NYSDOH Issues GIS 21 MA-25 & 26 Updating 2022 Regional Rates and Medicaid Levels

GIS 21 MA-26 Update Regional Rates:

The purpose of this General Information System (GIS) message is to inform local departments of social services of the year 2022 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/ADM5, “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 $11,328 – Broome, Jefferson, Oswego,Cayuga, Lewis, St. Lawrence, Chenango, Madison, Tioga, Cortland, Oneida, Tompkins, Herkimer, Onondaga;

NORTHEASTERN $12,560 – Albany, Fulton, Saratoga, Clinton, Greene, Schenectady, Columbia, Hamilton, Schoharie, Delaware, Montgomery, Warren, Essex, Otsego, Washington, Franklin, Rensselaer;

WESTERN $11,884 – Allegany, Niagara, Cattaraugus, Orleans, Chautauqua, Wyoming, Erie, Genesee;

NORTHERN METROPOLITAN $13,399 – Dutchess, Ulster, Orange, Westchester, Putnam, Rockland, Sullivan;

NEW YORK CITY $13,415 – Bronx, Queens, Kings (Brooklyn), Richmond (Staten Island), New York (Manhattan);

LONG ISLAND $14,012 – Nassau, Suffolk;

ROCHESTER $13,376 – Chemung, Seneca,Livingston, Steuben, Monroe, Wayne, Ontario, Yates, Schuyler.

GIS 21 MA-25 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, 2022. Due to the ongoing Public Health Emergency (PHE), Phase 1 of Mass Re-Budgeting (MRB), including the systematic update of the 5.9 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 2022 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 2022. However, due to the 5.9% COLA for Social Security Administration (SSA) payments effective January 1, 2022, 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.

The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. Most Medicare beneficiaries will pay this amount. Less than 3% of Medicare beneficiaries will pay less than the full Part B standard monthly premium amount in 2022. Due to the SSA 5.9% COLA, some beneficiaries who were held harmless against Part B premium increases in 2021 will pay the full monthly premium of $170.10 in 2022. This is because the increase in their Social Security benefits will be greater than or equal to the increase in their Part B premium. The “hold harmless” provision does not apply to the following beneficiaries whose Part B premium will increase to $170.10 in 2022:
• beneficiaries who do not receive Social Security benefits;
• those who are directly billed for their Part B premium;
• new Medicare Part B beneficiaries;
• those who have Medicare and Medicaid, and Medicaid pays the premiums; and
• those who pay an Income-Related Monthly Adjustment Amount (IRMAA).

Note: Budgets with a “From” date of January 1, 2022, or later, that utilize a Federal Poverty Level (FPL), must be calculated with the 2021 Social Security benefit amount and Medicare Part B premium amount until the 2022 FPLs are available on MBL. Upstate districts and New York City’s Human Resources Administration (HRA) are instructed not to update Social Security benefit amounts and Medicare Part B premium amounts for budgets that utilize an FPL until further notice.

Here are some of the GIS figures are effective January 1, 2022:

1. Medically Needy Income and Resources Levels.

HOUSEHOLD SIZE INCOME LEVEL RESOURCES ANNUAL MONTHLY
ONE $11,200 $934 $16,800
TWO $16,400 $1,367 $24,600
THREE $18,860 $1,572 $25,013
FOUR $21,320 $1,777 $28,275
FIVE $23,780 $1,982 $31,539
SIX $26,240 $2,187 $34,800
SEVEN $28,700 $2,392 $38,064
EIGHT $31,160 $2,597 $41,325
NINE $33,620 $2,802 $44,588
TEN $36,080 $3,007 $47,850
EACH ADD’L PERSON $2,460 $205 $3,263
2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $841/single and $1,261/couple.
3. The allocation amount is $433, the difference between the Medicaid income level for a household of two and one.
4. The 249e factors are .972 and .139.
5. The SSI resource levels remain $2,000 for individuals and $3,000 for couples.
6. The State Supplement is $87 for an individual and $104 for a couple living alone.
7. If an individual paid Medicare taxes for less than 30 quarters, the individual’s cost for Medicare Part A is $499. If an individual paid Medicare taxes for 30-39 quarters, the standard Part A premium is $274. 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 $170.10.
9. The Maximum federal Community Spouse Resource Allowance is $137,400.
10. The Minimum State Community Spouse Resource Allowance is $74,820.
11. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $3,435.
12. Maximum Family Member Allowance remains $726 until the FPLs for 2022 are published in the Federal Register.
13. Family Member Allowance formula number remains $2,178 until the FPLs for 2022 are published in the Federal Register.
14. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting is $433.
15. Substantial Gainful Activity (SGA) is: Non-Blind $1,350/month, Blind $2,260/month and Trial Work Period (TWP) $970/month.
16. SSI-related student earned income disregard limit of $2,040/monthly up to a maximum of $8,230/annually.
17. The home equity limit for Medicaid coverage of nursing facility services and community-based long-term care is $955,000.
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/ADM5 for further information) vary by region. For 2022, the amounts are: Northeastern $537; Central $466; Rochester $464 (a decrease from the 2021 figure); Western
$414; Northern Metropolitan $1,032 (a decrease from the 2021 figure); Long Island $1,414; and New York City $1,497 (a decrease from the 2021 figure).