Medicaid New York – Nancy E Kline

Regional Rates for 2020

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Jan 112020

The regional rates for the year 2020, for use in calculating Medicaid penalty periods, are found in GIS 20 MA/01, which is dated 01/10/2020. They are:

CENTRAL: $10,451
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, and Tompkins.

NORTHEASTERN: $11,295
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington.

WESTERN: $10,720
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming.

NORTH METROPOLITAN: $12,805
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.

NEW YORK CITY: $12,844
Bronx, Kings (Brooklyn), New York (Manhattan), Queens, and Richmond (Staten Island).

LONG ISLAND: $13,407
Nassau and Suffolk.

ROCHESTER: $12,460
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates.

Posted 01/11/2020

Substantial Home Equity Limit for 2020

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Dec 212019

The Substantial Home Equity Limit for 2020 is shown in GIS 19 MA/12, which is dated 12/19/19.

Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:

HOME EQUITY LIMIT FOR 2020
The home equity limit for Medicaid coverage of nursing facility services is $893,000 for 2020. GIS 19 MA/12, page 2.

For an explanation of how this rule works, see pages 13-14 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Posted 12/21/2019

Income Levels for 2019

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Dec 092018

Medicaid income levels for the year 2019 are shown in GIS 18 MA/15, which is dated 12/7/18.

Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:

INCOME LEVEL FOR 2019 — MONTH ONE — PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2019 is $859 per month. GIS 18 MA/15, page 2.

INCOME LEVEL FOR 2019 — MONTH ONE — PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE.
The Medically Needy Income Level for a household of one for 2019 is $859 per month. GIS 18 MA/15, page 2.

INCOME LEVEL FOR 2019 — AFTER MONTH ONE — PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2019 if they do not have a community spouse. GIS 18 MA/15, Attachment I.

INCOME LEVEL FOR 2019 — AFTER MONTH ONE — PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2019 if they have a community spouse. GIS 18 MA/15, Attachment I.

INCOME LEVEL FOR 2019 — COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,160.50 per month for 2019. GIS 18 MA/15, page 2.

Posted 12/09/2018

Regional Rates for 2018

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Dec 052017

The 2018 regional rates for calculating Medicaid penalty periods are found in GIS 17 MA/19. They are:

CENTRAL: $9,722
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $10,719
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $10,239
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $12,428
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $12,319
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $13,053
Nassau and Suffolk.

ROCHESTER: $11,692
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 12/05/2017

Substantial Home Equity Limit for 2017

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Dec 262016

Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:

HOME EQUITY LIMIT FOR 2017
The home equity limit for Medicaid coverage of nursing facility services is $840,000 for 2017. GIS 16 MA/18, page 2.

For an explanation of how this rule works, see pages 13-14 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Income Levels for 2017

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Dec 262016

Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:

INCOME LEVEL FOR 2017 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2017 is $825 per month. There is no change from 2015 or 2016. GIS 16 MA/18, page 2 and Attachment.

INCOME LEVEL FOR 2017 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2017 is $825 per month. There is no change from 2015 or 2016. GIS 16 MA/18, page 2 and Attachment.

INCOME LEVEL FOR 2017 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2017 if he/she does not have a community spouse. GIS 16 MA/18, Attachment.

INCOME LEVEL FOR 2017 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2017 if he/she has a community spouse. GIS 16 MA/18, Attachment.

INCOME LEVEL FOR 2017 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,022.50 per month for 2017. GIS 16 MA/18, page 2 and Attachment.

Long Term Home Health Care Program

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Dec 142016

Pages 123 through 133 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State discuss the Long Term Home Health Care Program. This program also has been referred to as the “Nursing Home Without Walls Program” and the “Lombardi Program.”

GIS 16 MA/11 states that this program was to formally close on May 27, 2016.

Substantial Home Equity Limit for 2016

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Jan 022016

Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:

HOME EQUITY LIMIT FOR 2016:
The home equity limit for Medicaid coverage of nursing facility services is $828,000 for 2016. There is no change from 2015. GIS 15 MA/21, page 2.

For an explanation of how this rule works, see pages 13-14 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Income Levels for 2016

Income Comments Off

Jan 022016

Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:

INCOME LEVEL FOR 2016 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The Medicaid Needy Income Level for a household of one for 2016 is $825 per month. There is no change from 2015. GIS 15 MA/21.

INCOME LEVEL FOR 2016 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medicaid Needy Income Level for a household of one for 2016 is $825 per month. There is no change from 2015. GIS 15 MA/21.

INCOME LEVEL FOR 2016 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The person in the nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2016 if he/she does not have a community spouse. There is no change from 2015. GIS 15 MA/21, Attachment 1.

INCOME LEVEL FOR 2016 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The person in a nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2016 if he/she does have a community spouse. There is no change from 2015. GIS 15 MA/21, Attachment 1.

INCOME LEVEL FOR 2016 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $2,980.50 per month for 2016. There is no change from 2015. GIS 15 MA/21, page 2.

INCOME LEVEL FOR 2016 – LONG TERM HOME HEALTH CARE PROGRAM PARTICIPANT
The participant in a Long Term Home Health Care Program (also referred to as the “Lombardi Program” and the “Nursing Home Without Walls Program”) is allowed to keep a Personal Needs Allowance for Certain Waiver Participants Subject to Spousal Impoverishment Budgeting of $384 per month for 2016. There is no change from 2015. GIS 15 MA/21, page 2.

Look-back Period Start Date

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May 282015

When a person applies for Medicaid, he can request coverage for the current month and for the three prior months, assuming that he was eligible during those prior months. 18 NYCRR 360-2.4 (c). If he does this, what is the beginning of the look-back period for transfer of assets? For example, if he applies on July 1, 2015 and asks for coverage beginning April 1, 2015, does the look-back period go back to July 1, 2010 or April 1, 2010?

GIS 15 MA/07 addresses this issue.

The GIS says that the look-back period is the 60 months immediately prior to the date that an individual is both institutionalized and has applied for Medicaid (the application date). The GIS specifically uses the word “both.”

The GIS says that if an applicant is requesting coverage of nursing home care for the three-month retroactive eligibility period: the look-back period is 60 months immediately preceding the month of application. In the past, Departments of Social Services had looked back to the 60 months prior to the first month that Medicaid coverage was sought, including the three retroactive months. Effective immediately, Departments of Social Services are limited to the 60 months immediately preceding the month of institutionalization and application.

Thus, in the above example, the look-back period would go back to July 1, 2010. It would not go back to April 1, 2010.

The GIS also says that if a Medicaid recipient requests an increase in coverage, the request can be for coverage of up to three months prior to the date the request is received by the Department of Social Services. In that case, the look-back period would be 60 months from the date of institutionalization, not 60 months from the date the increase in coverage is made.

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