Legal Support Center for Advocates April 2022 Virtual Training
March 22, 2022Legal 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 |