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

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.

September 2018 NEWS -- Those already enrolled in MLTC plans before they are admitted to a nursing home or adult home may obtain this budgeting upon discharge, if they meet the other criteria below.

"How nursing home administrators, adult home operators and MLTC plans should identify individuals who are eligible for the special income standard" and explains their duties to identify eligible individuals, and the MLTC plan must notify the local DSS that the individual may qualify:

"Nursing home administrators, nursing home discharge planning staff, adult home operators and MLTC health plans are encouraged to identify individuals who may qualify for the special income standard, if they can be safely discharged back to the community from a nursing home and enroll in, or remain enrolled in, an MLTC plan. Once an individual has been accepted into an MLTC plan, the MLTC plan must notify the individual's local district of social services that the transition has occurred and that the individual may qualify for the special income standard. The special income standard will be effective upon enrollment into the MLTC plan, or, for nursing home residents already enrolled in an MLTC plan, the month of discharge to the community.

Questions regarding the special income standard may be directed to DOH at 518-474-8887.

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 or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home

  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

(2018)

Central

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

$417

Long Island

Nassau, Suffolk

$1,274

NYC

Bronx, Kings, Manhattan, Queens, Richmond

$1,305

Northeastern

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

$467

North Metropolitan

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

$935

Rochester

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

$424

Western

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

$367

Past rates published as follows, available on DOH website

2018 rates published in GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates  The  guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05. 

2017 rate  --  GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards   Attachment 1
2016 rate  -- GIS 15-MA/021
2015 rate  -- Were not posted by DOH but were updated in WMS:

                2015
Central $382
Long Island $1,147
NYC $1,001
Northeastern $440
N.  Metropolitan $791
Rochester $388
Western $336

2014 rate  -- GIS-14-MA/017 

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, May  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. See September 2018  NYS DOH Medicaid Update that requires MLTC plan to help you ask for it. 

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

Form MAP-259f  (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard.

GOVERNMENT  DIRECTIVES (beginning with oldest):


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