Resource Levels for 2023 – Original

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Dec 302022
 

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2023:
The resource level for the Medicaid applicant is $28,133. GIS 22 MA/14 attachment.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2023:
The minimum resource level for the community spouse is $74,820 and the maximum is $148,620. GIS 22 MA/14 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.

Posted 12/30/2022

Income Levels for 2023

 Income  Comments Off on Income Levels for 2023
Dec 302022
 

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

INCOME LEVEL FOR 2023 – 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 $1,563 per month. GIS 22 MA/11; GIS 22 MA/14 and its attachment.

INCOME LEVEL FOR 2023 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one is $1,563 per month. GIS 22 MA/11; GIS 22 MA/14 and its attachment.

INCOME LEVEL FOR 2023 – 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 22 MA/14 attachment.

INCOME LEVEL FOR 2023 – 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 22 MA/14 attachment.

INCOME LEVEL FOR 2023 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,715.50 per month.  GIS 22 MA/14 and its attachment.

Posted 12/30/2022

New Life Expectancy Table

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Jul 202022
 

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

GIS 22 MA-06, dated 07/15/2022, 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.

Posted 07/20/2022

Substantial Home Equity Limit for 2022

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Jan 192022
 

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

HOME EQUITY LIMIT FOR 2022
The home equity limit for Medicaid coverage of nursing facility services is $955,000 for the year 2022. GIS 21 MA/25.

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 01/19/2022

Regional Rates for 2022

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Dec 312021
 

The 2022 regional rates for calculating Medicaid penalty periods are found in GIS 21 MA/26, which is dated 12/30/2021. They are:

CENTRAL: $11,328
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $12,560
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $11,884
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $13,399
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $13,415
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $14,012
Nassau and Suffolk.

ROCHESTER: $13,376
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 12/31/2021

Income Levels for 2022

 Income  Comments Off on Income Levels for 2022
Dec 292021
 

Medicaid income levels for the year 2022 are shown in GIS 21 MA/25, which is dated 12/28/21, and its Attachment I.

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

INCOME LEVEL FOR 2022 – 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 2022 is $934 per month. GIS 21 MA/25 and its Attachment I.

INCOME LEVEL FOR 2022 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2022 is $934 per month. GIS 21 MA/25 and its Attachment I.

INCOME LEVEL FOR 2022 – 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 2022 if they do not have a community spouse. GIS 21 MA/25, Attachment I.

INCOME LEVEL FOR 2022 – 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 2022 if they have a community spouse. GIS 21 MA/25, Attachment I.

INCOME LEVEL FOR 2022 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,435 per month for 2022. GIS 21 MA/25 and its Attachment I.

Posted 12/29/2021

Resource Levels for 2022

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Dec 292021
 

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2022:
The resource level for the Medicaid applicant is $16,800. GIS 21 MA/25 and its Attachment I.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2022:
The minimum resource level for the community spouse is $74,820 and the maximum is $137,400. GIS 21 MA/25 and its Attachment I. For an explanation of how this rule works, see page 9 of Medicaid Financial Eligibilty Rules for Nursing Home Care in New York State.

Posted 12/29/2021

New Medicaid Application Form

 Finding Documents & Information Online  Comments Off on New Medicaid Application Form
Dec 192021
 

GIS 21 MA/22, dated 12/15/2021, advises that the Medicaid application form has been revised.

The new form, DOH-4220 (8/21) is attached to the GIS.  The new form also may be found by going to the New York State Department of Health website at: www.health.ny.gov

Click on Individuals/Families

Health Topics A-Z

M

Medicaid

Scroll down past What do I need to apply for Medicaid?

Under DOH-4220, click on the appropriate language

The old form had 4 photos on the front and was dated 3/15.  It was called, “Access NY Health Care Health Insurance Application for Children, Adults and Families.”

The new form has 3 photos on the front and is dated 8/21.  It is called, “Access NY Health Care Health Insurance for Older Adults, People With Disabilities and Certain Other Populations Application.”

Posted 12/19/2021

New Life Expectancy Table

 Resources  Comments Off on New Life Expectancy Table
Oct 102021
 

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

GIS 21 MA/19, dated 10/08/2021, 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.

Posted 10/10/2021

Federal Emergency Declarations (COVID-19)

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Jul 282021
 

Federal governmental emergencies were declared due to the COVID-19 Pandemic.  There are two different federal emergencies to track.

1) The Public Health Emergency

a) On January 31, 2020, Alex M. Azar II, the federal Secretary of Health and Human Services, signed a declaration that a public health emergency existed due to COVID-19:

“As a result of confirmed cases of 2019 Novel Coronavirus (2019-n-CoV), on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby determine that a public health emergency exists and has existed since January 27, 2020, nationwide.”

The declaration can be found here:

https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx

Click on DECLARATIONS OF A PUBLIC HEALTH EMERGENCY on the right side of the screen.

 

b) Secretary Azar’s Public Health Emergency Declaration did not have an expiration date. A public health emergency terminates upon the Secretary declaring that the emergency no longer exists, or upon the expiration of the 90-day period beginning on the date on which the determination is made by the Secretary, whichever occurs first, per Public Health Service Act Sec. 318B [247c-2] which can be found at:

https://www.govinfo.gov/content/pkg/COMPS-8773/pdf/COMPS-8773.pdf#page=82

 

c) Secretary Azar signed renewals of the Public Health Emergency Declaration.   The renewals can be found on the same website as the declaration, the link for which appears above.

Secretary Azar signed renewals of the Declaration on the following dates:

April 21, 2020

July 23, 2020

October 2, 2020

January 7, 2021

 

d) Norris Cochran, the acting Secretary of Health and Human Services, signed a “Dear Governor” letter on January 21, 2021.  The letter stated, “The current public health emergency was renewed effective January 21, 2021 [sic], and will be in effect for 90 days.  To assure you of our commitment to the ongoing response, we have determined that the PHE will likely remain in place for the entirety of 2021, and when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.”

That letter can be found at:

https://aspr.hhs.gov/legal/PHE/Pages/Letter-to-Governors-on-the-COVID-19-Response.aspx

 

e) Xavier Becerra, the Secretary of Health and Human Services, signed renewals of Secretary Azar’s Public Health Emergency Declaration.  They can be found at the link shown above for Secretary Azar’s renewals.  Renewals were signed on the following dates:

April 15, 2021

July 19, 2021

October 15, 2021

January 14, 2022

April 12, 2022

July 15, 2022

October 13, 2022

January 11, 2023

 

2) The National Emergency

a) On March 30, 2020, President Trump signed a Proclamation stating that a national emergency existed due to COVID-19:

“NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States, by the authority vested in me by the Constitution and the laws of the United States of America, including sections 201 and 301 of the National Emergencies Act (50 U.S.C. 1601 et seq.) and consistent with section 1135 of the Social Security Act (SSA), as amended (42 U.S.C. 1320b-5), do hereby find and proclaim that the COVID-19 outbreak in the United States constitutes a national emergency, beginning March 1, 2020.  Pursuant to this declaration, I direct as follows:

Section 1.  Emergency Authority.  The Secretary of HHS may exercise the authority under section 1135 of the SSA to temporarily waive or modify certain requirements of the Medicare, Medicaid, and State Children’s Health Insurance programs and of the Health Insurance Portability and Accountability Act Privacy Rule throughout the duration of the public health emergency declared in response to the COVID-19 outbreak….”

The Proclamation can be found here:

https://www.federalregister.gov/documents/2020/03/18/2020-05794/declaring-a-national-emergency-concerning-the-novel-coronavirus-disease-covid-19-outbreak

 

b) On 02/24/2021, President Biden signed a notice continuing the national emergency:

“On March 13, 2020, by Proclamation 9994, the President declared a national emergency concerning the coronavirus disease 2019 (COVID-19) pandemic.  The COVID-19 pandemic continues to cause significant risk to the public health and safety of the Nation.  For this reason, the national emergency declared on March 13, 2020, and beginning on March 1, 2020, must continue in effect beyond March 1, 2021.  Therefore, in accordance with section 202(d) of the National Emergencies Act (50 U.S.C. 1622(d)), I am continuing the national emergency declared in Proclamation 9994 concerning the COVID-19 pandemic.”

This notice can be found at:

https://www.federalregister.gov/documents/2021/02/26/2021-04173/continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic

 

c) On 02/18/2022, President Biden signed another notice continuing the national emergency:

“On March 13, 2020, by Proclamation 9994, the President declared a national emergency concerning the coronavirus disease 2019 (COVID-19) pandemic.  The COVID-19 pandemic continues to cause significant risk to the public health and safety of the Nation.  For this reason, the national emergency declared on March 13, 2020, and beginning on March 1, 2020, must continue in effect beyond March 1, 2022.  Therefore, in accordance with section 202(d) of the National Emergencies Act (50 U.S.C. 1622(d)), I am continuing the national emergency declared in Proclamation 9994 concerning the COVID-19 pandemic.”

This notice can be found at:

https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/

 

3) Ending the Emergencies

a) The Office of Management and Budget of the Executive Office of the President released a Statement of Administration Policy on January 30, 2023.  The Statement notes that the COVID-19 national emergency currently is set to expire on March 1, and the COVID-19 Public Health Emergency currently is set to expire on April 11.  The Statement says, “At present, the Administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date.  This wind-down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.”

This Statement was in response to H.R.382 – 118th Congress (2023-2024), which was introduced in the House of Representatives on 01/17/2023 to terminate the Public Health Emergency declared on 01/31/2020 with respect to COVID-19.  It also was in response to H.J.Res.7 – 118th Congress (2023-2024) introduced in the House of Representatives on 01/09/2023 to terminate the national emergency concerning COVID-19 declared by the President on March 13, 2020; the termination would be pursuant to 50 U.S.C. 1622, which is section 202 of the National Emergency Act.

The Statement can be found at:

https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf

H.R.382 can be found at:

https://www.congress.gov/bill/118th-congress/house-bill/382?s=1&r=1

H.J.Res.7 can be found at:

https://www.congress.gov/bill/118th-congress/house-joint-resolution/7/text?s=1&r=10

 

b) Note that 50 U.S.C. 1622 (b) states that 6 months after a national emergency is declared, each house of Congress shall meet to consider a vote on a joint resolution to determine whether the emergency shall be terminated.  50 U.S.C. 1622 is the National Emergencies Act section 202.

Updated 02/01/2023