Regional Rates for 2023

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Dec 062022
 

The 2023 regional rates for calculating Medicaid penalty periods are found in GIS 22 MA/12, which is dated 12/5/2022. They are:

CENTRAL: $11,726
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $12,744
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $12,130
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $13,906
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $14,142
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $14,136
Nassau and Suffolk.

ROCHESTER: $13,421
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Posted 12/06/2022

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 2019

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Dec 092018
 

The Substantial Home Equity Limit for 2019 is 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:

HOME EQUITY LIMIT FOR 2019
The home equity limit for Medicaid coverage of nursing facility services is $878,000 for 2019. GIS 18 MA/15, 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 12/09/2018

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

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

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.

Resource 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:

RESOURCE LEVEL FOR THE MEDICAID APPLICANT FOR 2017:
For 2017, the resource level for the Medicaid applicant is $14,850. There is no change from 2015 or 2016. GIS 16 MA/18, page 2 and Attachment.

RESOURCE LEVEL FOR THE COMMUNITY SPOUSE FOR 2017:
For 2017, the minimum resource level for the community spouse is $74,820 and the maximum is $120,900. GIS 16 MA/18, page 2 and 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.

Regional Rates for 2017

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Dec 142016
 

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 2017 are found in GIS 16 MA/16. The GIS tells you which counties are in which region.

The GIS reminds you to use the regional rate which is in effect as of the date of the application, for the region in which the facility is located.

The 2017 regional rate are:

CENTRAL: $9,511
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.

NORTHEASTERN: $10,242
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Oswego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

WESTERN: $10,078
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.

NORTH METROPOLITAN: $12,198
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

NEW YORK CITY: $12,157
Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island).

LONG ISLAND: $12,811
Nassau and Suffolk.

ROCHESTER: $11,237
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

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.

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