportion of younger beneficiaries (mean [SD] age, 67.0 [12.3] years vs 63.9 [11.4] years).

Table. Characteristics of Dually Enrolled Individuals in New York State, 2022-2023.

Characteristic^a	No. (%)				P value^b
	New dually enrolled individuals^c		Switched from MSP or Medicaid to both Medicaid and MSP^d
	2022 (n = 127 226)	2023 (n = 179 866)	2022 (n = 29 964)	2023 (n = 173 291)
Race and ethnicity^e
American Indian or Alaska Native	308 (0.2)	298 (0.2)	67 (0.2)	470 (0.3)	<.001
Asian or Other Pacific Islander	16 542 (13.0)	19 408 (10.8)	6908 (23.1)	20 014 (11.5)
Black or African American	23 333 (18.3)	29 121 (16.2)	5112 (17.1)	28 744 (16.6)
Hispanic	25 614 (20.1)	34 120 (19.0)	7193 (24.0)	36 095 (20.8)
Non-Hispanic White	53 028 (41.7)	82 027 (45.6)	8708 (29.1)	79 076 (45.6)
Other	1444 (1.1)	3450 (1.9)	280 (0.9)	1857 (1.1)
Unknown	6957 (5.5)	11 442 (6.4)	1696 (5.7)	7035 (4.1)
Sex^f
Male	57 359 (45.1)	78 440 (43.6)	13 112 (43.8)	78 216 (45.1)	<.001
Female	69 867 (54.9)	101 426 (56.4)	16 852 (56.2)	95 075 (54.9)	<.001
Age, mean (SD), y	66.0 (13.0)	68.1 (12.7)	67.0 (12.3)	63.9 (11.4)	<.001
Age range, y
≤30	3212 (2.5)	3235 (1.8)	7248 (24.2)	47 832 (27.6)	<.001
31-40	3196 (2.5)	3571 (2.0)	608 (2.0)	2210 (1.3)
41-50	4315 (3.4)	4838 (2.7)	765 (2.6)	6000 (3.5)
51-55	4854 (3.8)	5337 (3.0)	1166 (3.9)	11 231 (6.5)
56-60	7127 (5.6)	8367 (4.7)	954 (3.2)	9950 (5.7)
61-65	54 399 (42.8)	66 189 (36.8)	1398 (4.7)	14 294 (8.2)
66-70	15 033 (11.8)	24 206 (13.5)	7987 (26.7)	50 052 (28.9)
71-75	10 816 (8.5)	19 708 (11.0)	4227 (14.1)	12 897 (7.4)
>75	24 274 (19.1)	44 415 (24.7)	5611 (18.7)	18 825 (10.9)
Original reason for Medicare entitlement
Age	92 090 (72.4)	133 617 (74.3)	21 606 (72.1)	101 847 (58.8)	<.001
Disability	34 138 (26.8)	45 131 (25.1)	7998 (26.7)	69 753 (40.3)
Kidney failure and kidney failure with disability	998 (0.8)	1118 (0.6)	360 (1.2)	1691 (1.0)
Medicare Advantage enrollment^g
Yes	74 248 (58.4)	88 347 (49.1)	11 697 (39.0)	52 425 (30.3)	<.001
No	52 978 (41.6)	91 519 (50.9)	18 267 (61.0)	120 866 (69.7)	<.001

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Abbreviations: MBSF, Master Medicare Beneficiary Summary; MSP, Medicare Savings Program.

^{^a}

All demographic variables were taken from the MBSF.

^{^b}

P values represent Pearson χ² comparisons between the respective groups over time (eg, new dually enrolled individuals in 2022 vs new dually enrolled individuals in 2023).

^{^c}

New dually enrolled individuals are those who gained MSP and/or Medicaid benefits who did not previously receive benefits during our study period (January 2021-December 2023). New dually enrolled individuals also include those who became Medicare eligible during our study period and subsequently gained the MSP and/or Medicaid. We counted an individual as a new dually enrolled person the month they first gained benefits. Dual status was defined using the dual eligible variables in the MBSF.

^{^d}

This group includes those who had Medicaid or MSP benefits (eg, Qualified Medicare Beneficiary without Medicaid, Medicaid without the MSP) for 3 months and then began receiving both the MSP and Medicaid. We counted an individual as a person who switched to MSP and Medicaid the month that they first gained both benefits.

^{^e}

Race and ethnicity were categorized using the MBSF Research Triangle Institute race code. We report beneficiaries’ race and ethnicity, which act as proxies for exposure to discrimination and social disadvantage.

^{^f}

Sex was determined using data from the MBSF, which is limited to “male” and “female” options.

^{^g}

We considered a person enrolled in Medicare Advantage if they were enrolled in a Medicare Advantage plan for at least 6 months of the given calendar year.

Discussion

We found that the New York 2023 MSP and Medicaid eligibility changes were associated with higher enrollment in programs that provide the most comprehensive financial assistance. Those with both programs have cost-sharing protections and access to wraparound services not covered by Medicare (eg, long-term care), unlike those enrolled in just one or neither program.^6,7 Enrollment in both may promote access to care and free up an individual’s limited income for other necessities.⁷ Limitations include a cross-sectional descriptive design that cannot assess causality and that we lacked the ability to observe beneficiary income and asset information.

This increase in enrollment resulted from shifting existing MSP or Medicaid enrollees into combined MSP and Medicaid enrollment, as well as newly eligible enrollees. The former likely indicates a reduction in Medicaid spenddowns, signifying a lower administrative burden for beneficiaries, their caregivers, and Medicaid staff. Those who shifted from one to both programs tended to be aged less than 65 years and eligible due to disability, while new dually enrolled individuals tended to be older. This may be because the baseline Medicaid enrollment rates for those aged less than 65 years are higher than those aged 65 and older.⁸

Medicaid eligibility rules for Medicare enrollees are often more restrictive than criteria for other adults^6,9; therefore, the transition from Medicaid to Medicare can be unwanted, complicated, and financially burdensome.⁶ New York is the only state that has aligned QMB and Medicaid income limits for adults,¹⁰ and is one of few states without an MSP asset limit.² Further research on the effects of the New York policy change, including the potential impact of replication in other states, is crucial, since access to QMB’s financial protections and Medicaid coverage would vary in magnitude across states.

Supplement 1.

eTable. Income and asset limits for the Medicare Savings Program (MSP) and Medicaid in New York State prepolicy and postpolicy changes effective January 2023

jamahealthforum-e262394-s001.pdf^{(140.2KB, pdf)}

Supplement 2.

Data Sharing Statement

jamahealthforum-e262394-s002.pdf^{(14.9KB, pdf)}

References

1.Ochieng N, Cubanski J, Neuman T, Damico A. Health Costs Consume a Large Portion of Income for Millions of People with Medicare. KFF. August 21, 2025. Accessed February 16, 2026. https://www.kff.org/medicare/health-costs-consume-a-large-portion-of-income-for-millions-of-people-with-medicare/
2.Florez G, Ayeh D, Shyken-Rothbart B. Increasing Access to Medicare Savings Programs: Lessons Learned and Policy Recommendations from New York. Medicare Rights Center. Accessed February 16, 2026. https://www.medicarerights.org/policy-documents/increasing-access-to-medicare-savings-programs
3.Koma JW, Yang Z, Price M, et al. Qualified Medicare Beneficiary Program: Enrollment Trends And Characteristics Of Low-Income Beneficiaries. Health Aff (Millwood). 2025;44(7):878-886. doi: 10.1377/hlthaff.2024.01189 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Sbrana L. Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level and Related Medically Needy and MBI-WPD Resource Level Changes. New York State Department of Health. Accessed February 16, 2026. https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf
5.Novick R. What You Need to Know About NYS Medicaid Expansion in 2023. NY Health Access. Accessed April 20, 2026. https://nyhealthaccess.org/index.php?View=entry&EntryID=248&Msg=&mobile=0#Increased_Resource_Limits_
6.Hayes SL, Byrnes ME, Furst W, Beathard E, Tipirneni R. Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study. J Gen Intern Med. 2026;41(5):1241-1249. Published online September 2, 2025. doi: 10.1007/s11606-025-09789-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Kertesz K. New Resources on QMB Billing Protections. Center for Medicare Advocacy. November 7, 2024. Accessed April 21, 2026. https://medicareadvocacy.org/new-resources-on-qmb-billing-protections/
8.How to Avoid the . “Medicare Cliff.” The National Council on Aging. August 26, 2024. Accessed April 20, 2026. https://www.ncoa.org/article/building-a-bridge-to-avoid-the-medicare-cliff-that-harms-older-adults/
9.Medicaid Eligibility for Medically Needy Populations . KFF. Accessed February 16, 2026. https://www.kff.org/medicaid/state-indicator/medicaid-eligibility-through-the-medically-needy-pathway/
10.Eligibility for Medicare Savings Programs for Qualifying Individuals (QIs) . KFF. Accessed February 16, 2026. https://www.kff.org/medicare/state-indicator/eligibility-for-medicare-savings-programs-for-qualifying-individuals-qis/

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eTable. Income and asset limits for the Medicare Savings Program (MSP) and Medicaid in New York State prepolicy and postpolicy changes effective January 2023

jamahealthforum-e262394-s001.pdf^{(140.2KB, pdf)}

Supplement 2.

Data Sharing Statement

jamahealthforum-e262394-s002.pdf^{(14.9KB, pdf)}

[ald260023r1] 1.Ochieng N, Cubanski J, Neuman T, Damico A. Health Costs Consume a Large Portion of Income for Millions of People with Medicare. KFF. August 21, 2025. Accessed February 16, 2026. https://www.kff.org/medicare/health-costs-consume-a-large-portion-of-income-for-millions-of-people-with-medicare/

[ald260023r2] 2.Florez G, Ayeh D, Shyken-Rothbart B. Increasing Access to Medicare Savings Programs: Lessons Learned and Policy Recommendations from New York. Medicare Rights Center. Accessed February 16, 2026. https://www.medicarerights.org/policy-documents/increasing-access-to-medicare-savings-programs

[ald260023r3] 3.Koma JW, Yang Z, Price M, et al. Qualified Medicare Beneficiary Program: Enrollment Trends And Characteristics Of Low-Income Beneficiaries. Health Aff (Millwood). 2025;44(7):878-886. doi: 10.1377/hlthaff.2024.01189 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ald260023r4] 4.Sbrana L. Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level and Related Medically Needy and MBI-WPD Resource Level Changes. New York State Department of Health. Accessed February 16, 2026. https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf

[ald260023r5] 5.Novick R. What You Need to Know About NYS Medicaid Expansion in 2023. NY Health Access. Accessed April 20, 2026. https://nyhealthaccess.org/index.php?View=entry&EntryID=248&Msg=&mobile=0#Increased_Resource_Limits_

[ald260023r6] 6.Hayes SL, Byrnes ME, Furst W, Beathard E, Tipirneni R. Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study. J Gen Intern Med. 2026;41(5):1241-1249. Published online September 2, 2025. doi: 10.1007/s11606-025-09789-9 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ald260023r7] 7.Kertesz K. New Resources on QMB Billing Protections. Center for Medicare Advocacy. November 7, 2024. Accessed April 21, 2026. https://medicareadvocacy.org/new-resources-on-qmb-billing-protections/

[ald260023r8] 8.How to Avoid the . “Medicare Cliff.” The National Council on Aging. August 26, 2024. Accessed April 20, 2026. https://www.ncoa.org/article/building-a-bridge-to-avoid-the-medicare-cliff-that-harms-older-adults/

[ald260023r9] 9.Medicaid Eligibility for Medically Needy Populations . KFF. Accessed February 16, 2026. https://www.kff.org/medicaid/state-indicator/medicaid-eligibility-through-the-medically-needy-pathway/

[ald260023r10] 10.Eligibility for Medicare Savings Programs for Qualifying Individuals (QIs) . KFF. Accessed February 16, 2026. https://www.kff.org/medicare/state-indicator/eligibility-for-medicare-savings-programs-for-qualifying-individuals-qis/

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Expansion of Medicaid Benefits for Medicare Beneficiaries in New York State

Em Balkan, MSW

Laura M Keohane, PhD

Momotazur Rahman, PhD

Jaclyn M W Hughto, PhD, MPH

David J Meyers, PhD, MPH

Abstract

Introduction

Methods

Results

Figure. Line Graphs of Medicaid and Medicare Savings Program (MSP) Enrollment in New York State, 2021-2023.

Table. Characteristics of Dually Enrolled Individuals in New York State, 2022-2023.

Discussion

References

Associated Data

Supplementary Materials

ACTIONS

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Expansion of Medicaid Benefits for Medicare Beneficiaries in New York State

Em Balkan, MSW

Laura M Keohane, PhD

Momotazur Rahman, PhD

Jaclyn M W Hughto, PhD, MPH

David J Meyers, PhD, MPH

Abstract

Introduction

Methods

Results

Figure. Line Graphs of Medicaid and Medicare Savings Program (MSP) Enrollment in New York State, 2021-2023.

Table. Characteristics of Dually Enrolled Individuals in New York State, 2022-2023.

Discussion

References

Associated Data

Supplementary Materials

ACTIONS

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RESOURCES

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