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.
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.
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.
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.