GIS 15 MA/021: 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards

To: Local District Commissioners, Medicaid Directors,

From: Judith Arnold, Director
Division of Eligibility and Marketplace Integration

Subject: 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards

Effective Date: January 1, 2016

Attachment: New York State Income and Resource Standards Chart

Contact Person: Local District Support Unit
Upstate (518) 474-8887 NYC (212) 417-4500

The purpose of this General Information System (GIS) message is to advise local departments of social services of the income levels and figures used in determining Medicaid eligibility, effective January 1, 2016.

With consumer prices down over the past year, Social Security and Supplemental Security Income (SSI) benefits will not increase in 2016. Therefore, the Medically Needy income and resource levels will not increase effective January 1, 2016, and will remain the same as in 2015. As a result, the Mass Rebudgeting (MRB) that is normally performed in November for January 1, 2016 budget changes did not occur.

There will also be no increase in the spousal impoverishment standards for 2016. For 2016, Federal Poverty Levels will not be estimated and will be updated when the actual amounts are published in the Federal Register. Further information will be forthcoming.

Effective January 1, 2016, Medicaid eligibility must be determined using the following figures:

1. Medically Needy Income and Resource Levels.

HOUSEHOLD SIZE MEDICALLY NEEDY
INCOME LEVEL		 RESOURCES
ANNUAL MONTHLY
ONE 9,900 825 14,850
TWO 14,500 1,209 21,750
THREE 16,675 1,390
FOUR 18,850 1,571
FIVE 21,025 1,753
SIX 23,200 1,934
SEVEN 25,375 2,115
EIGHT 27,550 2,296
NINE 29,725 2,478
TEN 31,900 2,659
EACH ADD'L PERSON 2,175 182
  • 2. The Supplemental Security Income federal benefit rate (FBR) for an individual living alone remains $733/single and $1,100/couple.
  • 3. The allocation amount remains $384, the difference between the Medicaid level for a household of two and one.
  • 4. The 249e factors are .968 and .160.
  • 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 Hospital Insurance Base Premium is $226/month for people having 30-39 work quarters and $411/month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters.
  • 8. The standard Medicare Part B monthly premium for individuals who are held harmless will remain $104.90 in 2016. The 2016 standard Medicare Part B for beneficiaries with income less than or equal to $85,000 is $121.80, income greater than $85,000 and less than or equal to $107,000 is $170.50, income greater than $107,000 and less than or equal to $160,000 is $243.60, greater than $160,000 and less than or equal to $214,000 is $316.70, and greater than $214,000 is $389.80.
  • 9. The Maximum federal Community Spouse Resource Allowance remains $119,220.
  • 10. The Minimum State Community Spouse Resource Allowance remains $74,820.
  • 11. The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) remains $2,980.50.
  • 12. Maximum Family Member Allowance remains $664 until the FPLs for 2016 are published in the Federal Register.
  • 13. Personal Needs Allowance for certain waiver participants subject to spousal impoverishment budgeting remains $384.
  • 14. Family Member Allowance formula number remains $1,992 until the FPLs for 2016 are published in the Federal Register.
  • 15. Substantial Gainful Activity (SGA): Non-Blind $1,130/month, Blind $1,820/month, Trial Work Period (TWP) $810/month.
  • 16. SSI-related student earned income disregard limit of $1,780/monthly up to a maximum of $7,180/annually.
  • 17. The home equity limit for Medicaid coverage of nursing facility services and community-based long-term care is $828,000.
  • 18. The special income standard for housing expenses is available to individuals who are discharged from a nursing facility and enroll in the Managed Long Term Care program (MLTC) or remain enrolled in MLTC (See 12 OHIP/ADM-5 for further information) and for recipients discharged from an adult home to the community and enroll in the MLTC program (See GIS 14 MA/17).. The special income standard amount varies by region. For 2016, the amounts for the seven State regions are: Northeastern-$445, Central-$384, Rochester-$400, Western-$341, Northern Metropolitan-$837, Long Island-$1,060, and New York City-$1,094.

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