Resource Levels for 2021

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Dec 312020
 

Medicaid resource levels for the year 2021 are shown in GIS 20 MA/13, which is dated 12/30/20.

Please note that there are attachments to the GIS. When the GIS originally was posted to the New York State Department of Health website, it included an attachment which had not been updated to include the changes for the year 2021. An updated Attachment I was later posted to the NYSDOH website. The incorrect attachment shows that it was revised on November 9, 2020. The revised attachment shows that it was revised on December 30, 2020.

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2021:
The resource level for the Medicaid applicant is $15,900. GIS 20 MA/13 and its revised Attachment I.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2021:
The minimum resource level for the community spouse is $74,820 and the maximum is $130,380. GIS 20 MA/13 and its revised 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 12/31/2020. Updated 01/01/2021.

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

Extension of Medicaid Application Process & Recertification Changes Due to COVID-19

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Dec 172020
 

GIS 20 MA/11, dated 12/15/2020,advises that on October 2, 2020, the federal government announced that the COVID-19 public health emergency has been extended through January 20, 2021.

The changes to Medicaid eligibilty and enrollment outlined in GIS 20 MA/04 will remain in effect through that time.

The Recertification process also has changed due to the COVID-19 public health emergency.
Medicaid coverage has been extended automatically; recipients have not needed to do Recertification paperwork.

If an Upstate New York recipient’s Medicaid coverage ended or will end in October 2020, November 2020, December 2020, January 2021 or February 2021: coverage has been extended for 12 months. If an Upstate New York recipient’s Medicaid coverage will end in March 2021: coverage will be extended on December 29, 2020.

If a New York City recipient’s Medicaid coverage ended in October 2020, November 2020 or December 2020: coverage has been extended for 12 months. If a New York City recipient’s Medicaid coverage will end in January 2021, February 2021 or March 2021: it will be extended for 12 months around the 18th of the expiration month.

Posted 12/17/2020

New Life Expectancy Table

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Aug 272020
 

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

GIS 20 MA/08, dated 08/25/20, 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 08/27/2020

Medicaid Application Process Changes Due to COVID-19

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May 082020
 

GIS 20 MA/04, dated 4/2/20, details some changes to the Medicaid application process which were prompted by the COVID-19 crisis.

The changes are to remain in effect for the duration of the COVID-19 public health emergency. GIS 20 MA/04, at 1.

Some of the changes for people applying for Medicaid to pay for nursing home care include being allowed to attest to income and resources. This includes attesting to any transfer of assets during the look-back period. It also includes attesting to naming the State as remainder beneficiary of an annuity. Proof/documentation will be required at renewal. GIS 20 MA/04, at 4.

For people in hospitals and nursing homes, the Medicaid application and Supplement A can be signed by someone acting on the applicant’s behalf. If the applicant or the applicant’s spouse cannot sign, Form DOH-5147 should be used for Upstate applicants; Section C of the form should be filled out to indicate that the applicant cannot sign the form due to rules preventing access to people in hospitals/nursing homes. Form MAP-3044 should be used for NYC applicants; the Reason for Submission/Section II should be filled out the same way. If the applicant is able to sign to authorize someone to apply for them, the applicant should sign Section D of Form DOH-5147. GIS 20 MA/04, at 4.

People turning age 65 must not be required to apply for other benefits, such as Medicare and Social Security, as a condition of Medicaid eligibility. GIS 20 MA/04, at 5.

People with health insurance will not be required to provide information about it. DSS is not required to make new cost effective determinations for possible reimbursement if sufficient information is not available. GIS 20 MA/04, at 5.

DSS may accept attestation of the amount being received from retirement accounts and annuities. GIS 20 MA/04, at 5.

No documentation should be requested based on Asset Verification System responses. GIS 20 MA/04, at 5-6.

Updated 05/08/2020

Economic Impact Payments for COVID-19: Medicaid treatment

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May 082020
 

GIS 20 MA/05, dated 04/20/20, says that for non-MAGI determinations (such as SSI-related people in nursing homes), stimulus payments received under the CARES Act are not countable as income. They are an exempt resource for 12 months. After the 12-month period, any part of the payment which remains is a countable resource.

Posted 05/08/2020

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

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.

Regional Rates for 2019

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Jan 032019
 

The 2019 regional rates for calculating Medicaid penalty periods are found in GIS 19 MA/01, which is dated 01/03/2019. They are:

CENTRAL: $10,068
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $11,280
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $10,556
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $12,636
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $12,419
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $13,407
Nassau and Suffolk.

ROCHESTER: $12,342
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 01/03/2019

New Life Expectancy Table

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Aug 312018
 

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

GIS 18 MA/08, dated 6/21/18, 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.

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