GIS 16 MA/018 - 2017 Medicaid Levels and Other Updates

The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) of the levels and figures used in determining Medicaid eligibility effective January 1, 2017.

Due to a 0.3 percent cost of living adjustment (COLA) for Social Security Administration (SSA) payments effective January 1, 2017, several figures used in determining Medicaid eligibility must be updated. Since the increase to the Supplemental Security Income (SSI) benefit levels was relatively small, the Medically Needy Income and Resource Levels will remain the same.

Due to the low COLA and a statutory "hold harmless" provision designed to ensure that a beneficiary's Social Security benefit is not lower in January than it was in December due solely to the increase in Medicare Part B premiums, Medicare Part B premiums will vary depending on the amount of an individual's Social Security benefit in 2017. Medicare Part B premiums will increase by the amount of the individual's Social Security COLA. The net result of the COLA increase for many Medicaid recipients will be a $0 change in net available monthly income.

Since information concerning the manner in which Medicare Part B premiums would be impacted by the COLA was not received in time to make the necessary changes for the scheduled Mass Re-Budgeting (MRB) upstate, it was decided not to perform the MRB. While the MRB will not occur, the MBL tables and figures will be updated to reflect the 2017 figures. The updated MBL tables for upstate will be available December 5, 2016 and for New York City on December 9, 2016.

A chart with the new Medicaid levels is attached. MBL will be programmed to use these figures when a "From" date of January 1, 2017, or greater is entered.

Note: Budgets with a "From" date of January 1, 2017, or later, that utilize an FPL, must be calculated with the 2016 Social Security benefit amount and Medicare Part B premium until the 2017 FPLs are available on MBL. Upstate districts should separately identify these cases for re-budgeting once the 2017 FPLs are available as these cases will not be included in Phase Two of Mass Re-budgeting. In New York City, the 2016 Social Security benefit amounts and Part B premium should be used until Phase Two of Mass Re-budgeting. Upstate districts are instructed to update Social Security benefit amounts and Medicare Part B premiums for budgets that do not utilize a FPL at next contact or recertification, whichever occurs first.

The following figures are effective January 1, 2017.

1. Medically Needy Income and Resources Levels.

   HOUSEHOLD SIZE	MEDICALLY NEEDY INCOME LEVEL		RESOURCES
   	ANNUAL	MONTHLY
   ONE	9,900	825	14,850
   TWO	14,500	1,209	21,750
   THREE	16,675	1,390
   FOUR	18,850	1,571
   FIVE	21,025	1,753
   SIX	23,200	1,934
   SEVEN	25,375	2,115
   EIGHT	27,550	2,296
   NINE	29,725	2,478
   TEN	31,900	2,659
   EACH ADD'L PERSON	2,175	182

2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $735/single and $1,103/couple.
3. The allocation amount is $384, the difference between the Medicaid income level for a household of two and one.
4. The 249e factors are .968 and .159.
5. The SSI resource levels remain $2,000 for individuals and $3,000 for couples.
6. The State Supplement is $87 for an individual and $104 for a couple living alone.
7. The Medicare Part A Hospital Insurance Base Premium is $227/month for people having 30- 39 work quarters and $413/month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters. The standard Medicare Part B monthly premium for beneficiaries with income less than or equal to $85,000 is $134.
8. The Maximum federal Community Spouse Resource Allowance is $120,900.
9. The Minimum State Community Spouse Resource Allowance is $74,820.
10. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $3,022.50.
11. Maximum Family Member Allowance is $668 until the FPLs for 2017 are published in the Federal Register.
12. Family Member Allowance formula number remains $2,003 until the FPLs for 2017 are published in the Federal Register.
13. Personal Needs allowance for certain waiver participants subject to spousal impoverishment budgeting is $384.
14. Substantial Gainful Activity (SGA) is: Non-Blind $1,170/month, Blind $1,950/month and Trial Work Period (TWP) $840/month.
15. SSI-related student earned income disregard limit of $1,790/monthly up to a maximum of $7,200/annually.
16. The home equity limit for Medicaid coverage of nursing facility services and community- based long-term care is $840,000.
17. The special income standard for housing expenses that is available to certain individuals who enroll in the Managed Long Term Care program (See 12 OHIP/ADM-5 for further information) vary by region. For 2017, the amounts are: Northeastern $471; Central $412; Rochester $419; Western $367; Northern Metropolitan $892; Long Island $1,285; and New York City $1,171.

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