GIS 11 MA/027: 2012 Medicaid Only Income and Resource Levels

Due to a 3.6 percent cost of living adjustment for SSA payments effective January 1, 2012, several figures used in determining Medicaid eligibility must be updated. With an increase to the SSI benefit levels, the medically needy income and resource levels will be adjusted accordingly. As a result of these changes, the Mass Rebudgeting (MRB) will be performed in November for January 1, 2012 budget changes.

In addition, an increase in the Consumer Price Index (CPI) requires an adjustment to the Medicaid Income Standards used for Singles/Childless Couples and Low Income Families.

Note: The Federal Poverty Levels (FPLs) will be updated when the actual amounts are published in the Federal Register. At that time, another Mass Rebudgeting of affected cases may be performed. Further information will be forthcoming.

Effective January 1, 2012, Medicaid eligibility must be determined using the following figures:

• 1. Medicaid Income Standards and Medically Needy Income and Resource Levels

  House Hold Size	Medicaid Standard S/CC – LIF		Medically Needy Income Level		Resources
  	Annual	Monthly	Annual	Monthly
  One	8,818	735	9,500	792	14,250
  Two	11,008	918	13,900	1,159	20,8509
  Three	13,098	1,092	15,985	1,333	23,978
  Four	15,208	1,268	18,070	1,506	27,105
  Five	17,389	1,450	20,155	1,680	30,233
  Six	18,984	1,582	22,240	1,854	33,360
  Seven	18,984	1,582	22,240	1,854	33,360
  Eight	22,822	1,902	26,410	2,201	39,615
  Each Add'l Person	1,236	104	2,085	174	3,128

• 2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone is $698/single and $1,048/couple.
• 3. The allocation amount is $367, the difference between the Medicaid income level for a household of two and one.
• 4. The 249e factors are .966 and .168.
• 5. The SSI resource levels remain $2,000 for individuals and $3,000 for couples.
• 6. The State supplement remains $87 for an individual and $104 for a couple living alone.
• 7. The Medicare Part A premium is $248/month for individuals having 30-39 work quarters and $451/month for those who are not otherwise eligible for premium-free hospital insurance and have less than 30 work quarters.
• 8. The Maximum federal Community Spouse Resource Allowance is $113,640.
• 9. The Minimum State Community Spouse Resource Allowance is $74,820.
• 10. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,841.
• 11. Maximum Family Member Allowance remains $613 until the FPLs for 2012 are published in the Federal Register.
• 12. Family Member Allowance formula number remains $1,839 until the FPLs for 2012 are published in the Federal Register.
• 13. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting is $367.
• 14. Substantial Gainful Activity (SGA): Non-Blind $1,010/month, Blind $1,690/month, Trial Work Period (TWP) $720/month.
• 15. SSI-related student earned income disregard limit of $1,700/monthly up to a maximum of $6,840/annually.

Medicare Part B Premium

The standard Medicare Part B monthly premium will be $99.90 in 2012. This represents a decrease of $15.50 from the 2011 premium of $115.40 and a decrease of $10.60 for the 2010 premium of $110.50. However, many Medicare beneficiaries were held harmless in 2010 and 2011, and continued paying the premium of $96.40 per month. The 2012 premium represents a $3.50 increase for these individuals.

The 2012 COLA increase of 3.6% combined with a decrease in the Medicare Part B premium cost may have a negative impact on Medicaid eligibility for some. For example, an individual receiving a monthly income increase in 2012 combined with a decrease in the Medicaid Part B MBL income deduction may no longer be income eligible.

A chart with the new Medicaid levels is attached. MBL will be programmed to use these figures when a "From" date of January 1, 2012 or greater is entered. Upstate Mass Rebudgeting will occur November 24th, and will be available on production November 25th. New York City Mass Rebudgeting will occur December 24, 2011.

Please direct any questions to the Local District Support Unit at 518-474-8887 Upstate and 212-417-4500 for NYC.

New York State Income and Resource Standards Effective January 1, 2012

House Hold Size	Medicaid STD S/CC - LIF		Medicaid Income Level		100% FPL		120% FPL		133% FPL		135% FPL		150% FPL		160% FPL		185% FPL		200% FPL		250% FPL		Resources SSI Related Only
	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly	Annual	Monthly
ONE	8,818	735	9,500	792	10,890	908	13,068	1,089	14,484	1,207	14,702	1,226	16,335	1,362	17,424	1,452	20,147	1,679	21,780	1,815	27,225	2,269	14,250	1
Two	11,008	918	13,900	1,159	14,710	1,226	17,652	1,471	19,565	1,631	19,859	1,655	22,065	1,839	23,536	1,962	27,214	2,268	29,420	2,452	36,775	3,065	20,850	2
Three	13,098	1,092	15,985	1,333	18,530	1,545			24,645	2,054			27,795	2,317	29,648	2,471	34,281	2,857	37,060	3,089			23,978	3
Four	15,208	1,268	18,070	1,506	22,350	1,863			29,726	2,478			33,525	2,794	35,760	2,980	41,348	3,446	44,700	3,725			27,105	4
Five	17,389	1,450	20,155	1,680	26,170	2,181			34,807	2,901			39,255	3,272	41,872	3,490	48,415	4,035	52,340	4,362			30,233	5
Six	18,984	1,582	22,240	1,854	29,990	2,500			39,887	3,324			44,985	3,749	47,984	3,999	55,482	4,624	59,980	4,999			33,360	6
Seven	20,665	1,723	24,325	2,028	33,810	2,818			44,968	3,748			50,715	4,227	54,096	4,508	62,549	5,213	67,620	5,635			36,488	7
Eight	22,822	1,902	26,410	2,201	37,360	3,136			50,048	4,171			56,445	4,704	60,208	5,018	69,616	5,802	75,260	6,272			39,615	8
Each Add'l Person	1,236	104	2,085	174	3,820	319			5,081	424			5,730	478	6,112	510	7,067	589	7,640	637			3,128	*

Spousal Impoverishment

Spousal Impoverishment	Income	Resources
Community Spouse	$2,841	$113,640
Institutionalized Spouse	$50	$14,250
Family Member Allowance	$1,839 is used in the FMA formula the maximum allowance is $631.	N/A

*In determining the community resource allowance on and after January 1, 2012, the community spouse is permitted to retain resources in an amount equal to the greater of the following $74,820 or the amount of the spousal share up to $113,640. 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 continuous period of institutionalization of the institutionalized spouse on or after September 30, 1989.