NYSDOH Issues GIS 22 MA-12 & 14 Updating 2023 Regional Rates and Medicaid Levels

GIS 22 MA-12 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 $11,726 – Broome, Jefferson, Oswego,Cayuga, Lewis, St. Lawrence, Chenango, Madison, Tioga, Cortland, Oneida, Tompkins, Herkimer, Onondaga;

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

WESTERN $12,130 – Allegany, Niagara, Cattaraugus, Orleans, Chautauqua, Wyoming, Erie, Genesee;

NORTHERN METROPOLITAN $13,906 – Dutchess, Ulster, Orange, Westchester, Putnam, Rockland, Sullivan;

NEW YORK CITY $14,142 – Bronx, Queens, Kings (Brooklyn), Richmond (Staten Island), New York (Manhattan);

LONG ISLAND $14,136 – Nassau, Suffolk;

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

GIS 22 MA-14 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, 2023.
Due to the ongoing Public Health Emergency (PHE), Phase 1 of Mass Re-Budgeting (MRB),
including the systematic update of the 8.7 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 pending any
other direction to districts from the Department. The Medicaid Budget Logic (MBL) has been
updated with the 2023 Medically Needy income levels. This ensures the revised income levels
are available in MBL for applications, and redeterminations. The methodology for determining
the Medically Needy income level has changed to 138% of the Federal Poverty Level. This
change is described in GIS 22 MA/11 “Increase of Medical Medically Needy Income Level to
138% of the Federal Poverty Level and Related Medically Needy and MBI-WPD Resource Level
Changes.” As instructed in GIS 22 MA/11, districts must recalculate income eligibility based on
the new levels and current income information when contacted by the consumer, or at next
renewal.
The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a
decrease of $5.20 from $170.10 in 2022. Most Medicare beneficiaries will pay this amount.
Less than 1% of Medicare beneficiaries will pay less than the full Part B standard monthly
premium amount in 2022. Due to the SSA 8.7% COLA, some beneficiaries who were held
harmless against Part B premium increases in 2022 will pay the full monthly premium of
$164.90 in 2023. 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 beneficiaries who:
• do not receive Social Security benefits;
• are directly billed for their Part B premium;
• are new Medicare Part B beneficiaries;
• have Medicare and Medicaid, and Medicaid pays the premiums; and
• pay an Income-Related Monthly Adjustment Amount (IRMAA).

Note: Budgets with a “From” date of January 1, 2023, or later, that utilize a Federal Poverty
Level (FPL), must be calculated with the 2022 Social Security benefit amount and Medicare Part B premium amount until the 2023 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.

For purposes of redetermining income eligibility as provided for in GIS 22 MA/11, districts must use the current income information that is reported by the consumer.

The following figures are effective January 1, 2023.

Medically Needy Income and Resources Levels are in effect until the FPLs for 2023 are
published in the Federal Register.

1. Medically Needy Income and Resources Levels.

HOUSEHOLD SIZE INCOME LEVEL RESOURCES

ANNUAL MONTHLY
ONE $18,755 $1,563 $28,133
TWO $25,268 $2,106 $37,902
THREE $31,782 $2,649
FOUR $38,295 $3,192
FIVE $44,809 $3,735
SIX $51,323 $4,277
SEVEN $57,836 $4,820
EIGHT $64,350 $5,363
NINE $70,863 $5,906
TEN $77,377 $6,449
EACH ADD’L PERSON $6,514 $543
2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $ $914.00/single and $1,371.00/couple.
3. The allocation amount is $543, the difference between the Medicaid income level for a household of two and one.
4. The 249e factors are .974 and .128
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 $506. If an individual paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278. 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 $97,000 is $164.90.
9. The Maximum federal Community Spouse Resource Allowance is $148,620.
10. The Minimum State Community Spouse Resource Allowance is $74,820.
11. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $3,715.50.
12. Maximum Family Member Allowance remains $763 until the FPLs for 2023 are published in the Federal Register.
13. Family Member Allowance formula number remains $2,289 until the FPLs for 2023 are published in the Federal Register.
14. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting is $543.
15. Substantial Gainful Activity (SGA) is: Non-Blind $1,470/month, Blind $2,460/month and Trial Work Period (TWP) $1,050/month.
16. SSI-related student earned income disregard limit of $2,220/monthly up to a maximum of $8,950/annually.
17. The home equity limit for Medicaid coverage of nursing facility services and community-based long-term care is $1,033,000.
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 2023, the amounts are: $425.00 (a decrease from the 2022 figure); Central $358.00 (a decrease from the 2022 figure); Rochester $367.00 (a decrease from the 2022 figure); Western $301.00 (a decrease from the 2022 figure); Northern Metropolitan $1,031.00 (a decrease from the 2022 figure); Long Island $1,445.00; and New York City $1,701.00.