Appendix E - Medicaid Net Available Monthly Income (NAMI) Overview
This overview is provided for nursing home residents, prospective residents, their applicable representatives, and their families to understand the Medicaid Net Available Monthly Income (NAMI).
What is a NAMI?
Nursing home residents who are enrolled in Medicaid are responsible to pay a certain amount of their nursing home costs each month. The NAMI is a calculated portion of the resident's (or prospective resident's) monthly income that the resident is expected to pay toward their cost of nursing home care.
Who calculates the NAMI?
The local department of social services calculates the NAMI and shares the determination with the resident and the nursing home or managed care plan.
Who collects the NAMI?
Generally, the nursing home collects the NAMI. For consumers enrolled in a Medicaid managed care plan, the plan may collect the NAMI or delegate collection of the NAMI to the nursing home.
What if I do not pay the NAMI?
Medicaid consumers are required to pay their NAMI. Possible actions a nursing home may take for a Medicaid consumer who fails to pay their NAMI obligation should be discussed with the nursing home.
Does the NAMI change?
The NAMI can change with changes in income or circumstances. Adjustments to NAMI are calculated by the local department of social services when changes to the consumer's income or circumstances are identified.
My spouse is entering a nursing home and has Medicaid coverage. Do I have to pay for their nursing home care?
The local department of social services reviews a couple's income and any deductible expenses to determine what income, if any, remains available to contribute toward the monthly cost of nursing home care, i.e., the NAMI. New York State recognizes that depletion of income and assets to pay for high-cost healthcare may impoverish a spouse who is residing in the community and applies rules that consider the needs of a spouse residing in the community. These rules are referred to as "Spousal Impoverishment" rules. For more information about "Spousal Impoverishment" rules, please click here.
What is considered income?
Examples of income include employment wages, alimony payments, social security, pension, rental income, workers' compensation, annuity with monthly distribution, IRA distribution, and unemployment compensation.
Do I have to pay NAMI if my care is being fully covered by my Medicare plan?
No. NAMI is specific to Medicaid coverage in nursing homes and does not apply when Medicare is paying for services provided in a nursing home.
I think my NAMI was calculated incorrectly.
If your think the NAMI is calculated incorrectly, you should contact your local department of social services. If you are unable to resolve your concerns, the NAMI notice that was sent to you includes information you may use to request a fair hearing to dispute the NAMI calculation.
I still have a mortgage to pay. Can the amount of my mortgage payment be deducted when the NAMI is calculated?
No. A mortgage payment is not deducted when calculating the NAMI.
How can I learn more?
The local department of social services, Long-Term Care Ombudsman Program or a local healthcare advocate may also be assistive.
