GIS 13 MA/002: 2013 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards

The purpose of this General Information System (GIS) message is to advise local department of social services (LDSS) of the income levels and figures used in determining Medicaid eligibility effective January 1, 2013.

Due to a 1.7 percent cost of living adjustment for Social Security Administration (SSA) payments effective January 1, 2013, several figures used in determining Medicaid eligibility must be updated. With an increase to the Supplemental Security Income (SSI) benefit levels, the Medically Needy income and resource levels will be adjusted accordingly. In addition, an increase in the Consumer Price Index (CPI) requires an adjustment to the Medicaid Income Standards used for Singles/Childless Couples and Low Income Families.

As a result of these changes, a Mass Rebudgeting (MRB) will be performed the weekend of December 22, 2012 for New York City (NYC) and January 19, 2013 for Upstate districts. Reductions in coverage are to be made effective February 1, 2013, or later, following 10 day notification. Budgets that utilize a federal poverty level will not be included in this Mass Rebudgeting. When the actual federal poverty levels (FPL) are available, a second Mass Rebudgeting of the affected cases will be performed. A separate GIS message will be issued when the 2013 FPLs are available.

For Upstate districts, if a budget utilizing the medically needy income levels is calculated prior to the Mass Rebudgeting completion date, and has a "From" date of January 1, 2013, the 2013 social security benefit amount(s) should be used in the budget. If using the 2013 social security benefit amount(s) with the 2012 Medicaid income levels results in a person having an increased spenddown or going from being fully Medicaid eligible to a spenddown, current case coverage should be continued until the 2013 Medicaid levels are available (January 21, 2013). These cases will not be included in the Mass Rebudgeting since the MBL budget "From" date is not prior to January 1, 2013. Districts will need to store the budget again for these cases after the Mass Rebudgeting date.

NOTE: Budgets with a "From" date of January 1, 2013 or later that utilize a FPL must be calculated with the 2012 social security benefit amount(s) and Medicare Part B premium, until the 2013 FPLs are available on MBL. Upstate districts should separately identify these cases for rebudgeting once the 2013 FPLs are available as these cases will not be included in Phase Two of Mass Rebudgeting. In New York City, the 2012 social security benefit amounts and Part B premium should be used until Phase Two of Mass Rebudgeting. Mass Rebudgeting in NYC will include cases with a "From" date of January or February.

Effective January 1, 2013, Medicaid eligibility must be determined using the following figures:

House Hold Size	Medicaid STD S/CC - LIF		Medicaid Income Level		Resources
	Annual	Monthly	Annual	Monthly
ONE	8,994	750	9,600	800	14,400
TWO	11,228	936	14,100	1,175	21,150
THREE	13,360	1,114	16,215	1,352	24,323
FOUR	15,512	1,293	18,330	1,528	27,495
FIVE	17,737	1,479	20,445	1,704	30,668
SIX	19,364	1,614	22,560	1,880	33,840
SEVEN	21,078	1,757	24,675	2,057	37,013
EIGHT	23,278	1,940	26,790	2,233	40,185
NINE	24,538	2,045	28,905	2,409	43,358
TEN	25,800	2,150	31,020	2,585	46,530
EACH ADD'L PERSON	1,262	106	2,115	177	3,3173

• 1. Medicaid Income Standards, Medically Needy Income and Resource Levels.
• 2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $710/single and $1,066/couple.
• 3. The allocation amount is $375, the difference between the Medicaid income level for a household of two and one.
• 4. The 249e factors are .967 and .165.
• 5. The SSI resource levels remain $2,000 for individuals and $3,000 for couples.
• 6. The State supplement remains $87 for an individual and $104 for a couple living alone.
• 7. The Medicare Part A premium is $243/month for 2013 for individuals having 30-39 work quarters. This is a $5 decrease from 2012. The Medicare Part A premium will be $441/month for those who are not otherwise eligible for premium-free hospital insurance and have less than 30 work quarters. This is a decrease of $10 from 2012.
• 8. The Maximum federal Community Spouse Resource Allowance is $115,920.
• 9. The Minimum State Community Spouse Resource Allowance remains $74,820.
• 10. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,898.
• 11. Maximum Family Member Allowance is $631 until the FPLs for 2013 are published in the Federal Register.
• 12. Family Member Allowance formula number is $1,892 until the FPLs for 2013 are published in the Federal Register.
• 13. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting is $375.
• 14. Substantial Gainful Activity (SGA): Non-Blind $1,040/month, Blind $1,740/month, Trial Work Period (TWP) $750/month.
• 15. SSI-related student earned income disregard limit of $1,730/monthly up to a maximum of $6,960/annually.
• 16. The home equity limit for Medicaid coverage of nursing facility services and community-based long-term care is $802,000.

Medicare Part B Premium

The standard Medicare Part B monthly premium will be $104.90 in 2013. This will be an increase of $5 from the 2012 premium of $99.90.

The 2013 COLA increase of 1.7% combined with the increase in Medicare Part B premium should not have a negative impact on Medicaid eligibility.

Please direct any questions to the Local District Support Unit at 518-474-8887 and 212-417-4500 for NYC.

New York State Income and Resource Standards Effective January 1, 2013

House Hold Size	Medicaid STD S/CC - LIF		Medicaid Income Level		100% FPL		120% FPL		133% FPL		135% FPL		150% FPL		160% FPL		185% FPL		200% FPL		250% FPL		Resources SSI Related Only
	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly
ONE	8,994	750	9,600	800	11,170	931	13,404	1,117	14,857	1,239	15,080	1,257	16,755	1,397	17,872	1,490	20,665	1,723	22,340	1,862	27,925	2,328	14,400	1
TWO	11,228	936	14,100	1,175	15,130	1,261	18,156	1,513	20,123	1,677	20,426	1,703	22,695	1,892	24,208	2,018	27,991	2,333	30,260	2,522	37,825	3,153	21,150	2
THREE	13,360	1,114	16,215	1,352	19,090	1,591	-	-	25,390	2,116	-	-	28,635	2,387	30,544	2,546	35,317	2,944	38,180	3,182	-	-	24,323	3
FOUR	15,512	1,293	18,330	1,528	23,050	1,921	-	-	30,657	2,555	-	-	34,575	2,882	36,880	3,074	42,643	3,554	46,100	3,842	-	-	27,495	4
FIVE	17,737	1,479	20,445	1,704	27,010	2,251	-	-	35,924	2,994	-	-	40,515	3,377	43,216	3,602	49,969	4,165	54,020	4,502	-	-	30,668	5
SIX	19,364	1,614	22,560	1,880	30,970	2,581	-	-	41,191	3,433	-	-	46,455	3,872	49,552	4,130	57,295	4,775	61,940	5,162	-	-	33,840	6
SEVEN	21,078	1,757	24,675	2,057	34,930	2,911	-	-	46,457	3,872	-	-	52,395	4,367	55,888	4,658	64,621	5,386	69,860	5,822	-	-	37,013	7
EIGHT	23,278	1,940	26,790	2,233	38,890	3,241	-	-	51,724	4,311	-	-	58,335	4,862	62,224	5,186	71,947	5,996	77,780	6,482	-	-	40,185	8
NINE	24,538	2,045	28,905	2,409	42,850	3,571	-	-	56,991	4,750	-	-	64,275	5,357	68,560	5,714	79,273	6,607	85,700	7,142	-	-	43,358	9
TEN	25,800	2,150	31,020	2,585	46,810	3,901	-	-	62,258	5,189	-	-	70,215	5,852	74,896	6,242	86,599	7,217	93,620	7,802	-	-	46,530	10
EACH ADD'L PERSON	1,262	106	2,115	177	3,960	330	-	-	5,267	439	-	-	5,940	495	6,336	528	7,326	611	7,920	660	-	-	3,173	+

Spousal Impoverishment

Spousal Impoverishment	Income	Resources
Community Spouse	$2,898	$115,920
Institutionalized Spouse	$50	$14,400
Family Member Allowance	$1,892 is used in the FMA formula the maximum allowance is $631.	N/A

*In determining the community resource allowance on and after January 1, 2013, 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 $115,920. 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 on or after September 30, 1989.

Revised December 14, 2012

Category

Category	Income Compared	Household Size		Resource Level		Special Notes
		1	2	1	2
Presumptive Eligibility for Pregnant Women	100% FPL	N/A	1,261	No Resource Test		Qualified provider makes the presumptive eligibility determination. Cannot spen-down to become eligible for presumptive eligibility.
	200% FPL	N/A	2,522
Pregnant Women	100% FPL	N/A	1,261	No Resource Test		A woman determined eligible for Medicaid for any time during her pregnancy remains eligible for Medicaid coverage until the last day of the month in which the 60th day from the date the pregnancy ends occurs, regardless of any change in income, resources or household composition. If the income is above 200% FPL the A/R must spend-down to the Medicaid income level. The baby will have guaranteed eligibility for one year.
	200% FPL	N/A	2,522
Children Under One	200% FPL	1,862	2,522	No Resource Test		If the income is above 200% FPL the A/R must spend-down to the Medicaid income level. One year guaranteed eligibility if mother is in receipt of Medicaid on delivery. Eligibility can be determined in the 3 months retro to obtain the one year extension.
Children Age 1 Through 18	133% FPL	1,239	1,677	No Resource Test		If the income is above 133% FPL the A/R must spenddown to the Medicaid income level.
Under 21, ADC-Related and FNP	Medicaid Level	800	1,175	No Resource Test		FNP parents cannot spenddown.
SINGLES/CHILDLESS COUPLES	MEDICAID STANDARD	750	936	No Resource Test		The A/R cannot spend-down income.
LOW INCOME FAMILIES	MEDICAID STANDARD	750	936	No Resource Test		The A/R cannot spend-down income.
SSI-RELATED	MEDICAID LEVEL	800	1,175	14,400	21,150	Household size is always one or two.
Qualified Medicare Beneficiary (QMB)	100%FPL	931	1,261	No Resource Test		Medicare Part A & B, coinsurance, deductible and premium will be paid if eligible.
COBRA CONTINUATION COVERAGE	100%FPL	931	1,261	4,000	6,000	A/R may be eligible for Medicaid to pay the COBRA premium.
AIDS INSURANCE	185%FPL	1,723	2,333	No Resource Test		A/R must be ineligible for Medicaid, including COBRA continuation.
QUALIFIED DISABLED & WORKING INDIVIDUAL	200%FPL	1,862	2,522	4,000	6,000	Medicaid will pay Medicare Part A premium.
SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMBS)	BETWEEN 100% BUT LESS THAN 120%FPL	931	1,261	No Resource Test		If the A/R is determined eligible, Medicaid will pay Medicare Part B premium.
		1,117	1,513
QUALIFIED INDIVIDUALS (QI-1)	BETWEEN 120% BUT LESS THAN 135%FPL	1,117	1,513	No Resource Test		If the A/R is determined eligible, Medicaid will pay Medicare Part B premium.
		1,257	1,703
FAMILY HEALTH PLUS PARENTS LIVING WITH CHILDREN SINGLES/CHILDLESS COUPLES	150% FPL	1,397	1,892	No Resource Test		The A/R must be ineligible for Medicaid. The A/R cannot spend-down to become eligible for Family Health Plus.
	100% FPL	931	1,261
FAMILY PLANNING BENEFIT PROGRAM (FPBP)	200%	1,862	2,522	No Resource Test		Provides Medicaid coverage for family planning services to persons with incomes at or below 200% FPL. Potentially eligible individuals will be screened for eligibility for Medicaid and FHPlus, unless they specifically request to be screened only for FPBP eligibility.
MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES (MBI-WPD)	250%FPL	2,328	3,153	20,000	30,000	A/R's with a net income that is at least 150% but at or below 250% FPL will pay a premium. Currently, there is a moratorium on premium payment collection. Otherwise countable retirement accounts are disregarded as resources effective 10/01/11.