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.
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