Medicaid New York – Nancy E Kline

Resource Levels for 2025

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Jan 092025

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2025:
The resource level for the Medicaid applicant remains at $31,175 for now. GIS 25 MA/01 and its Attachment.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2025:
The minimum resource level for the community spouse is $74,820 and the maximum is $157,920. GIS 25 MA/01 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.

CHANGE IS COMING: GIS 25 MA/01 is dated 01/08/2025. It advises that the Medically Needy resource level is based on a percentage of the Medically Needy income level, and the Medically Needy income level is based on a percentage of the Federal Poverty Level. When the 2025 Federal Poverty Level is announced, the Medically Needy resource level will be updated.

Posted 01/09/2025

Regional Rates for 2020

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Jan 112020

The regional rates for the year 2020, for use in calculating Medicaid penalty periods, are found in GIS 20 MA/01, which is dated 01/10/2020. They are:

CENTRAL: $10,451
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, and Tompkins.

NORTHEASTERN: $11,295
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington.

WESTERN: $10,720
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming.

NORTH METROPOLITAN: $12,805
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.

NEW YORK CITY: $12,844
Bronx, Kings (Brooklyn), New York (Manhattan), Queens, and Richmond (Staten Island).

LONG ISLAND: $13,407
Nassau and Suffolk.

ROCHESTER: $12,460
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates.

Posted 01/11/2020

Substantial Home Equity Limit for 2020

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Dec 212019

The Substantial Home Equity Limit for 2020 is 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:

HOME EQUITY LIMIT FOR 2020
The home equity limit for Medicaid coverage of nursing facility services is $893,000 for 2020. GIS 19 MA/12, 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.

Posted 12/21/2019

Income Levels for 2019

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Dec 092018

Medicaid income 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:

INCOME LEVEL FOR 2019 — 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 2019 is $859 per month. GIS 18 MA/15, page 2.

INCOME LEVEL FOR 2019 — MONTH ONE — PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE.
The Medically Needy Income Level for a household of one for 2019 is $859 per month. GIS 18 MA/15, page 2.

INCOME LEVEL FOR 2019 — 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 2019 if they do not have a community spouse. GIS 18 MA/15, Attachment I.

INCOME LEVEL FOR 2019 — 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 2019 if they have a community spouse. GIS 18 MA/15, Attachment I.

INCOME LEVEL FOR 2019 — COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,160.50 per month for 2019. GIS 18 MA/15, page 2.

Posted 12/09/2018

Regional Rates for 2018

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Dec 052017

The 2018 regional rates for calculating Medicaid penalty periods are found in GIS 17 MA/19. They are:

CENTRAL: $9,722
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $10,719
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $10,239
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $12,428
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $12,319
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $13,053
Nassau and Suffolk.

ROCHESTER: $11,692
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 12/05/2017

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.

Income Levels for 2016

Income Comments Off

Jan 022016

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.

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