GIS 12 MA/009: 2012 Federal Poverty Levels

The purpose of this GIS message is to inform the local departments of social services (LDSS) of the revised federal poverty levels (FPLs). The revised FPLs are effective January 1, 2012, and are the actual poverty levels published in the Federal Register on January 26, 2012.

The new FPLs are effective for cases with budget "From" dates of January 1, 2012 or later. The revised figures will be available on MBL March 19, 2012. For all new and pending applications, income must be compared to the revised FPLs. If a district determines that a previously budgeted case with a "From" date of January 1, 2012, has been negatively affected due to use of 2011 FPL, or a case is brought to the districts attention, the case should be rebudgeted using the revised FPLs. If eligible, covered medical expenses paid by an individual as a result of an improper calculation must be reimbursed pursuant to 10 OHIP/ADM-9, "Reimbursement of Paid Medical Expenses Under 18 NYCRR §360-7.5(a)."

Individuals enrolled in the Medicare Savings Program (MSP) received a cost of living (COLA) increase effective January 2012. This COLA increase was included in the Mass Rebudgeting (MRB) that occurred in November/December 2011. As a result, the eligibility of some MSP enrollees was adversely affected. The increase in the 2012 FPL is expected to offset the COLA increase, thereby sustaining MSP eligibility for those adversely affected by the COLA increase. Local districts received a list of affected cases. These cases should be rebudgeted when the new FPLs are available on MBL, the case reopened, retroactively to the effective date of closing.

As a result of the increase in the FPLs, the amount used in the Family Member Allowance (FMA) formula increased to $1,892. The maximum monthly FMA increased to $631. All spousal impoverishment cases involving a family member entitled to the family member allowance, which were active on or after January 1, 2012, and which were budgeted using the 2011 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, 2012, 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.

A chart with the new FPLs is attached to this GIS. Please see the previously issued GIS 11 MA027, "2012 Medicaid Only Income and Resource Levels," for other pertinent eligibility determination information.

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		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
ONE	8,818	735	9,500	792	11,170	931	13,404	1,117	14,857	1,239	15,080	1,257	16,755	1,397	20,665	1,723	22,340	1,862	27,925	2,328	14,250	1
TWO	11,008	918	13,900	1,159	15,130	1,261	18,156	1,513	20,123	1,677	20,426	1,703	22,695	1,892	27,991	2,333	30,260	2,522	37,825	3,153	20,850	2
THREE	13,098	1,092	15,985	1,333	19,090	1,591	-	-	25,390	2,116	-	-	28,635	2,387	35,317	2,944	38,180	3,182	-	-	23,978	3
FOUR	15,208	1,268	18,070	1,506	23,050	1,921	-	-	30,657	2,555	-	-	34,575	2,882	42,643	3,554	46,100	3,842	-	-	27,105	4
FIVE	17,389	1,450	20,155	1,680	27,010	2,251	-	-	35,924	2,994	-	-	40,515	3,377	49,969	4,165	54,020	4,502	-	-	30,233	5
SIX	18,984	1,582	22,240	1,854	30,970	2,581	-	-	41,191	3,433	-	-	46,455	3,872	57,295	4,775	61,940	5,162	-	-	33,360	6
SEVEN	20,665	1,723	24,325	2,028	34,930	2,911	-	-	46,457	3,872	-	-	52,395	4,367	64,621	5,386	69,860	5,822	-	-	36,488	7
EIGHT	22,822	1,902	26,410	2,201	38,890	3,241	-	-	51,724	4,311	-	-	58,335	4,862	71,947	5,996	77,780	6,482	-	-	39,615	8
EACH ADD'L PERSON	1,236	104	2,085	174	3,960	330	-	-	5,267	439	-	-	5,940	495	7,326	611	7,920	660	-	-	3,128	+

Spousal Impoverishment	Income	Resources
Community Spouse	$2,841	$113,640
Institutionalized Spouse	$50	$14,250
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, 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.