GIS 11 MA/027: 2012 Medicaid Only Income and Resource Levels

To: Local District Commissioners, Medicaid Directors

From: Judith Arnold, Director - Division of Coverage and Enrollment

Subject: Expanded Definition of Estate Regulations

Effective January 1, 2012

Contact Person: Local District Support Unit - Upstate (518)474-8887, NYC (212)417-4500

Due to a 3.6 percent cost of living adjustment for SSA payments effective January 1, 2012, several figures used in determining Medicaid eligibility must be updated. With an increase to the SSI benefit levels, the medically needy income and resource levels will be adjusted accordingly. As a result of these changes, the Mass Rebudgeting (MRB) will be performed in November for January 1, 2012 budget changes.

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.

Note: The Federal Poverty Levels (FPLs) will be updated when the actual amounts are published in the Federal Register. At that time, another Mass Rebudgeting of affected cases may be performed. Further information will be forthcoming.

Effective January 1, 2012, Medicaid eligibility must be determined using the following figures:

  • 1. Medicaid Income Standards and Medically Needy Income and Resource Levels
    House Hold Size Medicaid Standard S/CC – LIF Medically Needy Income Level Resources
    Annual Monthly Annual Monthly
    One 8,818 735 9,500 792 14,250
    Two 11,008 918 13,900 1,159 20,8509
    Three 13,098 1,092 15,985 1,333 23,978
    Four 15,208 1,268 18,070 1,506 27,105
    Five 17,389 1,450 20,155 1,680 30,233
    Six 18,984 1,582 22,240 1,854 33,360
    Seven 18,984 1,582 22,240 1,854 33,360
    Eight 22,822 1,902 26,410 2,201 39,615
    Each Add'l Person 1,236 104 2,085 174 3,128
  • 2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $698/single and $1,048/couple.
  • 3. The allocation amount is $367, the difference between the Medicaid income level for a household of two and one.
  • 4. The 249e factors are .966 and .168.
  • 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 $248/month for individuals having 30-39 work quarters and $451/month for those who are not otherwise eligible for premium-free hospital insurance and have less than 30 work quarters.
  • 8. The Maximum federal Community Spouse Resource Allowance is $113,640.
  • 9. The Minimum State Community Spouse Resource Allowance is $74,820.
  • 10. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,841.
  • 11. Maximum Family Member Allowance remains $613 until the FPLs for 2012 are published in the Federal Register.
  • 12. Family Member Allowance formula number remains $1,839 until the FPLs for 2012 are published in the Federal Register.
  • 13. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting is $367.
  • 14. Substantial Gainful Activity (SGA): Non-Blind $1,010/month, Blind $1,690/month, Trial Work Period (TWP) $720/month.
  • 15. SSI-related student earned income disregard limit of $1,700/monthly up to a maximum of $6,840/annually.

Medicare Part B Premium

The standard Medicare Part B monthly premium will be $99.90 in 2012. This represents a decrease of $15.50 from the 2011 premium of $115.40 and a decrease of $10.60 for the 2010 premium of $110.50. However, many Medicare beneficiaries were held harmless in 2010 and 2011, and continued paying the premium of $96.40 per month. The 2012 premium represents a $3.50 increase for these individuals.

The 2012 COLA increase of 3.6% combined with a decrease in the Medicare Part B premium cost may have a negative impact on Medicaid eligibility for some. For example, an individual receiving a monthly income increase in 2012 combined with a decrease in the Medicaid Part B MBL income deduction may no longer be income eligible.

A chart with the new Medicaid levels is attached. MBL will be programmed to use these figures when a "From" date of January 1, 2012 or greater is entered. Upstate Mass Rebudgeting will occur November 24th, and will be available on production November 25th. New York City Mass Rebudgeting will occur December 24, 2011.

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

New York State Income and Resource Standards Effective January 1, 2012
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 8,818 735 9,500 792 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 14,250 1
Two 11,008 918 13,900 1,159 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 3,065 20,850 2
Three 13,098 1,092 15,985 1,333 18,530 1,545 24,645 2,054 27,795 2,317 29,648 2,471 34,281 2,857 37,060 3,089 23,978 3
Four 15,208 1,268 18,070 1,506 22,350 1,863 29,726 2,478 33,525 2,794 35,760 2,980 41,348 3,446 44,700 3,725 27,105 4
Five 17,389 1,450 20,155 1,680 26,170 2,181 34,807 2,901 39,255 3,272 41,872 3,490 48,415 4,035 52,340 4,362 30,233 5
Six 18,984 1,582 22,240 1,854 29,990 2,500 39,887 3,324 44,985 3,749 47,984 3,999 55,482 4,624 59,980 4,999 33,360 6
Seven 20,665 1,723 24,325 2,028 33,810 2,818 44,968 3,748 50,715 4,227 54,096 4,508 62,549 5,213 67,620 5,635 36,488 7
Eight 22,822 1,902 26,410 2,201 37,360 3,136 50,048 4,171 56,445 4,704 60,208 5,018 69,616 5,802 75,260 6,272 39,615 8
Each Add'l Person 1,236 104 2,085 174 3,820 319 5,081 424 5,730 478 6,112 510 7,067 589 7,640 637 3,128 *
Spousal Impoverishment
Spousal Impoverishment Income Resources
Community Spouse $2,841 $113,640
Institutionalized Spouse $50 $14,250
Family Member Allowance $1,839 is used in the FMA formula
the maximum allowance is $631.
N/A

*In determining the community resource allowance on and after January 1, 2012, 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 $113,640. 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.