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Resource Levels for 2018

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Jan 042018
 

Medicaid resource levels for the year 2018 are shown in GIS 17 MA/20, which is dated 12/28/17. PLEASE NOTE: I have been told that on 01/03/18, local social services districts were notified that there is an error. The spousal impoverishment figures and statement in Attachment I of the GIS are incorrect. However, the figures in the text of the GIS itself are correct. By 01/16/18, the figures in the Attachment had been corrected.

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2018:
For 2018, the resource level for the Medicaid applicant is $15,150. GIS 17 MA/20, page 2.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2018:
For 2018, the minimum resource level for the community spouse is $74,820 and the maximum is $123,600. GIS 17 MA/20, page 3. For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Posted 01/04/18

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

New Life Expectancy Table

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Nov 072017
 

There is a new life expectancy table to use when determining if an annuity, promissory note, loan or mortgage is actuarially sound.

GIS 17 MA/16, dated 10/27/17, 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.

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.

Resource 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:

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2017:
For 2017, the resource level for the Medicaid applicant is $14,850. There is no change from 2015 or 2016. GIS 16 MA/18, page 2 and Attachment.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2017:
For 2017, the minimum resource level for the community spouse is $74,820 and the maximum is $120,900. GIS 16 MA/18, page 2 and 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.

Regional Rates for 2017

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Dec 142016
 

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 rate in order to calculate the penalty period. The regional rates for 2017 are found in GIS 16 MA/16. The GIS tells you which counties are in which region.

The GIS reminds you to use the regional rate which is in effect as of the date of the application, for the region in which the facility is located.

The 2017 regional rate are:

CENTRAL: $9,511
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $10,242
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Oswego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $10,078
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $12,198
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $12,157
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $12,811
Nassau and Suffolk.

ROCHESTER: $11,237
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

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.

New Life Expectancy Table

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Dec 142016
 

There are new life expectancy tables to use when determining if an annuity, loan, promissory note or mortgage is actuarially sound.

GIS 16 MA/10 stated 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 heading on the attachment is, “2015 Life Expectancy Table.”

GIS 16 MA/15 stated 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 heading on the attachment is, “2016 Life Expectancy Table.”

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.

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