
Legal Support Center for Advocates April 2022 Virtual Training
March 22, 2022
Legal Lessons: March Advocacy Tips and Important Deadlines
March 23, 2022http://www.wnylc.com/health/file/314/?f=1
| 2022 NYS INCOME AND RESOURCE STANDARDS AND FEDERAL POVERTY LEVELS (FPL) Reference Documents: GIS: 22/MA 01, 21/MA 26, 21/MA 25, WLM 2022-00022, 2021-00277, 2021-00054, and NYS Partnership for Long-Term Care. | 
 MAPDR-01 03/16/2022 (Obsoletes MAPDR-71) | 
Note: Staff is advised that no consumer who was in receipt of Medicaid coverage on or after March 18, 2020 is to lose their Medicaid coverage during the COVID-19 emergency. The only exceptions for discontinuing coverage are when a consumer voluntarily terminates coverage, is no longer a resident of the State or is deceased.
For additional details regarding Applications and Renewals, staff is directed to, 2020 MAP INF-04 COVID-19 (Coronavirus Easements), GIS 20 MA/04, Coronavirus (COVID-19) – Medicaid Eligibility Processes During Emergency Period, GIS 20 MA/11, Update to GIS 20/MA 04, Coronavirus (COVID-19) – Medicaid Eligibility Processes During Emergency Period .
Financial Levels for Medicaid and Related Program Eligibility
| 1. Non-MAGI Medicaid Levels (SSI and SSI-Related Consumers With or Without A Surplus) | |||||||||||
| Family Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Each Additional Person | 
| Monthly Income | $934 | $1,367 | $1,572 | $1,777 | $1,982 | $2,187 | $2,392 | $2,597 | $2,802 | $3,007 | $205 | 
| 2. Non-MAGI Resource Levels | |||||||||||
| Family Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Each Additional Person | 
| Resource Level | $16,800 | $24,600 | $25,013 | $28,275 | $31,539 | $34,800 | $38,064 | $41,325 | $44,588 | $47,850 | $3,263 | 
| 3. Spousal Support and Resource Levels | ||
| Income (MMMNA) – $3,435.00 (Inst Spouse) – $50 | Resources – (Minimum) – $74,820 (Maximum) – $137,400 (Inst Spouse) – $16,800 | Family Member Allowance Formula: Use – $2,289 $763 is the maximum monthly family member allowance | 
| 4.                                                                    NYS Partnership for Long Term Care (NYSP-LTC) Qualified Partnership Policy Holder (QPP) Medicaid Extended Coverage (MEC) Asset Disregards for Total Asset Policy Holders/Dollar-for-Dollar Asset Protection Plan Policy Holders | ||
| Nursing Home | ||
| Resource Allowance | Income Allowance (Monthly) | |
| Applicant | *$16,800 | $50 | 
| Community Spouse | *$137,400 (Maximum) | $3,435.00 | 
| Home Care (Community-Based-Long-Term Care Services) | ||
| Resource Allowance | Income Allowance (Monthly) | |
| Applicant | $16,800 | $934 Increased to $1,717.50 for QPP’s | 
| Applicant with Spouse | $24,600 | $1,367 Increased to $3,435. 00 for QPP’s | 
| *Note: The Resource Allowances in this chart does not apply to the Total Asset Protection Plan QPP Policy Holders. | ||
| 5. MBI-WPD (Persons 16-64) | ||
| Family Size | 1 | 2 | 
| Monthly Income 250% FPL | $2,832 | $3,815 | 
| Resources | $20,000 | $30,000 | 
| 6. Family Planning Benefit Program Income Levels (No Resource Test) | |||||||
| Family Size | 1 | 2 | 3 | 4 | 5 | 6 | Each Additional Person | 
| FPBP 223% FPL (Childbearing Age) | $2,526 | $3,403 | $4,280 | $5,157 | $6,035 | $6,912 | $878 | 
Note: FPBP eligibility is to be determined using only the applicant’s income. The applicant’s income is then compared to 223% of the federal poverty level for the appropriate family size. Family size continues to be determined using legal responsibility.
| 7. Medicare Savings Program (Buy-In) | 8. Other Important Figures | |||||
| Income | Medicare Part A Premium: $274.00 (30-39 Quarters) $499.00 (Less than 30 Quarters) Medicare Part B Premium: (Rates based upon 2020 income tax filings) · The Cost of Living adjustment (COLA) for Social Security will be 5.9% percent for 2022. · The standard monthly premium for Medicare Part B enrollees is $170.10 for 2022. Most Medicare beneficiaries will pay this amount. The standard Medicare Part B $170.10 monthly premium is for beneficiaries with income less than or equal to $91,000. 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. Under federal law commonly known as the “hold harmless” provision, Medicare Part B premiums cannot raise more than the COLA in any year for most consumers. However, this provision does not apply to the consumers listed below. Their Part B premium increase is currently $170.10 in 2022. · Individuals whose income is above $91,000, or a married individual when the couple’s combined income is over $182,000, will pay the standard premium and an Income Related Monthly Adjustment Amount (IRMAA); · Beneficiaries who do not receive Social Security benefits; · Individuals who are directly billed for the Part B premium; · New Medicare Part B beneficiaries; and · Individuals who have Medicare and Medicaid, and Medicaid pays the premiums. Standard Allocation: From non-SSI-related parent to non-SSI- related child $433.00 PASS-THROUGH FACTORS: .972 and.139 Note: Budgets with a “From” date of January 1, 2021, 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. The 2021 Social Security amounts and Part B premium must be used until Phase Two of the Mass Re-budgeting. | |||||
| Family of 1 | Family of 2 | |||||
| 
 
 
 
 QMB 100% FPL | Annual | $13,590 | $18,310 | |||
| Monthly | $1,133 | $1,526 | ||||
| SLIMB 120% FPL | Annual | $16,308 | $21,972 | Family Size | 1 | 2 | 
| Monthly | $1,359 | $1,831 | COBRA (100% FPL) | $1,133 | $1,526 | |
| QI-1 135% FPL | Annual | $18,347 | $24,719 | AIDS Health Ins. Program (AHIP) (185% FPL) | $2,096 | $2,823 | 
| Monthly | $1,529 | 2,060 | QWDI (200% FPL) | $2,265 | $3,052 | |
| NO RESOURCE TEST FOR ANY MSP PROGRAM | COBRA, QWDI (Resource Level) | $4,000 | $6,000 | |||
| Pickle/DAC/SSI (Resource Level) | $2,000 | $3,000 | ||||
| 9. Monthly Regional Nursing Home Rates (Use the rate for the region in which the facility is located) | |
| NEW YORK CITY (All boroughs) – $13,415 | LONG ISLAND – $14,012 Nassau, Suffolk | 
| NORTHEASTERN – $12,560 Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington | NORTHERN METROPOLITAN – $13,399 Duchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester | 
| WESTERN – $11,884 Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming | ROCHESTER – $13,376 Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates | 
| CENTRAL – $11,328 Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins | |
| 10. Fair Market Regional Rates (Averages) / Special Standards for Housing Expenses | |
| NEW YORK CITY (All boroughs) (Shelter = 59) – $1,497 | LONG ISLAND (Shelter = 60) – $1,414 | 
| NORTHEASTERN (Shelter = 54) – $537 | NORTHERN METROPOLITAN (Shelter = 58) – $1,032 | 
| WESTERN (Shelter = 57) – $414 | ROCHESTER (Shelter = 56) – $464 | 
| CENTRAL (Shelter = 55) – $466 | |
| CONGREGATE CARE LEVEL III – (42+ Regional Rate for County- Shelter = 63) – $1,949 – $3,032 | |
In determining the community spouse resource allowance on and after January 1, 2022, the community spouse is permitted to retain resources in an amount equal to the greater of the following: $74,820 or the amount of the spousal share up to $137, 400. The spousal share is the amount equal to one-half of the total value of the countable resources of the couple as of the beginning of the most recent continuous period of institutionalization of the institutionalized spouse. The look-back period is anchored in the month the A/R is both institutionalized and applying for MA.
| 11. MAGI Levels for Medicaid and Related Program Eligibility | ||||||||||||
| Family Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Each Add’l Person | |
| Pregnant Women and Infants Under Age 1 (223% FPL) | $2,526 | $3,403 | $4,280 | $5,157 | $6,035 | $6,912 | $7,789 | $8,666 | $9,543 | $10,420 | $878 | |
| Infants Under Age 1 223% FPL | $2,526 | $3,403 | $4,280 | $5,157 | $6,035 | $6,912 | $7,789 | $8,666 | $9,543 | $10,420 | $878 | |
| Children Age 1-5 154% FPL | $1,745 | $2,350 | $2,956 | $3,562 | $4,167 | $4,773 | $5,379 | $5,985 | $6,590 | $7,196 | $606 | |
| Children Age 6 -19 110% FPL | $1,246 | $1,679 | $2,112 | $2,544 | $2,977 | $3,410 | $3,842 | 4,275 | $4,708 | $5,140 | $433 | |
| Children Age 6-19 (Expanded – 154% FPL) | $1,745 | $2,350 | $2,956 | $3,562 | $4,167 | $4,773 | $5,379 | $5,985 | $6,590 | $7,196 | $606 | |
| Parents and Caretaker Relatives 138% FPL | $1,563 | $2,106 | $2,649 | $3,192 | $3,735 | $4,277 | $4,820 | $5,363 | $5,906 | $6,449 | $543 | |
| 19 and 20 Year Olds Living with Parents 138% FPL | $1,563 | $2,106 | $2,649 | $3,192 | $3,735 | $4,277 | $4,820 | $5,363 | $5,906 | $6,449 | $543 | |
| 19 and 20 Year Olds Living with Parents (Expanded – 155% FPL) | $1,756 | $2,366 | $2,975 | $3,585 | $4,195 | $4,804 | $5,414 | $6,024 | $6,633 | $7,243 | $610 | |
| S/CCs and 19 and 20 Year Olds Living Alone (100% FPL) | $1,133 | $1,526 | $1,920 | $2,313 | $2,706 | $3,100 | $3,493 | $3,886 | $4,280 | $4,673 | $394 | |
| S/CCs and 19 and 20 Year Olds Living Alone (Expanded 138% FPL) | $1,563 | $2,106 | $2,649 | $3,192 | $3,735 | $4,277 | $4,820 | $5,363 | $5,906 | $6,449 | $543 | |
| 12. Children’s Medicaid Income Eligibility Levels | |||||||||
| Family Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional Person | 
| Children Under 1; Pregnant Adult* | $2,526 | $3,403 | $4,280 | $5,157 | $6,035 | $6,912 | $7,789 | $8,666 | $878 | 
| Children 1-18 Years | $1,745 | $2,350 | $2,956 | $3,562 | $4,167 | $4,773 | $5,379 | $5,985 | $606 | 
| Note: *Pregnant adult household size calculation includes all expected children. | |||||||||
| 13. Child Health Plus Premium Levels – Monthly Income by Family Size (Children Under 19 Not Medicaid Eligible) | |||||||
| Premium Categories | 1 | 2 | 3 | 4 | 5 | 6 | Each Add’l Person | 
| Free Insurance (under 160% FPL) | $1,811 | $2,441 | $3,070 | $3,699 | $4,329 | $4,958 | $629 | 
| $9 per child per month (Max. $27 per family) (160% – 222% FPL) | $2,515 | $3,388 | $4,261 | $5,134 | $6,007 | $6,881 | $874 | 
| $15 per child per month (Max $45/family) (223% – 250% FPL) | $2,832 | $3,815 | $4,798 | $5,782 | $6,765 | $7,748 | $984 | 
| $30 per child per month (Max. $90 per family) (251% – 300% FPL) | $3,398 | $4,578 | $5,758 | $6,938 | $8,118 | $9,298 | $1,180 | 
| $45 per child per month (Max. $135 per family) (301% – 350% FPL) | $3,964 | $5,341 | $6,718 | $8,094 | $9,471 | $10,848 | $1,377 | 
| $60 per child per month (Max. $180 per family) (351%-400% FPL) | $4,530 | $6,104 | $7,677 | $9,250 | $10,824 | $12,397 | $1,574 | 
| Full Premium per child/month if over 400% FPL (Premium amount varies from plan to plan) | Over $4,530 | Over $6,104 | Over $7,677 | Over $9,250 | Over $10,824 | Over $12,397 | Over 1,574 | 
| Note: *Pregnant women count as two. | |||||||
| 14. Disabled Adult Children (DAC) Levels | ||
| Living Arrangements | Shelter Types | Amount | 
| 1 | 15 | $1,107.48 | 
| 1 | 28 | $1,069.48 | 
| 1 | 16 | $1,276.00 | 
| 1 | 29 | $1,246.00 | 
| 1 | 42 | $1,535.00 | 
| 1 or 5 | Other than: 15, 16, 28, 29 or 42 | $928.00 | 
| 2 | 15 | $2,214.96 | 
| 2 | 28 | $2,138.96 | 
| 2 | 16 | $2,552.00 | 
| 2 | 29 | $2,492.00 | 
| 2 | 42 | $3,070.00 | 
| 2 or 6 | Other than: 15, 16, 28, 29 or 42 | $1,365.00 | 
| 3 | All | $1,069.48 | 
| 4 | All | $1,107.48 | 
| 15. Congregate Care Level I, II and III Levels | ||
| Shelter Codes | PNA | Shelter Amount | 
| 15 – (NYC, Nassau, Suffolk, Westchester, Rockland Counties) Level I | $161.00 | $946.48 | 
| 16 – (NYC, Nassau, Suffolk, Westchester, Rockland Counties) Level II | $186.00 | $1,090.00 | 
| 28 – (Rest of State) Level I | $161.00 | $908.48 | 
| 29 – (Rest of State) Level II | $186.00 | $1,060.00 | 
| 42 – (NYC, Nassau, Suffolk, Westchester, Rockland Counties) Level III | $222.00 | $1,313.00 | 
| 42 – (Rest of State) Level III | $222.00 | $1,313.00 | 
| 16. SSI Levels | ||||
| SSI Consumer | Amount | |||
| Allocation Amount (The difference between the regular Medicaid levels for a household of two [$1,367.00] and a household of one [$934.00]) | $433.00 | |||
| Personal Needs Allowance (Certain waiver participants subject to spousal impoverishment budgeting) | $433.00 | |||
| Maximum Social Security Benefit at Full Retirement Age | $3,345.00 | |||
| State Supplement (For an individual living with others) | $23.00 | |||
| Federal Benefit Rate | Individual | $841.00 | Couple | $1,261.00 | 
| SSI Resource Levels | Individual | $2,000.00 | Couple | $3,000.00 | 
| Family Care Level (LA 3 & 4) | NYC and Nassau, Suffolk, Westchester and Rockland | $1,107.48 | Upstate | $1,069.48 | 
| SSI-related Student Earned Income Disregard | Monthly | $2,040.00 | Annual Max. | $8,230.00 | 
| 17. Substantial Gainful Activity (SGA) Levels | ||
| Category | Amount | Payment Occurrence | 
| Non-Blind | $1,350.00 | Monthly | 
| Blind | $2,260.00 | Monthly | 
| Month Trial Work Period | $970.00 | Monthly | 
| 18. Home Equity Maximum | |
| Medicaid Coverage Limit (RVI 1 and 2 cases) | $955,000 | 


