250 0 obj <>stream In other words, the income limit for a family of 5 may be higher than the income limit for a single person. However, if the couple has more limited assets, the non-applicant spouse is able to retain 100% of their joint assets, up to $74,820. New York Consumer-Directed Personal Assistance Program (CDPAP) – CDPAP can be thought of more as a program option, rather than a program in and of itself, and is available for seniors who are enrolled in the MLTC program or the Community First Choice Option. Their household size will be determined using federal income tax rules, which are very complicated. Put another way, the income of the non-applicant spouse is not factored into the applicant spouse’s eligibility. As of 2020, up to $3,216 / month can be transferred to the community spouse. There are good changes and bad changes. However, if the couple has more limited assets, ... (formally referred to as Community Medicaid in NY), … As of 2020, the community spouse can retain half of the couple’s joint assets, up to $128,640, as the chart indicates above. New Opportunities and New Hurdles for Low-Income Communities in New York City, NYS Directives on Medicaid changes under the Affordable Care Act, The Affordable Care Act Implementation: Medicaid Expansion and MAGI Budgeting, "MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare, Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan, Know Your Rights: NYLAG Webinars on Medicare and Medicaid -, http://www.health.state.ny.us/health_care/medicaid/publications/docs/gis/10ma026.pdf, https://www.health.ny.gov/health_care/medicaid/publications/pub2014gis.htm. Attachment I (General Medicaid for Aged, Blind & Disabled); Attachment II ("from GIS 20/MA/02 - Non-MAGI levels for 2020 based on FPL) " " 3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (anyone who is eligible will receive assistance) & is provided at home or adult day care. New York Managed Long Term Care (MLTC) Program Waiver – MLTC is intended for seniors who require a skilled nursing facility level of care, but who prefer to live at home or in an assisted living facility. This is called the Monthly Maintenance Needs Allowance (MMNA) and is intended to prevent spousal impoverishment. There are several different Medicaid long-term care programs for which New York seniors may be eligible. Which household size applies? Once one has paid down their excess income to the Medicaid eligibility limit, Medicaid will kick in for the month. For persons in this situation, Medicaid planning exists. ��#���@wNdF2�#��D3�&s�lcN,���JIAg�fd� ����jH��q,d��PrF��j�2Yo��Kʉ�V���!���c��T�l�e�1�ʼnJ�0��d�3�X�(\��+W�W� �r�$31{�}�>$�o����Wh��ⷛ_�LJ����#W0��$Ϗ>�t�+�����χ\����_�7�O�_�~/N��o�Ű�=Ow�����맛����{@c�������ǻ��pO7��o�o~�{���ȟ���W�xx���7���G�u �/o�u�L�|�ǯd���%�O��4����XW�������ُ����gu ��+�'�����-Wqӻ�px��3�V�=Ͽ͞��Y�Y�N�w��Ͽ�_�~=�3�S��L�L����j�T��N1y1y9� �~1�l�l�|�~6�l������,7���ρ�G���ͮh�Q�ͭ�Us��t*�T�¡�aB�f(hWLsiWaSaS;��5�+ɂ~N6�7�x�{++m���(��I�H��,�tĤ�d�\l� h��P�P/>�C�?����`�����D(�,R�BjMUڗC�!�{+�q&�s�[�[ �V�^ƈ�k�o�w�%5m8\0�RV��A�[He!��Aj[HU�ăT���"%R�BꊔH݊�V��El�[z�V"e�(lǰf�3�;r� �OP��ܭ�4c4�_�1��P��T���l��=Ķ"�;���dǔ��=3�mI�BUT݃��,w��A鲢��R����J�`���J��Y�tg�ҕ�{ְ���Vc�j�[���\�����]kJ�3%]ªgJ-�A)#UϺ�dJ��Y�[܃RV�����-���T=X���R�`�{P�J�C���lR>X�+6�����[EU.���))�eі���=D[���_�mi{P�J��J��A)++����T�s�[]k��'v|#v~#v�#v�#v�#ys�/�m(]&����.���.�V>(���ⰼ�t���X�pK�=(��4���\;m[�V�-�XɈ��X�H�+�t�l��@�U. Countable assets (often called resources) include cash, stocks, bonds, investments, vacation homes, and savings and checking accounts. To apply for Medicaid in New York, seniors can apply in person at their local Department of Social Services office, or alternatively, they can call their local office and apply via phone. If the healthy spouse has monthly income of his or her own, the applicant spouse can only transfer an amount that brings the community spouse’s monthly income to $3,216. Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. All of the attachments with the various levels are posted here. Unfortunately, at the time of this writing, there is not an option for New Yorkers 65 years of age and older to apply online. § 435.4. Prenatal Care Assistance Program (PCAP) was Medicaid  for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for the Disabled, Aged or Blind (DAB) is also known as NON-MAGI. 2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. :��H0�V�{8K:��Q���>#`�n������A��6���9�7v������C��v�5p 4pVM&0 ���� That being said, for Regular Medicaid, the income of both spouses is counted towards the income limit, regardless if one, or both spouses, are applicants. Read more or connect with a Medicaid planner. NYS announced the 2020 Income and Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels, Here is the 2020 HRA Income and Resources Level Chart, Disabled, 65+ or  Blind  ("DAB" or SSI-Related) and have Medicare, For MAGI-eligible people over MAGI income limit up to 200% FPL. However, for Medicaid eligibility purposes, there are many assets that are considered exempt (non-countable). This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group. Again, it is very important assets are not gifted or sold cheaply in order to meet Medicaid’s asset limit. GOOD:  Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. Past Medicaid income and resource levels in NYS are shown on these old NYC HRA  charts for 2001 through 2019, in chronological order. This category had lower income limits than DAB/ADC-related, but had no asset limits. For Medicaid eligibility purposes, all income that one receives from any source is counted towards the income limit. In addition, the application process can be quite complicated and assistance with the process may be welcomed. For New York residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid. These include Medicaid levels for MAGI and non-MAGI populations, Child Health Plus, MBI-WPD, Medicare Savings Programs and other public health programs in NYS. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid. The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a New York Medicaid program. Use of this content by websites or commercial organizations without written permission is prohibited. These benefits might include assistance with daily living activities, home health aides, and durable medical equipment. IMPORTANT, not meeting all of the requirements below does not mean one is ineligible for Medicaid or cannot become eligible. Other names for the Medicaid Excess Income Program include Spenddown Program and Surplus Income Program. It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. ��Qh\�v0�D�|�@g��KY��9��._��M�x�M �LP#���,:�/���/�4Ϟ��.�m�ˊ=}̊iQg��*��f��VD That said, an important change is coming January 1, 2021; the Look-Back Period will be implemented for home and community based long-term care services (formally referred to as Community Medicaid in NY), such as home health care, adult day care, personal care assistance, and assisted living services. Certain populations have an even higher income limit -. The CSRA allows the healthy spouse to retain a higher portion of the couples’ assets. See income levels for past years from 2001  through 2019 here. This site is for information purposes; it is not a substitute for professional legal advice. Also see Legal Aid Society and Empire Justice Center materials, OLD RULE used until end of 2013 --  Count the person(s) applying for Medicaid who live together, plus any  of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. However, there are ways in which one can “spend down” assets and still meet Medicaid’s asset limit. Through this option, program participants are able to hire the personal care assistant of their choosing, including select relatives. 3. 2) Medicaid Waivers / Home and Community Based Services (HCBS) – is not an entitlement (there are a limited number of participants) & is provided at home, adult day care, or in assisted living. NYS announced the 2020 Income and Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels . MedicaidPlanningAssistance.org is a free service provided by the American Council on Aging, What is the Medicaid Estate Recovery Program, local Department of Social Services office, 2020 New York Medicaid Long Term Care Eligibility for Seniors, $15,750 for applicant & $128,640 for non-applicant, Medicaid Waivers / Home and Community Based Services, Regular Medicaid / Aged Blind and Disabled. To contact a lawyer, visit. Alternatively, it may be helpful to take the Medicaid Eligibility Test. New York Medicaid applicants should be positive that all eligibility requirements, which are covered in detail above, are met prior to submitting an application for benefits. While there are several different eligibility groups, including pregnant women, children, and disabled individuals, this page is focused on Medicaid eligibility for New York senior residents (aged 65 and over). 1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes. %PDF-1.7 %���� While the Look-Back Period for Community Medicaid will ultimately be 30 months (2.5 years) instead of 60 months as it is for Institutional Medicaid, it will be phased in. endstream endobj 251 0 obj <>stream }��f�0)G���a�lRY�3�Ͱ�u4%�s�����?��Hi�\����rX�[��0r����=!n������k��n�x�`�;�r(�)4�R()�ӕ z����[Eg�C��_��(uEw�ј35��tXR���,V$R��t(S,3�@{J�,���� ,�R�H f bZ,4Z���S ��d����Z��V�C� Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21  (though if the child is disabled, use the rule in the 1st "DAB" category. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS? Make note, Medicaid in New York is sometimes referred to as Medicaid Managed Care. 1) Medically Needy Pathway – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills. This has now been folded into the new MAGI adult group whose limit is 138% FPL. 2. To learn more about what is counted as income and how Medicaid calculates income, click here. SOURCE for 2019 figures is  GIS 18 MA/015 - 2019 Medicaid Levels and Other Updates (PDF). New York Community First Choice Option (CFCO) – This is an option that allows elderly individuals to receive long-term home and community based services under the state Medicaid plan. 42 C.F.R. For married couples with just one spouse applying for nursing home Medicaid or a Medicaid waiver, a portion of the applicant’s income can be transferred to the non-applicant spouse (also referred to as the community spouse, the well spouse, or the healthy spouse). These programs have differing functional and financial eligibility requirements, as well as varying benefits. Here are the 2 basic categories and the rules for calculating their household size. Long-term care supports are provided to promote independence, including personal care assistance, adult day care, meal delivery, and home modifications. Starting January of 2021, the Look-Back Period will be 3 months and it will increase by one month each subsequent month until it is 30 months in April of 2023.

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