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.
"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.
How much is the allowance?
The rates vary by region and change yearly.
Past rates published as follows, available on DOH website
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
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 $3,709.90/month paying a Medigap premium of $261/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-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):