Medicaid Renewals – No Resource Test At This Time

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Jul 312024
 

GIS 24 MA/07, dated 07/25/2024, advises that the resource test will be waived for SSI-related recipients who are renewing Medicaid eligibility.  The resource test will be waived whether the person is in the community or in a nursing home.  The Medicaid caseworker processing the renewal will not send asset verification requests to the Asset Verification System (AVS).  If a person has been determined to be eligible for Medicaid, no action can be taken to discontinue Medicaid coverage due to excess resources, through 06/30/2025.

The resource test also will be waived, through 06/30/2025, for people who have Medicaid Community Coverage without Long Term Care, and who ask for their coverage to be increased to Medicaid Community Coverage With Long Term Care.

However, the resource test is not waived for people who are newly applying for Medicaid.  Furthermore, the resource test is not waived for people who have Medicaid Community Coverage and are asking to have their coverage increased to include nursing home care.  In those situations, the Medicaid caseworker will send asset verification requests to the Asset Verification System.

There is no change to the lookback requirements.  There is no change to the transfer of assets rules.

The GIS has an attachment, which is a chart showing which tests apply for different types of requests.

For an explanation of Medicaid categories, such as “SSI-related,” see page 2 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State.

Posted 07/31/2024.

 

 

New Life Expectancy Table

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Jun 112024
 

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

GIS 24 MA/05, dated 06/10/2024, 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 06/11/2024

Resource Levels for 2024 – Updated

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Feb 162024
 

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2024:
The resource level for the Medicaid applicant is $31,175. GIS 24 MA/01 Attachment.

This is an update from the 2024 resource level which had previously been announced.

Posted 02/16/2024.

 

Substantial Home Equity Limit for 2024

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Dec 292023
 

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

HOME EQUITY LIMIT FOR 2024
The home equity limit for Medicaid coverage of nursing facility services is $1,071,000. GIS 23 MA/23, which is dated 12/29/2023.

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 12/29/2023

Income Levels for 2024

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Dec 292023
 

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

INCOME LEVEL FOR 2024 – 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 $1,677 per month for now. GIS 23 MA/23 and its attachment.

INCOME LEVEL FOR 2024 – MONTH ONE – PERSON IN A NURSING HOME WHO DOES HAVE A COMMUNITY SPOUSE
The Medically Needy Income Level for a household of one is $1,677 per month for now. GIS 23 MA/23 and its attachment.

INCOME LEVEL FOR 2024 – 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 23 MA/23 attachment.

INCOME LEVEL FOR 2024 – 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 23 MA/23 attachment.

INCOME LEVEL FOR 2024 – COMMUNITY SPOUSE
The community spouse is allowed to keep a Minimum Monthly Maintenance Needs Allowance of $3,853.50 per month.  GIS 23 MA/23 and its attachment.

CHANGE IS COMING: GIS 23 MA/23 is dated 12/29/2023.  It advises that the Medically Needy income level is based on a percentage of the Federal Poverty Level.  When the 2024 Federal Poverty Level is announced, the Medically Needy income level will be updated.  This is the level which is is used for Month One for a person in a nursing home who does not have a community spouse, and for Month One for a person in a nursing home who does have a community spouse.

Posted 12/29/2023

Resource Levels for 2024

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Dec 292023
 

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

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2024:
The resource level for the Medicaid applicant remains at $30,182 for now. GIS 23 MA/23 and its Attachment.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2024:
The minimum resource level for the community spouse is $74,820 and the maximum is $154,140. GIS 23 MA/23 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 23 MA/23 is dated 12/29/2023.  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 2024 Federal Poverty Level is announced, the Medically Needy resource level will be updated.

 

Posted 12/29/2023

Regional Rates for 2024

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Dec 272023
 

The 2024 regional rates for calculating Medicaid penalty periods are found in GIS 23 MA/21, which is dated 12/26/2023. They are:

CENTRAL: $12,196
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $13,235
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $12,241
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $14,165
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $14,273
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $14,668
Nassau and Suffolk.

ROCHESTER: $14,419
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 12/27/2023

New Medicaid Application Form

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Sep 032023
 

GIS 23 MA/17, which is dated 08/29/2023, advises that there is a new Medicaid application form.

The new version of the Access NY Health Care Application will show this at the bottom of each page: (1/23).

The new version of the form is an attachment to the GIS.

It also may be found by going to: http://www.health.ny.gov/forms/doh-4220.pdf

If that link stops working, the form may be found on the New York State Department of Health website.

Go to www.health.ny.gov

Click on: Individuals/Families

Click on: Health Topics A to Z

Click on: the letter M

Click on: Medicaid

Click on: How to Apply (this will be on the left side of the screen)

Scroll down to: Medicaid Application for Non-MAGI Eligibility Group

Click on: DOH-4220

Posted 09/03/2023

New Life Expectancy Table

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Jul 162023
 

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

GIS 23 MA-09, dated 04/11/2023, 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 07/16/2023

Substantial Home Equity Limit for 2023

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Dec 302022
 

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

HOME EQUITY LIMIT FOR 2023
The home equity limit for Medicaid coverage of nursing facility services is $1,033,000. GIS 22 MA/14.

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 12/30/2022