Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan

A huge barrier to people returning to the community from nursing homes is the high cost of housing.    One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay for rent or other shelter costs, rather than having to "spend down" their "excess income" or spend-down on the cost of Medicaid home care.

The special income standard for housing expenses helps pay for housing expenses to help certain nursing home or adult home residents to safely  transition back to the community with MLTC.   Originally it was just for former nursing home residents but in 2014 it was expanded to include people who lived in adult homes.  GIS 14/MA-017 

Since you are allowed to keep more of your income, you may no longer need to use a pooled trust.

KNOW YOUR RIGHTS - FACT SHEET on THREE ways to Reduce Spend-down, including this Special Income Standard. 

September 2018 NEWS -- Those already enrolled in MLTC plans before they are admitted to a nursing home or adult home may obtain this budgeting upon discharge, if they meet the other criteria below.

• See GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept. 28, 2018
• In the September Medicaid Update that DOH sends to Medicaid providers, DOH explains:

"How nursing home administrators, adult home operators and MLTC plans should identify individuals who are eligible for the special income standard" and explains their duties to identify eligible individuals, and the MLTC plan must notify the local DSS that the individual may qualify:

"Nursing home administrators, nursing home discharge planning staff, adult home operators and MLTC health plans are encouraged to identify individuals who may qualify for the special income standard, if they can be safely discharged back to the community from a nursing home and enroll in, or remain enrolled in, an MLTC plan. Once an individual has been accepted into an MLTC plan, the MLTC plan must notify the individual's local district of social services that the transition has occurred and that the individual may qualify for the special income standard. The special income standard will be effective upon enrollment into the MLTC plan, or, for nursing home residents already enrolled in an MLTC plan, the month of discharge to the community.

Questions regarding the special income standard may be directed to DOH at 518-474-8887.

Who is eligible for this special income standard?  

1. must be age 18+,

2. must have been in a nursing home or an adult home for 30 days or more,

3. must have had Medicaid pay toward the nursing home care - this can be just the Medicare coinsurance.  MLTC plan paying nursing home  for coinsurance counts!

4. must enroll in or REMAIN ENROLLED IN a Managed Long Term Care (MLTC) plan or FIDA plan upon leaving the nursing home or adult home

   • Initially this special income standard was only for those newly enrolling in MLTC when leaving the nursing home, but GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept. 28, 2018 says it is available for those "who enroll into or remain enrolled in the MLTC program in order to receive community based long term services and supports."  This change in state policy belatedly complies with the  January 17, 2017 CMS Special Terms and Conditions. 

5. must have a housing expense

6. if married, spouse may not receive a "spousal impoverishment" allowance once the individual is enrolled in MLTC.   Must choose to use either spousal impoverishment or this housing allowance.

How much is the allowance?  

The rates vary by region and change yearly.  

Past rates published as follows, available on DOH website

2024 rates published in GIS 24 MA/01 - Attachment I 

2023 rates published in Attachment I to GIS 22 MA/14

2022 rates published in Attachment I  to GIS 21 MA/25 

2021 rates published in Attachment I to GIS 20 MA/13 -- 2021 Medicaid Levels and Other Updates

2020 rates published in Attachment I  to GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates 

2019 rates published in Attachment 1 to  GIS 18/MA015 - 2019 Medicaid Levels and Other Updates

2018 rates published in GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates  .  The  guidance on how the standardized amount of the disregard is calculated is found in NYS DOH 12- ADM-05. 

2017 rate  --  GIS 16 MA/018 - 2016 Medicaid Only Income and Resource Levels and Spousal Impoverishment Standards   Attachment 1
2016 rate  -- GIS 15-MA/021
2015 rate  -- Were not posted by DOH but were updated in WMS:

2014 rate  -- GIS-14-MA/017 

HOW DOES IT WORK?

Here is a sample budget for a single person in NYC with Social Security income of $4,138/month paying a Medigap premium of $281/mo.

WITH NO SPEND-DOWN, May  NOT NEED POOLED TRUST!

* NOTE re Medicare Part B premium - this is a deduction from income because the consumer is not eligible for a Medicare Savings Program at this income level. If a consumer is eligible for an MSP program, then you cannot deduct the cost of the Part B premium. 

HOW TO OBTAIN THE HOUSING DISREGARD:

When you are ready to leave the nursing home or adult home, or soon after you leave, you or your MLTC plan must request that your  local Medicaid program change your Medicaid budget to give you the Housing Disregard. See September 2018  NYS DOH Medicaid Update that requires MLTC plan to help you ask for it. 

The procedures in NYC are explained in this Troubleshooting guide. In NYC, submit the application with the MAP-751W (check off "Budgeting Changes" and "Special Housing Standard").   (The MAP-751W is also posted in languages other than English in this link.  (Updated 3-15-2021.))

NYC Medicaid program prefers that your MLTC plan file the request, using 

Form MAP-3057E - Special income housing Expenses NH-MLTC.pdf and

Form  MAP-3047B - MLTC/NHED Cover Sheet

Form MAP-259f  (revised 7-31-18)(page 7 of PDF)(DIscharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard.

GOVERNMENT  DIRECTIVES (beginning with oldest):

• NYS DOH 12- ADM-05 - Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility who Enroll into the Managed Long Term Care (MLTC) Program

  • Attachment II  - OHIP-0057 - Notice of Intent to Change Medicaid Coverage, (Recipient Discharged from a Skilled Nursing Facility and Enrolled in a Managed Long Term Care Plan)  

  • Attachment III  - Attachment III – OHIP-0058 - Notice of Intent to Change Medicaid Coverage, (Recipient Disenrolled from a Managed Long Term Care Plan, No Special Income Standard)  

• MLTC Policy 13.02: MLTC Housing Disregard 

• NYC HRA Medicaid Alert Special Income Standard for housing expenses NH-MLTC 2-9-2013.pdf  

• 2018-07-28   HRA MICSA ALERT   Special Income Standard for Housing Expenses for Individuals  Discharged from a Nursing Facility and  who Enroll into the  MLTC Program  - update on previous policy.   References Form MAP-259f  (revised 7-31-18)(page 7 of PDF)(Discharge Notice) - NH must file with HRA upon discharge, certifying resident was informed of availability of this disregard.

• GIS 18 MA/012 - Special Income Standard for Housing Expenses for Certain Managed Long-Term Care Enrollees Who are Discharged from a Nursing Home issued Sept. 28, 2018 - this finally implements the most recent Special Terms & Conditions of the CMS 1115 Waiver that governs the MLTC program,  dated Jan. 19, 2017.  The section on this income standard is at pages 26-27.  In these revised ST&C, this special income standard applies to people who were in a NH or adult home paid by Medicaid and "who enroll into or remain enrolled in the MLTC program in order to receive community based long term services and supports" and to those in a NH who were required to enroll into MLTC because of "...the mandatory Nursing Facility transition, and subsequently able to be discharged to the community from the nursing facility, with the services of MLTC program in place."  

• September 2018 DOH Medicaid Update  - explains this benefit to medical providers (nursing homes, MLTC plans, home care agencies, adult home operators, and requires them to identify potential individuals who could benefit and help them apply - described here.