2022 New York Medicaid Levels and Other Important Updates

2022 New York Medicaid Levels and Other Important Updates

Everyone receiving Medicaid benefits in New York should keep fully informed and up to date on all the changes that became effective on January 1, 2022. The New York Office of Health Insurance Programs (NYOHIP) recently released their “2022 Medicaid Levels and Other Updates,” announcing the new income and resource limits for NY Medicaid eligibility.

Medicaid eligibility tests and available benefits can vary among different groups of applicants, depending on factors like age, pregnancy, disability, medical needs, risks of spousal impoverishment, etc. The complexities of the numerous NY Medicaid programs are beyond the scope of this blog post, but this review of 2022 updated eligibility and benefit changes should be helpful.

If you or someone you care about wants more information or you need to know how these changes affect you and your loved ones, call Ely J. Rosenzveig and Associates. We have extensive experience helping people like you get the Medicaid coverage that you need, now or in the future. Call us at (914) 816-2900.

*A special note — the newly published NYHIP document announcing the changes advises that the NYOHIP unit has not completed its “re-budgeting” process to account for the 5.9% increase in the 2022 federal Cost of Living Adjustment (COLA). Many of the automatic systems used to renew users’ Medicaid benefits and to complete redeterminations of eligibility (recertifications) have been updated to reflect higher “medically-needy income” and resource levels. The agency suggests that this should enable it to make any necessary corrections at the end of the COVID-19 related public health emergency this year.

Changes for Medicaid Users Receiving SSI — New Benefit and Income Levels

  • The 2022 Supplemental Security Income (SSI) maximum monthly benefit payment is increased to $841 for individuals and $1,261 for eligible couples. The State of New York supplements that payment with an additional $87 for individuals and $104 for a couple living alone. In New York, SSI payment amounts are determined by subtracting the amount of countable income an individual recipient makes each month from the maximum potential benefit of $841 plus $87 ($928).
  • An SSI disability determination depends partially on an SSI applicant’s inability to perform “substantial gainful activity” (SGA) which is identified as a certain monthly income. In 2022, the amount of the SGA for SSI eligibility is $1,350 per month. If an SSI applicant can make $1,350 or more per month, then they generally are not eligible for SSI benefits for that period. (Contact Ely J. Rosenzveig and Associates to learn about the exceptions to this general rule.)
  • The financial resource (or asset) limit for SSI eligibility remains at $2,000 for individuals and $3,000 for couples.

Medicaid Users of Nursing Homes or Community-Based Long-Term Care — 2022 Resource Allowances

2022 New York Medicaid Levels and Other Important Updates
In situations where one spouse applies for Medicaid coverage and the other spouse does not, the couple’s assets are counted with 50% being attributed to each spouse.

Aging and disabled New Yorkers who reside in nursing homes or need community-based care at home are now required to meet new financial thresholds for New York Medicaid eligibility. When a couple has one spouse in need of institutional nursing home care while the other spouse (often called the “well-spouse” or the “community spouse”) continues to live in their home, Medicaid coverage, and more specifically, asset and income calculations, are often dependent on the available financial resources of the couple. A similar issue arises when one spouse needs Medicaid-paid community-based or in-home assistance, while the other spouse does not.

The 2022 New York and federal financial resource allowances for Medicaid eligibility are set at new, higher levels.

Community Spouse Resource Allowance (Assets): In situations where one spouse applies for Medicaid coverage and the other spouse does not, the couple’s assets are counted with 50% being attributed to each spouse. Medicaid permits the non-applicant spouse to retain enough resources to avoid becoming impoverished, but no more than a capped amount. If 50% of the couple’s assets is still beneath the minimum level of assets that the non-applicant spouse is permitted to keep, then that spouse may keep the couple’s assets up to the minimum amount set by Medicaid.  Here are the 2022 minimum and maximum community spousal resource allowance figures:

  • 2022 Maximum federal Community Spouse Resource Allowance = $137,000
  • 2022 Minimum NY Community Spouse Resource Allowance = $74,820

Community Spouse Minimum Monthly Maintenance Needs Allowance (Income): Again, where one spouse claims Medicaid coverage for institutional nursing home care and the other spouse lives in their home, Medicaid recognizes the financial need for the at-home, non-applicant spouse to meet daily living expenses.

  • 2022 Community Spouse Minimum Monthly Maintenance Needs Allowance = $3,435

Family Member Allowance: In addition to the community spouse’s minimum monthly maintenance needs allowance, the dependent family members living in the home are allowed a portion of the Medicaid applicant’s income for daily living expenses. This family member allowance applies to the Medicaid applicant themselves and to the spouse and other dependents living in the home. The family needs allowance is determined by subtracting each family members’ income from the total of the family needs allowance multiplied by the number of family members.

The amount of the 2022 family member allowance is set temporarily at the same level as 2021. The reason is that the allowance is actually calculated as multiple of the federal poverty level (FPL) which is adjusted each year. The New York Office of Insurance Programs will not adjust the “per family member” maximum allowance until it learns the 2022 FPL figures when they are published in the Federal Register.

  • 2022 Maximum Family Member Allowance = $726 per dependent family member (Temporary)
  • 2022 Maximum Total Family Member Allowance = $2,178

*Though the current temporary maximum family member allowance is the same as 2021, other significant federal programs have seen up to a 5.9% increase in benefit or eligibility levels for 2022. It is reasonable to expect that the FPL will also be adjusted meaningfully upward for 2022, and, with it, the maximum family member allowance.

Home Equity Limit for Nursing Home and Community-Based Long-Term Care Medicaid Coverage: Medicaid coverage is needed by many elderly and disabled individuals who still own homes with substantial equity. The 2022 limit on home-equity that a Medicaid applicant or recipient may own is $955,000.

Consult an Experienced Medicaid, Elder Law, and Estate Planning Lawyer for More Details

Even the best educated person will  find it difficult to navigate the maze of Medicaid regulations for each of the many available programs. Contact the experienced elder law and Medicaid attorneys at Ely J. Rosenzveig and Associates for guidance on how these 2022 Medicaid changes affect you or your family members. We have extensive experience representing clients who we help qualify for long-term Medicaid coverage, that can provide much needed support services, and, at the same time, safeguard their lifesavings for their own and their family’s security and enjoyment.

Call us at +1 (914) 816-2900

Ariel S. Rosenzveig
Ariel Rosenzveig

Ariel S. Rosenzveig received his Juris Doctor from the Benjamin N. Cardozo School of Law in May, 2011, and has been practicing law with the firm since August, 2011. During his summers while in law school, Ariel interned with the United States Commodity Futures Trading Commission in New York and with the Securities & Futures Commission in Hong Kong, China.

While in law school, Ariel served on the staff of the Cardozo Public Law, Policy & Ethics Journal, volunteered with the Cardozo Advocates for Battered Women, and participated in the National Institute for Trial Advocacy’s Intensive Trial Advocacy Program. Prior to attending law school, Ariel worked as an arbitrage trader for a small proprietary trading firm on Wall Street. Ariel graduated summa cum laude from Yeshiva University in 2006.

Ariel is licensed to practice law in the states of New York and New Jersey, and is a member of the New York State Bar Association (NYSBA), NYSBA’s Elder Law section, and the National Academy of Elder Law Attorneys (NAELA). In June, 2015, Ariel successfully completed a certificate program in mediation through the Program on Negotiation at Harvard Law School.

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