GIS 11 MA/005: 2011 Federal Poverty Levels

The purpose of this GIS message is to inform the local department of social services (LDSS) of revised federal poverty levels (FPLs). The revised FPLs are effective January 1, 2011, and are the actual poverty levels published in the Federal Register on January 20, 2011.

The new FPLs are effective for cases with budget "From" dates of January 1, 2011 or later. The revised figures will be available on MBL April 11, 2011. For all new and pending applications, income must be compared to the revised FPLs. When districts have determined that previously budgeted cases with a "From" date of January 1, 2011, have been negatively affected, or if cases are brought to the districts attention, such cases should be rebudgeted using the revised FPLs. If eligible, covered medical expenses paid by an individual as a result of improper calculations must be reimbursed pursuant to 10 OHIP/ADM-9 "Reimbursement of Paid Medical Expenses Under 18 NYCRR §360-7.5(a)."

A chart with the new FPLs is attached to this GIS. Please see the previously issued GIS 10 MA/26, "2011 SSI, LIF/SCC Medicaid Standard and Medicaid Income and Resource Levels," for other pertinent eligibility determination information.

As a result of the increase in the FPLs, the amount used in the Family Member Allowance (FMA) formula increased to $1,839. The maximum FMA increased to $613. All spousal impoverishment cases involving a family member entitled to the family member allowance, which were active on or after January 1, 2011, and which were budgeted using the 2010 family member allowance, must be rebudgeted using the new family member allowance. In addition, the increased family member allowance must be used effective January 1, 2011 in determining any requested contribution of income from a community spouse or from a spouse living apart from a SSI-related applicant/recipient. Budget adjustments should be made at next contact or renewal.

Further information will be forthcoming in an Upstate WMS Coordinator Letter and MBL transmittal.

New York State Income and Resource Standards Effective January 1, 2011

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	8,487	708	9,200	767	10,890	908	13,068	1,089	14,484	1,207	14,702	1,226	16,335	1,362	17,424	1,452	20,147	1,679	21,780	1,815	27,225	2,269	13,800	1
TWO	10,595	883	13,400	1,117	14,710	1,226	17,652	1,471	19,565	1,631	19,859	1,655	22,065	1,839	23,536	1,962	27,214	2,268	29,420	2,452	36,775	3,036	20,100	2
THREE	12,606	1,051	15,410	1,285	18,530	1,545	-	-	24,645	2,054	-	-	27,795	2,317	29,648	2,471	34,281	2,857	37,060	3,089	-	-	23,115	3
FOUR	14,637	1,220	17,420	1,452	22,350	1,863	-	-	29,726	2,478	-	-	33,525	2,794	35,760	2,980	41,348	3,446	44,700	3,725	-	-	26,130	4
FIVE	16,736	1,395	19,430	1,620	26,170	2,181	-	-	34,807	2,901	-	-	39,255	3,272	41,872	3,490	48,415	4,035	52,340	4,362	-	-	29,145	5
SIX	18,271	1,523	21,440	1,787	29,990	2,500	-	-	39,887	3,324	-	-	44,985	3,749	47,984	3,999	55,482	4,624	59,980	4,999	-	-	32,160	6
SEVEN	19,889	1,658	23,450	1,955	33,810	2,818	-	-	44,968	3,748	-	-	50,715	4,227	54,096	4,508	62,549	5,213	67,620	5,635	-	-	35,175	7
EIGHT	21,965	1,831	25,460	2,122	37,630	3,136	-	-	50,048	4,171	-	-	56,445	4,704	60,208	5,018	69,616	5,802	75,260	6,272	-	-	38,190	8
EACH ADD'L PERSON	-	99	2,010	168	3,820	319	-	-	5,081	424	-	-	5,730	478	6,112	510	7,067	589	7,640	637	-	-	3,015	+

Spousal Impoverishment

Spousal Impoverishment	Income	Resources
Community Spouse	$2,739	$109,560
Institutionalized Spouse	$50	$13,800
Family Member Allowance	$1,839 is used in the FMA formula the maximum allowance is $631.	N/A

Category

Category	Income Compared	Household Size		Resource Level		Special Notes
		1	2	1	2
Presumptive Eligibility for Pregnant Women	100% FPL	N/A	1,226	No Resource Test		Qualified provider makes the presumptive eligibility determination. Cannot spendown to become eligible for presumptive eligibility.
	200% FPL	N/A	2,452
Pregnant Women	100% FPL	N/A	1,226	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	2,452
Children Under One	200% FPL	1,815	2,452	No Resource Test		If the income is above 200% FPL the A/R must spenddown 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 5	133% FPL	1,207	1,631	No Resource Test		If the income is above 133% FPL the A/R must spenddown to the Medicaid income level.
CHILDREN AGE 6 THROUGH 18	100%	908	1,226	No Resource Test		If the income is above 100% FPL the A/R must spenddown to the Medicaid income level.
Under 21, ADC-Related and FNP	Medicaid Level	767	1,117	No Resource Test		FNP parents cannot spenddown.
SINGLES/CHILDLESS COUPLES	MEDICAID STANDARD	708	883	No Resource Test		The A/R cannot spend-down income.
LOW INCOME FAMILIES	MEDICAID STANDARD	708	883	No Resource Test		The A/R cannot spend-down income.
SSI-RELATED	MEDICAID LEVEL	767	1,117	13,800	20,100	Household size is always one or two.
Qualified Medicare Beneficiary (QMB)	100%FPL	908	1,226	No Resource Test		Medicare Part A & B, coinsurance, deductible and premium will be paid if eligible.
COBRA CONTINUATION COVERAGE	100%FPL	908	1,226	4,000	6,000	A/R may be eligible for Medicaid to pay the COBRA premium.
AIDS INSURANCE	185%FPL	1,679	2,679	No Resource Test		A/R must be ineligible for Medicaid, including COBRA continuation.
QUALIFIED DISABLED & WORKING INDIVIDUAL	200%FPL	1,815	2,452	4,000	6,000	Medicaid will pay Medicare Part A premium.
SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMBS)	BETWEEN 100% BUT LESS THAN 120%FPL	908	1,226	No Resource Test		If the A/R is determined eligible, Medicaid will pay Medicare Part B premium.
		1,089	1,471
QUALIFIED INDIVIDUALS (QI-1)	BETWEEN 120% BUT LESS THAN 135%FPL	1,226	1,655	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	1,362	1,839	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%	1,815	2,452	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	250%FPL	2,269	3,3065	13,800	20,100	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.