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Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes and Enroll in MLTC Plan

Views: 5984
Posted: 15 May, 2015
by Valerie Bogart (New York Legal Assistance Group)
Updated: 03 Apr, 2017
by Valerie Bogart (New York Legal Assistance Group)

A huge barrier to people returning to the community from nursing homes is the high cost of housing.    One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay for rent or other shelter costs, rather than having to "spend down" their "excess income" or spend-down on the cost of Medicaid home care.

The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to safely  transition back to the community with MLTC.   Originally it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes.  GIS 14/MA-017 

Since you are allowed to keep more of your income, you may no longer need to use a pooled trust.

Who is eligible for this special income standard?  

  1. must be age 18+,

  2. must have been in a nursing home or an adult home for 30 days or more,

  3. must have had Medicaid pay toward  the nursing home care, and

  4. must enroll in a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home

    • (NOTE -12 ADM-05 and MLTC Policy 13.02  implied that the income standard was only for those newly enrolling in MLTC when leaving the nursing home, but the January 17, 2017 CMS Special Terms and Conditions say it is available for those "who enroll into or remain enrolled in the MLTC program in order to receive community based long term services and supports" and to those in a NH who were required to enroll into MLTC because of "...the mandatory Nursing Facility transition, and subsequently able to be discharged to the community from the nursing facility, with the services of MLTC program in place."  (emphasis added).  The State has not yet issued a directive that incorporates this updated agreement with CMS.  

  5. must have a housing expense

  6. if married, spouse may not receive a "spousal impoverishment" allowance once the individual is enrolled in MLTC

How much is the allowance?  

The rates vary by region and change yearly. 

Region

Counties

Deduction
(2017)

Central

Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins

$412

Long Island

Nassau, Suffolk

$1,285

NYC

Bronx, Kings, Manhattan, Queens, Richmond

$1,271

Northeastern

Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington

$471

North Metropolitan

Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester

$892

Rochester

Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates

$419

Western

Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming

$367

2017 rates published in GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards   Attachment 1The  guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05

 

HOW DOES IT WORK?

Here is a sample budget for a single person in NYC with Social Security income of $2,386/month paying a Medigap premium of $261/mo.

Gross monthly income

$2,386

DEDUCT Health insurance premiums

 (Medicare Part B)        - 109

(Medigap)        - 261

DEDUCT Unearned income disregard

- 20

DEDUCT Shelter deduction
(NYC—2017)

- 1,171

Net countable income

$825

DEDUCT Income limit for single (2017)

- 825

Excess income or Spend-down 

$0

WITH NO SPEND-DOWN, DO NOT NEED POOLED TRUST!

HOW TO OBTAIN THE HOUSING DISREGARD:

When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your  local Medicaid program change your Medicaid budget to give you the Housing Disregard.  

The procedures in NYC are explained in this Troubleshooting guide.

NYC Medicaid program prefers that your MLTC plan file the request, using 

Form MAP-3057E - Special income housing Expenses NH-MLTC.pdf and

Form  MAP-3047B - MLTC/NHED Cover Sheet

GOVERNMENT  DIRECTIVES:

 The Housing Disregard was created by agreement between CMS and NYS in the "Special Terms and Conditions" (ST&C) approving the MLTC program that are part of the "1115 Waiver."   These conditions are changed periodically. The most recent ST&C are dated Jan. 19, 2017.  The section on this income standard is at pages 26-27.  In these revised ST&C, this special income standard applies to people who were in a NH or adult home paid by Medicaid and "who enroll into or remain enrolled in the MLTC program in order to receive community based long term services and supports" and to those in a NH who were required to enroll into MLTC because of "...the mandatory Nursing Facility transition, and subsequently able to be discharged to the community from the nursing facility, with the services of MLTC program in place."  

Attached files
file HCSP-3047b 1-26-2015.pdf (55 kb)
file MAP-259H Intent to Return Home 2008-06-20.pdf (236 kb)
file MAP-2159i Notice of Permanent Placement Medicaid Managed Care.pdf (36 kb)
file 2015-04-03 Transition of Long Term Nursing Home Benefit into Medicaid Managed Care.pdf (690 kb)
file 2015-03-31 NHED EXPEDITED RENEWAL PROTOCOL.pdf (200 kb)
file Troubleshooting - 4-16-15 pp.pdf (2.11 mb)

Also read
document How to use a pooled SNT to eliminate the Medicaid spend-down.
document Step-by-step guide to enrolling in a pooled income trust for Medicaid spend-down
document Medicaid Spend-Down
document Managed Long Term Care
document Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan - Pooled Trusts Allowed as an Option
document "FIDA (Fully-Integrated Dual Advantage)" - Managed Care Expansion for Dual Eligibles in NYC Metro Area - Delayed Until Jan. 2015
document KNOW YOUR RIGHTS: Managed Long Term Care and FIDA - Fact Sheets, Live and Recorded Webinars

Also listed in
folder Medicaid -> Financial Eligibility
folder Medicaid -> Home Care
folder Medicaid -> Medicaid Managed Care

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