GIS 20MA/12 Update Regional Rates:
The purpose of this General Information System (GIS) message is to inform local departments of social services of the year 2021 Medicaid regional nursing home rates which must be used when calculating a transfer of assets penalty period for coverage of nursing facility services. This is in accordance with 96 ADM-8, “OBRA ’93 Provisions on Transfers and Trusts” and 06 OMM/ADM-5, “Deficit Reduction Act of 2005 – Long-Term Care Medicaid Eligibility Changes.” These rates are based on average private pay nursing home costs in each of the seven regions in the State. Districts must use the regional rate in effect as of the date of application or the date of request for an increase in coverage for the region in which the facility is located. The seven regions and their 2021 rates are: CENTRAL $10,857 – Broome, Jefferson, Oswego,Cayuga, Lewis, St. Lawrence, Chenango, Madison, Tioga, Cortland, Oneida, Tompkins, Herkimer, Onondaga; NORTHEASTERN $11,689 – Albany, Fulton, Saratoga, Clinton, Greene, Schenectady, Columbia, Hamilton, Schoharie, Delaware, Montgomery, Warren, Essex, Otsego, Washington, Franklin, Rensselaer; WESTERN $11,054 – Allegany, Niagara, Cattaraugus, Orleans, Chautauqua, Wyoming, Erie, Genesee; NORTHERN METROPOLITAN $13,206 – Dutchess, Ulster, Orange, Westchester, Putnam, Rockland, Sullivan; NEW YORK CITY $13,037 – Bronx, Queens, Kings (Brooklyn), Richmond (Staten Island), New York (Manhattan); LONG ISLAND $13,834 – Nassau, Suffolk; ROCHESTER $13,020 – Chemung, Seneca,Livingston, Steuben, Monroe, Wayne, Ontario, Yates, Schuyler.
GIS 20 MA/13 Updated Medicaid Levels:
The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) of the income levels and figures used to determine Medicaid eligibility, effective January 1, 2021. Due to the ongoing Public Health Emergency (PHE), Phase 1 of Mass Re-Budgeting (MRB), including the systematic update of the 1.3 percent (%) Cost of Living Adjustment (COLA), was not run. Districts will be informed of any updates regarding MRB. During the PHE, individuals with Medicaid coverage will be held harmless by maintaining their current budgets. The Medicaid Budget Logic (MBL) has been updated with the 2021 Medically Needy income levels. This ensures the revised income levels are available in MBL for
applications, and redeterminations at the end of the PHE, in 2021. However, due to the 1.3% COLA for Social Security Administration (SSA) payments effective January 1, 2021, figures used to determine Medicaid eligibility must be updated. With an increase in the Supplemental Security Income (SSI) benefits level, the Medically Needy income and resources levels will also be adjusted accordingly.
Here are some of the GIS figures are effective January 1, 2021:
1. Medically Needy Income and Resources Levels.
HOUSEHOLD MEDICALLY NEEDY RESOURCES
SIZE INCOME LEVEL
LEVEL ANNUAL MONTHLY
ONE 10,600 884 15,900
TWO 15,600 1,300 23,400
THREE 17,940 1,495 25,013
FOUR 20,280 1,690 28,275
FIVE 22,620 1,885 31,539
SIX 24,960 2,080 34,800
SEVEN 27,300 2,275 38,064
EIGHT 29,640 2,470 41,325
NINE 31,980 2,665 44,588
TEN 34,320 2,860 47,850
EACH ADD’L
PERSON 2,340 195 3,263
2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $794/single and $1,191/couple.
3. The allocation amount is $416, the difference between the Medicaid income level for a
household of two and one.
4. The 249e factors are .970 and .148.
5. The SSI resource levels remain $2,000 for individuals and $3,000 for couples.
6. The State Supplement is $23 for an individual living with others.
7. If an individual paid Medicare taxes for less than 30 quarters, the individual’s cost for
Medicare Part A is $471. If an individual paid Medicare taxes for 30-39 quarters, the
standard Part A premium is $259. For individuals who paid Medicare taxes for 40 quarters or
more, there is no cost for Medicare Part A.
8. The standard Medicare Part B monthly premium for beneficiaries with income less than or
equal to $88,000 is $148.50.
9. The Maximum federal Community Spouse Resource Allowance is $130,380.
10. The Minimum State Community Spouse Resource Allowance is $74,820.
11. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is
$3,259.50.
12. Maximum Family Member Allowance remains $719 until the FPLs for 2021 are published in
the Federal Register.
13. Family Member Allowance formula number remains $2,155 until the FPLs for 2021 are
published in the Federal Register.
14. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment
budgeting is $416.
15. Substantial Gainful Activity (SGA) is: Non-Blind $1,310/month, Blind $2,190/month and Trial
Work Period (TWP) $940/month.
16. SSI-related student earned income disregard limit of $1,930/monthly up to a maximum of
$7,770/annually.
17. The home equity limit for Medicaid coverage of nursing facility services and community based long-term care is $906,000.
18. The special income standard for housing expenses that is available to certain individuals who
enroll in the Managed Long-Term Care program (See 12 OHIP/ADM-5 for further information)
vary by region. For 2021, the amounts are: Northeastern $524; Central $450; Rochester
$469; Western $413; Northern Metropolitan $1,075; Long Island $1,393; and New York City
$1,535. All regions had an increase from the 2020 figure.
