GIS 14 MA/017: Expansion of the Special Income Standard for Housing Expenses to Individuals Discharged from an Adult Home and the 2014 Levels for the Special Income Standard for Housing Expenses

The purpose of this General Information System (GIS) message is to inform local departments of social services of the expansion of the special income standard for housing expenses to certain Medicaid recipients who move from an adult home to the community. This GIS also provides the 2014 levels for the special income standard for housing expenses.

Chapter 59 of the Laws of 2011 amended Section 366(14) of the Social Services Law to provide authorization for the State to seek approval under the 1115 waiver to establish a special income standard for housing expenses to certain Medicaid recipients. The necessary approval was obtained and Administrative Directive, 12 OHIP/ADM-5, "Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility who Enroll into the Managed Long Term Care (MLTC) Program," advised local districts of the policy and procedures regarding the availability of the special income standard for housing expenses. The special income standard for housing expenses is available to individuals receiving Medicaid coverage of nursing facility services, who are discharged to the community, enroll in a MLTC plan and do not meet the definition of "institutionalized spouse."

In order to provide the same assistance with housing costs to Medicaid recipients residing in adult homes who move to the community, Chapter 56 of the Laws of 2013 further amended Section 366(14) of the Social Services Law to expand the special income standard to individuals who are in receipt of Medicaid while in an adult home, are discharged to the community and if eligible, enroll in a MLTC plan. Individuals who meet the definition of an "institutionalized spouse" do not qualify for the housing allowance. An adult home is defined as an adult care facility established and operated for the purpose of providing long-term residential care, room, board, housekeeping, personal care (either directly or indirectly), and supervision to five or more adults who are unrelated to the operator.

The attached OHIP-0075, "Notice of Intent to Change Medicaid Coverage (Recipient Discharged from an Adult Home - Eligible for Special Income Standard for Housing Expenses)" is to be used to inform a Medicaid recipient of a change in financial eligibility due to entitlement to the special income standard.

Districts must use the appropriate Shelter Type Code in MBL Budget Type "04," as directed in the 12 OHIP/ADM-5, to calculate the special income standard. If there are other applying household members who are not entitled to the special income standard, a second budget will be required to calculate the eligibility of the other applying household members. Due to Upstate system limitations, MBL has the capacity to store only one budget. Districts are instructed to store the MBL Budget Type "04" with the applicable Shelter Type Code for the special income standard. A copy of the second budget for family members not entitled to the special income standard for housing costs must be stored in the case record. A manual notice must be sent in this situation.

For individuals who are eligible under the MAGI category, MAGI-like budgeting (MBL Budget Type "01" with the Expanded Eligibility Code of "M") is used. However, the MAGI-like budget does not currently support the Shelter Type Codes to determine the special income standard, therefore districts must manually calculate eligibility by adding the appropriate regional shelter amount to the MAGI income level (138% FPL). The OHIP-0075 includes a box to check for MAGI individuals whose gross income is used to determine eligibility for all Medicaid covered care and services.

The method used to establish the special income standard for each of the seven regions of the State is described in 12 OHIP/ADM-5. For 2014, the amounts for the seven regions are:

Central $380

• Broome
• Cayuga
• Chenango
• Cortland
• Herkimer
• Jefferson
• Lewis
• Madison
• Oneida
• Onondaga
• Oswegoa
• St. Lawrence
• Tioga
• Tompkins

Northeastern $435

• Albany
• Clinton
• Columbia
• Delaware
• Essex
• Franklin
• Fulton
• Greene
• Hamilton
• Montgomery
• Otsego
• Rensselaer
• Saratoga
• Schenectady
• Schoharie
• Warren
• Washington

Western $315

• Allegany
• Cattaraugus
• Chauatauqua
• Erie
• Genesee
• Niagara
• Orleans
• Wyoming

Northern Metropolitan $786

• Dutchess
• Orange
• Putnam
• Rockland
• Sullivan
• Ulster
• Westchester

New York City $972

• Bronx
• Kings (Brooklyn)
• New York (Manhattan)
• Queens
• Richmond (Staten Island)

Long Island $1,066

• Nassau
• Suffolk

Rochester $372

• Chemung
• Livingston
• Monroe
• Ontario
• Schuyler
• Seneca
• Steuben
• Wayne
• Yates

The new levels for the special income standards for housing expenses are effective for cases with budget "From" dates of January 1, 2014 or later.