Important News for SS, SSI & Medicaid Applicants!

The government recently announced that the rates used to calculate resources and income levels for Social Security, Social Security Income (SSI) and Medicaid benefits remain the same in 2016 and they were in 2015.

Medicaid Income and Resource Allowances for 2016 Remain at 2015 Levels! (See chart below)

Medicaid Nursing Home Regional Rates Rise!

As of January 1, 2016, a new “regional rate” applies to the calculation used to determine the “transfer penalty period” for nursing home applicants who made “uncompensated transfers” within 60 months of the date of applying for Medicaid nursing home coverage (a.k.a., the “look-back period“ or the “5 year look back period”). Anyone in the process of setting up a transfer of assets through a promissory note/gift or trust should calculate the penalty period using the newly published 2016 regional rates for their region! (See chart below).

For those who are interested, the penalty period equals the number of months calculated using the value of the “uncompensated transfer” divided by the “regional rate” in effect on the date the application is filed or the request for an increase in nursing home benefits is made.

Word of caution: This is a very precise and complex calculation, and best done by an Elder Lawyer or very experienced advisor.

Translating from “Legalize” into English: What Does This Mean?

Medicaid “income” is income that an applicant receives from earned and unearned sources (i.e., SSI and VA benefits, annuity and trust payments, employment, in-kind income, etc.)

Medicaid “resources” are anything of monetary value that can be converted into cash (i.e., real estate, personal property, bank accounts, life insurance policies, stocks and bonds, etc.)

Income and resource “disregards” are categories of “income” and “resources” that are disregarded when calculating these totals. If a disregard applies to an individual, he/she may be eligible for Medicaid even though his/her income or resources appear to be over the eligibility limit.

The “regional rate” is the average daily private pay rate for nursing home care for each of New York’s seven nursing home regions. The regional rate set each year.

The “penalty period” or “transfer penalty period” is a number of months determined that Medicaid determines that an applicant for nursing home benefits is ineligible to receive payment for nursing home costs from Medicaid. (A penalty period may apply to an applicant residing in a nursing home when applying for an increase in benefits.)

An “uncompensated transfer” is a transfer of property, cash, real estate, stocks, etc. by the Medicaid applicant for less than fair market value 60 months prior to submission of an application for benefits.

Medicaid Income and Resource Allowances for 2016

Community Based Care (Home Care, etc.)

- Applicant Resource Allowance: $14,850
- Community Spouse Resource Allowance: $21,750
- Applicant Income Allowance: $825
- Community Spouse Income Allowance: $1,209

Institutional/Nursing Home Care

- Applicant Resource Allowance: $14,850
- Community Spouse Resource Allowance: $119,220 (Max.)
- Applicant Income Allowance: $50
- Community Spouse Income Allowance: $2,980

Regional Nursing Home Rates for 2016