Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2025:
The resource level for the Medicaid applicant is $32,396. GIS 25 MA/03 Attachment.
This is an update from the 2025 resource level which had previously been announced.
Posted 02/20/2025.
The 2025 regional rates for calculating Medicaid penalty periods are found in GIS 25-02, which is dated 01/13/2025. They are:
CENTRAL: $13,042
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, and Tompkins.
NORTHEASTERN: $13,916
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington.
WESTERN: $12,842
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming.
NORTH METROPOLITAN: $14,569
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.
NEW YORK CITY: $14,582
Bronx, Kings (Brooklyn), New York (Manhattan), Queens, and Richmond (Staten Island).
LONG ISLAND: $14,914
Nassau and Suffolk.
ROCHESTER: $15,127
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates.
Posted 01/14/2025
GIS 25 MA/01, which is dated 01/08/2025, discusses Medicaid renewal (recertification).
It advises that when a Medicaid case is up for renewal with a budget “From” date of 01/01/2025 or later: it should be re-budgeted using the person’s 2025 Social Security benefit amount and the person’s 2025 Medicare Part B premium.
However, if this calculation results in the person going from no spenddown to having a spenddown, or if it results in the person’s spenddown increasing: the case should be budgeted using the person’s 2024 Social Security benefit amount and the person’s 2024 Medicare Part B premium. These cases should be tracked. After the 2025 Federal Poverty Level is issued, a new Medically Needy Income level will be announced based on the 2025 Federal Poverty level. After that time, these cases should be updated using the person’s 2025 Social Security benefit amount and the person’s 2025 Medicare Part B premium.
All redeterminations effective 01/01/2025 or later will need to be re-budgeted, retroactive to 01/01/2025, after the new Medically Needy Income level based on the 2025 Federal Poverty Level is announced.
Posted 01/09/2025
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
INCOME LEVEL FOR 2025 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one is $1,732 per month for now. GIS 25 MA/01 and its attachment.
INCOME LEVEL FOR 2025 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one is $1,732 per month for now. GIS 25 MA/01 and its attachment.
INCOME LEVEL FOR 2025 – 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 if they do not have a community spouse. GIS 25 MA/01 attachment.
INCOME LEVEL FOR 2025 – 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 if they have a community spouse. GIS 25 MA/01 attachment.
INCOME LEVEL FOR 2025 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,948 per month. GIS 25 MA/01 and its attachment.
CHANGE IS COMING: GIS 25 MA/01 is dated 01/08/2025. It advises that the Medically Needy income level is based on a percentage of the Federal Poverty Level. When the 2025 Federal Poverty Level is announced, the Medically Needy income level will be updated. This is the level which is is used for Month One for a person in a nursing home who does not have a community spouse, and for Month One for a person in a nursing home who does have a community spouse.
Posted 01/09/2025
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2025:
The resource level for the Medicaid applicant remains at $31,175 for now. GIS 25 MA/01 and its Attachment.
RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2025:
The minimum resource level for the community spouse is $74,820 and the maximum is $157,920. GIS 25 MA/01 and its Attachment. For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.
CHANGE IS COMING: GIS 25 MA/01 is dated 01/08/2025. It advises that the Medically Needy resource level is based on a percentage of the Medically Needy income level, and the Medically Needy income level is based on a percentage of the Federal Poverty Level. When the 2025 Federal Poverty Level is announced, the Medically Needy resource level will be updated.
Posted 01/09/2025
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
HOME EQUITY LIMIT FOR 2025
The home equity limit for Medicaid coverage of nursing facility services is $1,097,000. GIS 25 MA/01, which is dated 01/08/2025.
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 01/09/2025
GIS 24 MA/07, dated 07/25/2024, advises that the resource test will be waived for SSI-related recipients who are renewing Medicaid eligibility. The resource test will be waived whether the person is in the community or in a nursing home. The Medicaid caseworker processing the renewal will not send asset verification requests to the Asset Verification System (AVS). If a person has been determined to be eligible for Medicaid, no action can be taken to discontinue Medicaid coverage due to excess resources, through 06/30/2025.
The resource test also will be waived, through 06/30/2025, for people who have Medicaid Community Coverage without Long Term Care, and who ask for their coverage to be increased to Medicaid Community Coverage With Long Term Care.
However, the resource test is not waived for people who are newly applying for Medicaid. Furthermore, the resource test is not waived for people who have Medicaid Community Coverage and are asking to have their coverage increased to include nursing home care. In those situations, the Medicaid caseworker will send asset verification requests to the Asset Verification System.
There is no change to the lookback requirements. There is no change to the transfer of assets rules.
The GIS has an attachment, which is a chart showing which tests apply for different types of requests.
For an explanation of Medicaid categories, such as “SSI-related,” see page 2 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.
Posted 07/31/2024.
There is a new life expectancy table to use when determining if an annuity, promissory note, loan or mortgage is actuarially sound.
GIS 24 MA/05, dated 06/10/2024, states that the life expectancy table in its attachment is to be used rather than the table which was attached to 06 OMM/ADM-5.
Posted 06/11/2024
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2024:
The resource level for the Medicaid applicant is $31,175. GIS 24 MA/01 Attachment.
This is an update from the 2024 resource level which had previously been announced.
Posted 02/16/2024.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
HOME EQUITY LIMIT FOR 2024
The home equity limit for Medicaid coverage of nursing facility services is $1,071,000. GIS 23 MA/23, which is dated 12/29/2023.
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 12/29/2023