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.
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.
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.
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.
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.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
INCOME LEVEL FOR 2016 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES NOT HAVE A COMMUNITY SPOUSE
The Medicaid Needy Income Level for a household of one for 2016 is $825 per month. There is no change from 2015. GIS 15 MA/21.
INCOME LEVEL FOR 2016 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medicaid Needy Income Level for a household of one for 2016 is $825 per month. There is no change from 2015. GIS 15 MA/21.
INCOME LEVEL FOR 2016 – 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 2016 if he/she does not have a community spouse. There is no change from 2015. GIS 15 MA/21, Attachment 1.
INCOME LEVEL FOR 2016 – AFTER MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The person in a nursing home is allowed to keep a Personal Needs Allowance of $50 per month for 2016 if he/she does have a community spouse. There is no change from 2015. GIS 15 MA/21, Attachment 1.
INCOME LEVEL FOR 2016 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $2,980.50 per month for 2016. There is no change from 2015. GIS 15 MA/21, page 2.
INCOME LEVEL FOR 2016 – LONG TERM HOME HEALTH CARE PROGRAM PARTICIPANT
The participant in a Long Term Home Health Care Program (also referred to as the “Lombardi Program” and the “Nursing Home Without Walls Program”) is allowed to keep a Personal Needs Allowance for Certain Waiver Participants Subject to Spousal Impoverishment Budgeting of $384 per month for 2016. There is no change from 2015. GIS 15 MA/21, page 2.
When a person applies for Medicaid, he can request coverage for the current month and for the three prior months, assuming that he was eligible during those prior months. 18 NYCRR 360-2.4 (c). If he does this, what is the beginning of the look-back period for transfer of assets? For example, if he applies on July 1, 2015 and asks for coverage beginning April 1, 2015, does the look-back period go back to July 1, 2010 or April 1, 2010?
GIS 15 MA/07 addresses this issue.
The GIS says that the look-back period is the 60 months immediately prior to the date that an individual is both institutionalized and has applied for Medicaid (the application date). The GIS specifically uses the word “both.”
The GIS says that if an applicant is requesting coverage of nursing home care for the three-month retroactive eligibility period: the look-back period is 60 months immediately preceding the month of application. In the past, Departments of Social Services had looked back to the 60 months prior to the first month that Medicaid coverage was sought, including the three retroactive months. Effective immediately, Departments of Social Services are limited to the 60 months immediately preceding the month of institutionalization and application.
Thus, in the above example, the look-back period would go back to July 1, 2010. It would not go back to April 1, 2010.
The GIS also says that if a Medicaid recipient requests an increase in coverage, the request can be for coverage of up to three months prior to the date the request is received by the Department of Social Services. In that case, the look-back period would be 60 months from the date of institutionalization, not 60 months from the date the increase in coverage is made.
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 2015 are found in GIS 15 MA/01. The GIS tells you which counties are in which region. It reminds you to use the rate for the region in which the facility is located.
The 2015 regional rates are:
CENTRAL: $8,768
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins counties.
NORTHEASTERN: $9,414
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties.
WESTERN: $9,422
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties.
NORTHEASTERN METROPOLITAN:$11,455
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties.
NEW YORK CITY: $11,843
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).
LONG ISLAND: $12,390
Nassau and Suffolk counties.
ROCHESTER: $10,660
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties.
Medicaid Financial Eligibility Rules for Nursing Home Care in New York State should be updated as follows:
HOME EQUITY LIMIT FOR 2015:
The home equity limit for Medicaid coverage of nursing facility services is $828,000 for 2015. GIS 14 MA/29.
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.
LONG-TERM CARE INSURANCE POLICIES ISSUED UNDER THE NEW YORK STATE PARTNERSHIP FOR LONG-TERM CARE
TYPES OF POLICIES
As explained on pages 118-119 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State, there are two types of long-term care insurance policies issued under the New York State Partnership for Long-Term Care: Total Asset Protection plans and Dollar for Dollar Protection plans.
When the book was published, there were two types of Total Asset Protection plans. The Total Asset 50 Protection Plan will pay for 3 years of care in a nursing home or 6 years of care at home, or some combination, with 2 home care days equaling 1 nursing home day. 11 NYCRR 39.3 refers to this as the 3/6/50 plan.
The Total Asset 100 Protection Plan will pay for 4 years of care in a nursing home or 4 years of care at home, with 1 home care day equaling 1 nursing home day. 11 NYCRR 39.5 refers to this as the 4/4/100 plan.
When the book was published, there were two types of Dollar for Dollar Protection plans. The Dollar for Dollar 50 Protection Plan will pay for 1.5 years of care in a nursing home or 3 years of care at home, or some combination, with 2 home care days equaling 1 nursing home day. 11 NYCRR 39.4 refers to this as the 1.5/3/50 plan.
The Dollar for Dollar 100 Protection Plan will pay for 2 years of care in a nursing home or 2 years of care at home, or some combination, with 1 home care days equaling 1 nursing home day. 11 NYCRR 39.6 refers to this as the 2/2/100 plan.
The sections of 11 NYCRR Part 39 mentioned above do not specify whether a given plan is Total Asset Protection or Dollar for Dollar. However, Social Services Law section 367-f (1)(a) discusses the Medicaid aspect of Partnership plans. It defined “Medicaid extended coverage” to mean eligibility for Medicaid without regard to the resource rules of Social Services Law section 366 [which would be Total Asset Protection]
OR
without consideration of an amount of resources equivalent to the value of the benefits received under the Partnership plan [which would be Dollar for Dollar Protection], for people with a Partnership plan which has a residential health care facility benefit of less than three years.
Social Services Law section 367-f was amended by Chapter 59, section 82 of the Laws of 2011. The law was enacted on March 31, 2011. This portion of it became effective on January 1, 2012. It replaced the word “three” in the preceding paragraph with the word “two.” In other words, it now states:
OR
without consideration of an amount of resources equivalent to the value of the benefits received under the Partnership plan [which would be Dollar for Dollar Protection], for people with a Partnership plan which has a residential health care facility benefit of less than three two years.
The reason for this change may be that 11 NYCRR 39.7 added a new type of Partnership Plan: the 2/4/50 plan. It will pay for 2 years of care in a nursing home or 4 years of care at home, with 2 home care days equaling 1 nursing home day. It became effective June 1, 2012.
The website of the New York State Partnership for Long Term Care may be found at www.nyspltc.org. It says that the new 2/4/50 plan is a Total Asset Protection Plan.
Under the old language of Social Services Law section 367-f (1)(a), the new 2/4/50 plan would have been a Dollar for Dollar Plan, because plans of less than three years did not provide Total Asset Protection. With the change to Social Services Law section 367-f (1)(a), the new 2/4/50 plan can be a Total Asset Protection Plan because it does not have a benefit of less than two years.
Question: what about the old 2/2/100 Plan? It was supposed to be a Dollar for Dollar Protection Plan. But the amended Social Services Law section 367-f (1)(a) seems to define Dollar for Dollar Protection Plans as those which have a residential health care facility benefit of less than two years. This plan does not have a residential health care facility benefit of less than two years.
USE OF MEDICAID EXTENDED COVERAGE IN OTHER STATES
Another recent change to Partnership plans involves Medicaid Extended coverage.
When the owner of a Partnership plan has used up his benefits under the policy, he can apply for Medicaid. Special Medicaid eligibility rules apply. Previously, he had to be in New York State when he went on Medicaid if he wanted to take advantage of the special Medicaid eligibility rules.
The federal Deficit Reduction Act of 2005 discusses reciprocity among states for Partnership plans. See section 6021 (b) of the DRA. Instructions on how to find the DRA are in the section of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State which discusses how to find documents and information online.
The website of the New York State Partnership for Long Term Care had a bulletin which said that New Yorkers who move to one of the 40 other states which have Partnership plans will be able to take advantage of Medicaid extended coverage in those states. The bulletin said that reciprocity would be available as soon as New York State Department of Financial Services Insurance Regulation 144 became effective.
New York State Department of Financial Services Insurance Regulation 144 became effective on June 1, 2012. It added 11 NYCRR 39.8.
11 NYCRR 39.8 (a) states that insurers must provide disclosures. 11 NYCRR 39.8 (a)(3) states that the disclosure must advise that a person who leaves New York may not be eligible for Medicaid asset protection in another state if his destination is no longer a reciprocal state, so he should verify reciprocity.
11 NYCRR 39.8 (a)(5) states that a person will not be eligible for Medicaid asset protection in a non-Partnership state and in a non-reciprocal state.
11 NYCRR 39.8 (a)(7) states that if a person with a New York Total Asset Protection plan applies for Medicaid in a reciprocal state, he will only get Medicaid asset protection equal to the benefits paid by the plan. Thus, his Total Asset Protection plan becomes a type of Dollar for Dollar Protection plan.
To find Department of Financial Services Insurance Regulation 144, go to http://www.dfs.ny.gov/
Click on LEGAL at the toolbar near the top of the page.
Click on REGULATIONS.
Scroll down to FINAL ADOPTIONS.
Click on INSURANCE.
Click on 2012.
Scroll down to NOTICE OF ADOPTION OF 3RD AMENDMENT TO REGULATION 144 (11 NYCRR 39)(PDF FORMAT)
DEFINITION OF “ASSET” FOR PARTNERSHIP PLANS
Please note that when the term “asset” is used in connection with Partnership long-term care insurance plans, it refers to resources; it does not include income. Thus “total asset protection” means protection of resources but not protection of income. Medicaid Reference Guide, at glossary ii.
CITATION CHANGES
The Medicaid Reference Guide was updated since Medicaid Financial Eligibility Rules for Nursing Home Care in New York State was published.
On page 119, 1st full paragraph:
Change the Medicaid Reference Guide citation from page 684 to page 685.1.
On page 121, 2nd full paragraph:
Change the Medicaid Reference Guide citation from page 684 to page 685.1.
Posted 06/16/2012