Social Security, Medicaid Income And Resource Levels And The Regional Rates For Calculating A Penalty Period For 2016

By: Ami S. Longstreet

The Social Security and Supplemental Security Income (SSI) benefits did not increase for 2016, and remain the same as in 2015.

There is also no increase in the spousal impoverishment standards for 2016.  The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) remains at $2,980.50.  This is the amount of monthly income a spouse who is in the community, whose spouse is institutionalized, may keep.

The community spouse resource allowance for 2016 ranges from $74,820 to a maximum of $119,220.  This is the amount of non-exempt resources a spouse, whose spouse is institutionalized, may keep. The community spouse is permitted to retain resources equal to the greater of the following: $74,820 or the amount of the spousal share up to $119,220.  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 period of institutionalization of the institutionalized spouse.

An institutionalized individual (or his or her spouse) who has made a gift (in trust or outright) during the look back period (5 years from the date of applying for Medicaid) is subject to a period of ineligibility for Medicaid coverage of nursing home care.  The period of ineligibility, or penalty period, is the number of months equal to the uncompensated value of the transferred assets (i.e., the value of the gift) divided by the Medicaid regional rate established for the region in which the nursing facility is located.  The rates are subject to change annually.

This table provides the 2016 regional rates:

Long Island (Nassau/Suffolk) $12,633
New York City (5 Boroughs) $12,029
Central (Syracuse, Broome, Cayuga, Oswego, etc.) $9,252
Northeastern (Albany, Rensselaer, Saratoga, Schenectady, etc) $9,806
Northern Metropolitan (Westchester, Dutchess, Orange, Rockland, etc.) $11,768
Rochester (Monroe, Ontario, Seneca, etc.) $11,145
Western (Buffalo, Erie, Niagra, Genesee, etc.) $9,630

EXAMPLE:  Senior in Central New York transfers $92,520 to her children on July 1, 2016 and keeps $150,000 in her name.  Senior needs to go into a nursing home on July 1, 2017 and spends down her $150,000 in one year’s time. But for the gift in 2016, she would be eligible for Medicaid on July 1 2018.  But, she would not be eligible until April 30, 2019.  (92,520 ÷ 9,250 = 10 months from July 1, 2018 when she is out of money and otherwise eligible for Medicaid).


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