A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay for rent or other shelter costs, rather than having to “spend down” their “excess income” or spend-down on the cost of Medicaid home care.
The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to safely transition back to the community with MLTC. Originally it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes. GIS 14/MA-017
Since you are allowed to keep more of your income, you may no longer need to use a pooled trust.
September 2018 NEWS — Now those already enrolled in MLTC plans who spend 30 days in a Nursing Home, then return home while enrolled in the NH, may request this Special Income Standard from their local DSS. See GIS 18 MA/012 – Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept. 28, 2018
Who is eligible for this special income standard?
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must be age 18+,
-
must have been in a nursing home or an adult home for 30 days or more,
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must have had Medicaid pay toward the nursing home care, and
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must enroll in or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home
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must have a housing expense
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if married, spouse may not receive a “spousal impoverishment” allowance once the individual is enrolled in MLTC.
How much is the allowance?
The rates vary by region and change yearly.
|
Region |
Counties |
Deduction (2018) |
|
Central |
Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins |
$417 |
|
Long Islan |
Nassau, Suffolk |
$1,274 |
|
NYC |
Bronx, Kings, Manhattan, Queens, Richmond |
$1,305 |
|
Northeastern |
Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington |
$467 |
|
North Metropolitan |
Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester |
$935 |
|
Rochester |
Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates |
$424 |
|
Western |
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming |
$367 |
Past rates published as follows, available on DOH website
2018 rates published in GIS 17 MA/020 – 2018 Medicaid Levels and Other Updates . The guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05.
2017 rate — GIS 16 MA/018 – 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards Attachment 1
2016 rate — GIS 15-MA/021
2015 rate — Were not posted by DOH but were updated in WMS:
2015
| Central | $382 |
| Long Island | $1,147 |
| NYC | $1,001 |
| Northeastern | $440 |
| N. Metropolitan | $791 |
| Rochester | $388 |
| Western | $336 |
2014 rate — GIS-14-MA/017
HOW DOES IT WORK?
Here is a sample budget for a single person in NYC with Social Security income of $2,386/month paying a Medigap premium of $261/mo.
|
Gross monthly income |
$2,386 |
|
DEDUCT Health insurance premiums |
(Medicare Part B) – 109 (Medigap) – 261 |
|
DEDUCT Unearned income disregard |
– 20 |
|
DEDUCT Shelter deduction (NYC—2017) |
– 1,171 |
|
Net countable income |
$825 |
|
DEDUCT Income limit for single (2017) |
– 825 |
|
Excess income or Spend-down |
$0 |
WITH NO SPEND-DOWN, DO NOT NEED POOLED TRUST!
HOW TO OBTAIN THE HOUSING DISREGARD:
When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your local Medicaid program change your Medicaid budget to give you the Housing Disregard.
The procedures in NYC are explained in this Troubleshooting guide.
NYC Medicaid program prefers that your MLTC plan file the request, using
Form MAP-3057E – Special income housing Expenses NH-MLTC.pdf and
Form MAP-3047B – MLTC/NHED Cover Sheet
Form MAP-259f (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) – NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard.
GOVERNMENT DIRECTIVES:
The Housing Disregard was created by agreement between CMS and NYS in the “Special Terms and Conditions” (ST&C) approving the MLTC program that are part of the “1115 Waiver.” These conditions are changed periodically. The most recent ST&C are dated Jan. 19, 2017. The section on this income standard is at pages 26-27. In these revised ST&C, this special income standard applies to people who were in a NH or adult home paid by Medicaid and “who enroll into or remain enrolled in the MLTC program in order to receive community based long term services and supports” and to those in a NH who were required to enroll into MLTC because of “…the mandatory Nursing Facility transition, and subsequently able to be discharged to the community from the nursing facility, with the services of MLTC program in place.”