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Regional Rates for 2016

Transfer of Assets (Gifting) Comments Off

Jan 022016

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 2016 are found in GIS 15 MA/23. The GIS tells you which counties are in which region.

GIS 15 MA/23 advises of a change regarding which regional rate to use. In the past, you used the regional rate in effect on the “pick-up date” (the date you wanted Medicaid coverage to start). Now you use the rate in effect on the date that the application is filed. The GIS gives an example. If the application is filed in February 2016, and the application requests coverage beginning in November 2015, you need to use the 2016 regional rate. This rule is “effective immediately.” The GIS is dated 12/23/15.

GIS 15 MA/01, which contained the 2015 regional rates, reminded people to use the rate for the region in which the facility is located.

The 2016 regional rates are:

CENTRAL: $9,252
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins counties.

NORTHEASTERN: $9,806
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties.

WESTERN: $9,630
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties.

NORTHERN METROPOLITAN:$11,768
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties.

NEW YORK CITY: $12,029
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $12,633
Nassau and Suffolk counties.

ROCHESTER: $11,145
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties.

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.

Resource Levels for 2016

Resources Comments Off

Jan 022016

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2016:
For 2016, the resource level for the Medicaid applicant is $14,850. There is no change from 2015. GIS 15 MA/21.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2016:
For 2016, the minimum resource level for the community spouse is $74,820 and the maximum is $119,220. There is no change from 2015. GIS 15 MA/21. For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Look-back Period Start Date

Transfer of Assets (Gifting) Comments Off

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.

Regional Rates for 2015

Transfer of Assets (Gifting) Comments Off

Feb 032015

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 2015 are found in GIS 15 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 facility is located.

The 2015 regional rates are:

CENTRAL: $8,768
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins counties.

NORTHEASTERN: $9,414
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties.

WESTERN: $9,422
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties.

NORTHEASTERN METROPOLITAN:$11,455
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties.

NEW YORK CITY: $11,843
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $12,390
Nassau and Suffolk counties.

ROCHESTER: $10,660
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties.

Income Levels for 2015

Income Comments Off

Jan 082015

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

INCOME LEVEL FOR 2015 — 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 2015 is $825 per month. GIS 14 MA/29.

INCOME LEVEL FOR 2015 — MONTH ONE — PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2015 is $825 per month. GIS 14 MA/29.

INCOME LEVEL FOR 2015 — 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 2015 if he does not have a community spouse.

INCOME LEVEL FOR 2015 — 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 2015 if he does have a community spouse.

INCOME LEVEL FOR 2015 — COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $2,980.50 per month for 2015. GIS 14 MA/29.

INCOME LEVEL FOR 2015 — 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 2015. GIS 14 MA/29.

New Life Expectancy Table

Resources Comments Off

Jan 082015

There is a new life expectancy table to use when determining if an annuity, loan, promissory note or mortgage is actuarially sound. GIS 14 MA/28 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.

Resource Levels for 2015

Resources Comments Off

Jan 082015

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2015:
The resource level for the Medicaid applicant is $14,850 for the year 2015. GIS 14 MA/29.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2015:
For 2015, the minimum resource level for the community spouse is $74,820 and the maximum is $119,220. GIS 14 MA/29. For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Substantial Home Equity Limit for 2015

Resources Comments Off

Jan 082015

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

HOME EQUITY LIMIT FOR 2015:
The home equity limit for Medicaid coverage of nursing facility services is $828,000 for 2015. GIS 14 MA/29.

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.

New Life Expectancy Table

Resources Comments Off

Mar 072014

There is a new life expectancy table to use when determining if an annuity, loan, promissory note or mortgage is actuarially sound. GIS 13 MA/020 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. This GIS was issued in 2013. Note that GIS 12 MA/025, which had an updated table, was issued in 2012.

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