Medicaid Levels for 2020 Have Been Published

December 23, 2019 Austin F DuBois

Each year, the New York State Department of Health publishes updated Medicaid limits on resources and income. These updates were published on December 19, 2019, for the new year. The most relevant numbers are summarized here.

In New York State, many Medicaid levels are updated each year, usually very close to the end of the preceding year. On December 19, 2020, this General Information System message (GIS 19 MA/12) was published.

For those of us in the Hudson Valley, the most important numbers are as follows:

  • $15,750 – this is the value of “resources” a single person is permitted to retain and still be considered eligible for Medicaid. In other words, if you have more than $15,750, you are not eligible for Medicaid. This includes bank accounts, investment accounts, cash value of a life insurance policy, vacation homes or investment real estate, and under certain circumstances, retirement accounts and your primary residence.
  • $128,640 – this is the value of “resources” the spouse of a Medicaid applicant/recipient is permitted to retain to still be considered Medicaid eligible. However, in New York, we have “spousal refusal”, which, in most Hudson Valley counties, means that the spouse can keep resources in excess of this amount. However, each county treats spousal refusal differently.
  • $3,216  speaking of spousal limits, this is the Minimum Monthly Maintenance Needs Allowance–but is better described as the joint spousal income limit. If one spouse is on Nursing Home Medicaid, the other spouse is allowed to keep as much of the nursing home spouse’s income as they need to hit this limit. For example, if the spouse at home has $1,216 of income per month, that spouse could keep $2,000 of the Nursing Home spouse’s income. Anything above that would need to be paid to the nursing home. And if the spouse at home has more monthly income than this limit, they aren’t permitted to keep any of the nursing home spouse’s income.
  • $875 – this is the individual limit for a person living at home and receiving Community Medicaid. That means that this is the amount that person is allowed to keep, and according to basic Medicaid rules, the rest of their income must be spent on their care–which in today’s Medicaid world typically means being paid over to whatever Managed Long Term Care (MLTC) provider they are enrolled with. However, it is important to remember that a person receiving Community Medicaid can use a Pooled Income Trust such as the one provided by NYSARC Trust Services to shelter the excess income–in short, this allows them to use ALL of their income for themselves rather than paying it over.

Soon after the New Year, we will receive the updated “Regional Rates”, which the NYS Dept. of Health issue which reflect the average cost of care of a nursing home in each NY region. This number is a critical factor in helping a person protect assets even if they have done no prior planning and need a nursing home immediately. Stay tuned for that update, as well as an upcoming article on how we can save people’s home and savings even in the last minute.

But remember, even though we have options in the last minute, planning proactively is the best way not only to save money, but to ensure that you or your loved one doesn’t end up in the nursing home.