January 2025 – Nancy E Kline

Regional Rates for 2025

Transfer of Assets (Gifting) Comments Off

Jan 142025

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

Recertification Information for Early 2025

Recertifications Comments Off

Jan 092025

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

Income Levels for 2025

Income Comments Off

Jan 092025

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

Resource Levels for 2025

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Jan 092025

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

Substantial Home Equity Limits for 2025

Resources Comments Off

Jan 092025

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