Regional Rates for 2021

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Dec 292020
 

The 2021 regional rates for calculating Medicaid penalty periods are found in GIS 20 MA/12, which is dated 12/28/2020. They are:

CENTRAL: $10,857
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $11,689
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $11,054
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $13,206
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $13,037
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $13,834
Nassau and Suffolk.

ROCHESTER: $13,020
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 12/29/2020

Income Levels for 2020

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Dec 212019
 

Medicaid income levels for the year 2020 are shown in GIS 19 MA/12, which is dated 12/19/19.

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

INCOME LEVEL FOR 2020 – 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 2020 is $875 per month. GIS 19 MA/12, page 2.

INCOME LEVEL FOR 2020 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2020 is $875 per month. GIS 19 MA/12, page 2.

INCOME LEVEL FOR 2020 – 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 Perseonal Needs Allowance of $50 per month for 2020 if they do not have a community spouse. GIS 19 MA/12, Attachment 1.

INCOME LEVEL FOR 2020 – 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 2020 if they have a community spouse. GIS 19 MA/12, Attachment 1.

INCOME LEVEL FOR 2020 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,216 per month for 2020. GIS 19 MA/12, page 2 and Attachment 1.

Posted 12/21/2019

Resource Levels for 2020

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Dec 212019
 

Medicaid resource levels for the year 2020 are shown in GIS 19 MA/12, which is dated 12/19/19.

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2020:
For 2020, the resource level for the Medicaid applicant is $15,750. GIS 19 MA/12, page 2 and Attachment 1.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2020:
For 2020, the minimum resource level for the community spouse is $74,820 and the maximum is $128,640. GIS 19 MA/12, page 2 and Attachment 1. 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 12/21/2019

New Life Expectancy Table

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Jun 162019
 

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

GIS 19 MA/07, dated 05/23/19, 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.

Resource Levels for 2019

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Dec 092018
 

Medicaid resource levels for the year 2019 are shown in GIS 18 MA/15, which is dated 12/7/18.

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2019:
For 2019, the resource level for the Medicaid applicant is $15,450. GIS 18 MA/15, page 2.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2019:
For 2019, the minimum resource level for the community spouse is $74,820 and the maximum is $126,420. GIS 18 MA/15, page 2. 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 12/09/2018

New Life Expectancy Table

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Nov 072017
 

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

GIS 17 MA/16, dated 10/27/17, 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.

Substantial Home Equity Limit for 2017

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Dec 262016
 

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

HOME EQUITY LIMIT FOR 2017
The home equity limit for Medicaid coverage of nursing facility services is $840,000 for 2017. GIS 16 MA/18, 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.

Income Levels for 2017

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Dec 262016
 

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

INCOME LEVEL FOR 2017 – 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 2017 is $825 per month. There is no change from 2015 or 2016. GIS 16 MA/18, page 2 and Attachment.

INCOME LEVEL FOR 2017 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one for 2017 is $825 per month. There is no change from 2015 or 2016. GIS 16 MA/18, page 2 and Attachment.

INCOME LEVEL FOR 2017 – 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 2017 if he/she does not have a community spouse. GIS 16 MA/18, Attachment.

INCOME LEVEL FOR 2017 – 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 2017 if he/she has a community spouse. GIS 16 MA/18, Attachment.

INCOME LEVEL FOR 2017 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,022.50 per month for 2017. GIS 16 MA/18, page 2 and Attachment.

Long Term Home Health Care Program

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Dec 142016
 

Pages 123 through 133 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State discuss the Long Term Home Health Care Program. This program also has been referred to as the “Nursing Home Without Walls Program” and the “Lombardi Program.”

GIS 16 MA/11 states that this program was to formally close on May 27, 2016.

Substantial Home Equity Limit for 2016

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Jan 022016
 

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.

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