Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
HOME EQUITY LIMIT FOR 2014:
The home equity limit for Medicaid coverage of nursing facility services is $814,000 for 2014. GIS 13 MA/022, page 3.
Note that it was $803,000 for the year 2013. GIS 13 MA/02, page 3.
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.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2014:
The resource level for the Medicaid applicant is $14,550 for the year 2014. GIS 13 MA/022, page 2 and Attachment 2. Note that Attachment 1 lists the amount as $14,400, which was the 2013 amount; I assume this is a typo.
RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2014:
For 2014, the minimum is $74,820 and the maximum is $117,240. GIS 13 MA/022, page 3 and Attachment 1.
For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
INCOME LEVEL FOR 2014 – 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 2014 is $809 per month. GIS 13 MA/022, page 2 and Attachment 2.
INCOME LEVEL FOR 2014 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2014 is $809 per month. GIS 13 MA/022, page 2 and Attachment 2.
INCOME LEVEL FOR 2014 – 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 2014 if he does not have a community spouse. GIS 13 MA/022, Attachment 1.
INCOME LEVEL FOR 2014 – 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 2014 if he does have a community spouse. GIS 13 MA/022, Attachment 1.
INCOME LEVEL FOR 2014 – COMMUNITY SPOUSE
The community spouse is allowed to keep $2,931 per month of income for 2014. GIS 13 MA/022, page 3 and Attachment 1.
INCOME LEVEL FOR 2014 – 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 $383 per month for 2014. GIS 13 MA/022, page 3.
GIS 13 MA/06 advises that GIS 12 MA/001 has the correct method for calculating the value of a life estate, but the IRS website addresses provided in GIS 12 MA/001 are incorrect. This problem has already been noted on this website.
Unfortunately, GIS 13 MA/06 also contains an incorrect web address.
GIS 13 MA/06 does note that the IRS website can be changed at any time. Thus, GIS 13 MA/06 suggests that interest rates can be found by going to the IRS website and typing the following term in the search box: “Section 7520 Interest Rates”
GIS 13 MA/06 suggests that Table S can be found by going to the IRS website and typing the following term in the search box: “Table S”
As previously noted on this website, GIS 12 MA/001 changed the method of calculating the value of a life estate. Page 40 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State describes the old rule which was changed by GIS 12 MA/001.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
INCOME LEVEL FOR 2013 – 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 2013 is $800 per month. GIS 13 MA/02, at 2.
INCOME LEVEL FOR 2013 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2013 is $800 per month. GIS 13 MA/02, at 2.
INCOME LEVEL FOR 2013 – 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 2013 if he does not have a community spouse. GIS 13 MA/02, Attachment I.
INCOME LEVEL FOR 2013 – 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 2013 if he does have a community spouse. GIS 13 MA/02, Attachment I.
INCOME LEVEL FOR 2013 – COMMUNITY SPOUSE
The community spouse is allowed to keep $2,898 per month of income during 2013. GIS 13 MA/02, Attachment I.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2013:
The resource level for the Medicaid applicant is $14,400 for the year 2013. GIS 13 MA/02, Attachment I.
COMMUNITY SPOUSE RESOURCE ALLOWANCE FOR 2013:
For 2013, the minimum is $74,820 and the maximum is $115,920. The community spouse may keep $74,820 or the amount of the spousal share, up to $115,920, whichever is greater. The “spousal share” is the amount equal to one-half of the total value of the couple’s countable resources as of the beginning of the most recent continuous period of institutionalization of the institutionalized spouse. GIS 03 MA/02, Attachment I.
Page 54 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State describes how to calculate a penalty period when someone has made a gift. You need to know the regional rates in order to calculate the penalty period. The regional rates for 2013 are found in GIS 13 MA/01. The GIS tells you which counties are in which region. It reminds you to use the rate for the region in which the nursing home is located. The GIS may be found at the New York State Department of Health website: health.ny.gov
The 2013 rates by region are as follows:
Central: $8,432
Northeastern: $8,950
Western: $8,682
Northern Metropolitan: $10,737
New York City: $11,350
Long Island: $12,034
Rochester: $9,782
There is a new life expectancy table to use when determining if an annuity, promissory note, loan or mortgage is actuarially sound. GIS 12 MA/025 states that the life expectancy table in its attachment is to be used in place of the life expectancy table at 06 OMM/ADM-5.
The third full paragraph on page 40 of Medicaid Financial Eligibilty Rules for Nursing Home Care in New York State describes how to calculate the value of a life estate for Medicaid purposes. At the time the book was published, 96 ADM-8, at 20, and Medicaid Reference Guide, at 353, stated that Social Service Districts may, but are not required to, use the life estate and remainder interest table attached to 96 ADM-8 when calculating the value of life estates and remainder interests.
Effective September 26, 2011, a different method must be used when calculating the value of a life estate or a remainder interest for Medicaid purposes. 11 OHIP/ADM-8, at 7; GIS 12 MA/001. The Internal Revenue Service tables must now be used. 11 OHIP/ADM-8, at 7; GIS 12 MA/001.
In order to do the calculation, you must know the age of the life estate holder on the date of the transaction.
STEP ONE
When doing the calculation, the first step is to find the IRS code 7520 interest rate for the appropriate month and year. 11 OHIP/ADM-8, at 7.
The ADM contained a link which was supposed to take you to the 7520 interest rate table. The link in the ADM was http://www.irs.gov/businesses/small/article/0,,id=112482,00.html
Unfortunately, if you use that link, you get the following error message from the IRS website: “We have redesigned the IRS.gov website to make it easier and faster to find the information you need. If you have reached this page by selecting a bookmark that worked previously, it is likely the URL has changed. To navigate to the new redesigned IRS website click on the homepage link. You may also Search the site for specific information. Once you have arrived at the desired page, please update your bookmark.”
To find the 7520 interest rate table, go to www.irs.gov
In the search box, type in: 7520
Click on SEARCH
Click on the link for 7520 interest rates.
You will be taken to a table which shows Section 7520 interest rates for the current year.
If you need the Section 7520 interest rates for a prior year, you will see “For prior years’ rates, please refer to Section 7520 Interest Rates for Prior Years” directly beneath the table for the current year.
However, this link does not work, either.
If you click on the link, it will take you to a list of years. If you click on the year that you need, you will get a message telling you that you will be leaving the IRS website. If you click on LEAVE IRS WEBSITE, you will be taken to a blank page.
Several non-IRS websites contain the Section 7520 rate tables for prior years. To find one, google a search term such as: 7520 Rates 2011.
Once you get to a Section 7520 table that you are able to use, make a note of the interest rate for the month and year that you need.
STEP TWO
11 OHIP/ADM-8, at 7, says that the next step is to find Table S.
11 OHIP/ADM-8, at 7 stated that a direct link could be found at http://www.irs.gov/retirement/article/0,,id=206601,00.html
However, if you try this link, you will get the same error message from the IRS website that is shown in Step One, above.
To find Table S, go to www.irs.gov
In the search box, type in: Section 7520 Actuarial Table
Click on SEARCH
Click on the link for Actuarial Tables.
You will be taken to the Table of Contents for Publication 1457: Annuities, Life Estates & Remainders.
Click on TABLE S, which is in Section 1.
Note that this is an Excel spreadsheet. If you do not have the Excel application on your computer, you might not be able to open this document.
You will see a table with headings Age, Annuity, Life Estate, Remainder and then Age, Annuity, Life Estate and Remainder again. Above those headings, you will see that it says Interest at 0.2 Percent. If you scroll down, it will say Interest at 0.4 Percent above the next table. Keep scrolling down until you find the interest rate that you were told to use in Step One.
When you find the correct interest rate, scroll down until you find the row for the age of the person for whom you are calculating the life estate value.
Use the Life Estate column for that row.
EXAMPLE FROM 11 OHIP/ADM-8, AT 7
Calculate the value of a life estate owned by a 76-year old in July of 2011. The fair market value of the property is $270,000.
Step One: find the IRS Code 7520 interest rate for the appropriate month and year.
For July 2011, it is: 2.4%.
Step Two: Find Table S.
Find the Interest at 2.4% heading.
Find the Life Estate column for a 76-year old: it is 0.21231.
$270,000 x 0.21231 = $57,323.70. That is the value of the 76-year-old’s life estate.
LONG-TERM CARE INSURANCE POLICIES ISSUED UNDER THE NEW YORK STATE PARTNERSHIP FOR LONG-TERM CARE
TYPES OF POLICIES
As explained on pages 118-119 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State, there are two types of long-term care insurance policies issued under the New York State Partnership for Long-Term Care: Total Asset Protection plans and Dollar for Dollar Protection plans.
When the book was published, there were two types of Total Asset Protection plans. The Total Asset 50 Protection Plan will pay for 3 years of care in a nursing home or 6 years of care at home, or some combination, with 2 home care days equaling 1 nursing home day. 11 NYCRR 39.3 refers to this as the 3/6/50 plan.
The Total Asset 100 Protection Plan will pay for 4 years of care in a nursing home or 4 years of care at home, with 1 home care day equaling 1 nursing home day. 11 NYCRR 39.5 refers to this as the 4/4/100 plan.
When the book was published, there were two types of Dollar for Dollar Protection plans. The Dollar for Dollar 50 Protection Plan will pay for 1.5 years of care in a nursing home or 3 years of care at home, or some combination, with 2 home care days equaling 1 nursing home day. 11 NYCRR 39.4 refers to this as the 1.5/3/50 plan.
The Dollar for Dollar 100 Protection Plan will pay for 2 years of care in a nursing home or 2 years of care at home, or some combination, with 1 home care days equaling 1 nursing home day. 11 NYCRR 39.6 refers to this as the 2/2/100 plan.
The sections of 11 NYCRR Part 39 mentioned above do not specify whether a given plan is Total Asset Protection or Dollar for Dollar. However, Social Services Law section 367-f (1)(a) discusses the Medicaid aspect of Partnership plans. It defined “Medicaid extended coverage” to mean eligibility for Medicaid without regard to the resource rules of Social Services Law section 366 [which would be Total Asset Protection]
OR
without consideration of an amount of resources equivalent to the value of the benefits received under the Partnership plan [which would be Dollar for Dollar Protection], for people with a Partnership plan which has a residential health care facility benefit of less than three years.
Social Services Law section 367-f was amended by Chapter 59, section 82 of the Laws of 2011. The law was enacted on March 31, 2011. This portion of it became effective on January 1, 2012. It replaced the word “three” in the preceding paragraph with the word “two.” In other words, it now states:
OR
without consideration of an amount of resources equivalent to the value of the benefits received under the Partnership plan [which would be Dollar for Dollar Protection], for people with a Partnership plan which has a residential health care facility benefit of less than three two years.
The reason for this change may be that 11 NYCRR 39.7 added a new type of Partnership Plan: the 2/4/50 plan. It will pay for 2 years of care in a nursing home or 4 years of care at home, with 2 home care days equaling 1 nursing home day. It became effective June 1, 2012.
The website of the New York State Partnership for Long Term Care may be found at www.nyspltc.org. It says that the new 2/4/50 plan is a Total Asset Protection Plan.
Under the old language of Social Services Law section 367-f (1)(a), the new 2/4/50 plan would have been a Dollar for Dollar Plan, because plans of less than three years did not provide Total Asset Protection. With the change to Social Services Law section 367-f (1)(a), the new 2/4/50 plan can be a Total Asset Protection Plan because it does not have a benefit of less than two years.
Question: what about the old 2/2/100 Plan? It was supposed to be a Dollar for Dollar Protection Plan. But the amended Social Services Law section 367-f (1)(a) seems to define Dollar for Dollar Protection Plans as those which have a residential health care facility benefit of less than two years. This plan does not have a residential health care facility benefit of less than two years.
USE OF MEDICAID EXTENDED COVERAGE IN OTHER STATES
Another recent change to Partnership plans involves Medicaid Extended coverage.
When the owner of a Partnership plan has used up his benefits under the policy, he can apply for Medicaid. Special Medicaid eligibility rules apply. Previously, he had to be in New York State when he went on Medicaid if he wanted to take advantage of the special Medicaid eligibility rules.
The federal Deficit Reduction Act of 2005 discusses reciprocity among states for Partnership plans. See section 6021 (b) of the DRA. Instructions on how to find the DRA are in the section of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State which discusses how to find documents and information online.
The website of the New York State Partnership for Long Term Care had a bulletin which said that New Yorkers who move to one of the 40 other states which have Partnership plans will be able to take advantage of Medicaid extended coverage in those states. The bulletin said that reciprocity would be available as soon as New York State Department of Financial Services Insurance Regulation 144 became effective.
New York State Department of Financial Services Insurance Regulation 144 became effective on June 1, 2012. It added 11 NYCRR 39.8.
11 NYCRR 39.8 (a) states that insurers must provide disclosures. 11 NYCRR 39.8 (a)(3) states that the disclosure must advise that a person who leaves New York may not be eligible for Medicaid asset protection in another state if his destination is no longer a reciprocal state, so he should verify reciprocity.
11 NYCRR 39.8 (a)(5) states that a person will not be eligible for Medicaid asset protection in a non-Partnership state and in a non-reciprocal state.
11 NYCRR 39.8 (a)(7) states that if a person with a New York Total Asset Protection plan applies for Medicaid in a reciprocal state, he will only get Medicaid asset protection equal to the benefits paid by the plan. Thus, his Total Asset Protection plan becomes a type of Dollar for Dollar Protection plan.
To find Department of Financial Services Insurance Regulation 144, go to http://www.dfs.ny.gov/
Click on LEGAL at the toolbar near the top of the page.
Click on REGULATIONS.
Scroll down to FINAL ADOPTIONS.
Click on INSURANCE.
Click on 2012.
Scroll down to NOTICE OF ADOPTION OF 3RD AMENDMENT TO REGULATION 144 (11 NYCRR 39)(PDF FORMAT)
DEFINITION OF “ASSET” FOR PARTNERSHIP PLANS
Please note that when the term “asset” is used in connection with Partnership long-term care insurance plans, it refers to resources; it does not include income. Thus “total asset protection” means protection of resources but not protection of income. Medicaid Reference Guide, at glossary ii.
CITATION CHANGES
The Medicaid Reference Guide was updated since Medicaid Financial Eligibility Rules for Nursing Home Care in New York State was published.
On page 119, 1st full paragraph:
Change the Medicaid Reference Guide citation from page 684 to page 685.1.
On page 121, 2nd full paragraph:
Change the Medicaid Reference Guide citation from page 684 to page 685.1.
Posted 06/16/2012