GIS 13 MA/022: 2014 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards

The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) of the income levels and figures used in determining Medicaid eligibility effective January 1, 2014.

Due to a 1.5 percent cost of living adjustment (COLA) for Social Security Administration (SSA) payments effective January 1, 2014, 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 (S/CC) and Low Income Families (LIF).

As a result of these changes, a Mass Re-budgeting (MRB) will be performed on November 28, 2013, for upstate and December 6, 2013, for New York City for January 1, 2014, budget changes. Budgets that utilize a federal poverty level will not be included in this Mass Re-budgeting. When the actual federal poverty levels (FPLs) are available, a second Mass Re-budgeting of the affected cases will be performed. A separate GIS message will be issued when the 2014 FPLs are available.

For cases with individuals in a MAGI eligibility group, although any Social Security Administration (SSA) income will be increased based on the applied COLA, the case should not be re-budgeted until the following:

1. For cases renewed in October, November or December with a "From" date of January, February or March 2014 -

• If eligible under pre-ACA rules, the income change can be re-budgeted effective April 1, 2014;
• If found ineligible under pre-ACA rules, the income change can be re-budgeted once MAGI-like budgeting is available (February 18, 2014).

2. For cases that will have a renewal "From" date on or after April 1, 2014, the income change is to be budgeted at the time of the regularly scheduled renewal.

NOTE: Budgets with a "From" date of January 1, 2014, or later that utilize an FPL must be calculated with the 2013 Social Security benefit amount(s) and Medicare Part B premium, until the 2014 FPLs are available on MBL. Upstate districts should separately identify these cases for re-budgeting once the 2014 FPLs are available as these cases will not be included in Phase Two of Mass Re-budgeting. In New York City, the 2013 Social Security benefit amounts and Part B premium should be used until Phase Two of Mass Re-budgeting. Mass Re-budgeting in NYC will include cases with a "From" date of January or February.

Medicare Part B Premium

The standard Medicare Part B monthly premium will remain $104.90 in 2014.

A chart with the new Medicaid levels is attached. MBL will be programmed to use these figures when a "From" date of January 1, 2014, or greater is entered. Upstate Mass Re-budgeting will occur November 28, 2013. There will also be a second phase of the Mass Re-budgeting for Medicare Savings Program (MSP) cases. This will be done after the final FPL's are published to avoid re-budgeting any MSP cases which may be negatively affected. New York City Mass Re-budget will occur December 7, 2013.

Effective January 1, 2014, Medicaid eligibility must be determined using the following figures:

HOUSEHOLD SIZE	MEDICAID STANDARD S/CC � LIF		MEDICALLY NEEDY INCOME LEVEL		Resources
	Annual	Monthly	Annual	Monthly
ONE	9,102	759	9,700	809	14,550
TWO	11,363	947	14,300	1,192	21,450
THREE	13,520	1,127	16,445	1,371	24,668
FOUR	15,698	1,309	18,590	1,550	27,885
FIVE	17,950	1,496	20,735	1,728	31,103
SIX	19,596	1,633	22,880	1,907	34,320
SEVEN	21,331	1,778	25,025	2,086	37,538
EIGHT	23,557	1,964	27,170	2,265	40,755
NINE	24,832	2,070	29,315	2,443	43,973
TEN	26,110	2,176	31,460	2,622	47,190
EACH ADD'L PERSON	1,277	107	2,145	179	3,218

• 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 $721/single and $1,082/couple.
• 3. The allocation amount is $383, the difference between the Medicaid income level for a household of two and one.
• 4. The 249e factors are .967 and .163.
• 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 2014 for individuals having 30-39 work quarters. This is a $9 decrease from 2013. The Medicare Part A premium will be $426/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 $15 from 2013.
• 8. The Maximum federal Community Spouse Resource Allowance is $117,240.
• 9. The Minimum State Community Spouse Resource Allowance remains $74,820.
• 10. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,931.
• 11. Maximum Family Member Allowance is $647 until the FPLs for 2014 are published in the Federal Register.
• 12. Family Member Allowance formula number is $1,939 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 $383.
• 14. Substantial Gainful Activity (SGA): Non-Blind $1,070/month, Blind $1,800/month, Trial Work Period (TWP) $770/month.
• 15. SSI-related student earned income disregard limit of $1,750/monthly up to a maximum of $7,060/annually.
• 16. The home equity limit for Medicaid coverage of nursing facility services and community-based long-term care is $814,000.

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