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Elimination of resource test for adults in Family Health Plus and many adults in Medicaid

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Posted: 02 Dec, 2009
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Updated: 06 Sep, 2011
by Valerie Bogart (New York Legal Assistance Group)

Beginning January 1, 2010 the resource test for all adults in Family Health Plus and many adults in Medicaid is eliminated.  There is no resource test for Medicaid recipients who are

  • Singles/Chlldless Couples (S/CC)(over age 21 and under age 65 and not disabled and not caring for children under age 21) or

  • ADC-related (under age 21 or a parent or other caretaker relative of a child under 21).  

The resource test remains for all adults who are eligible based on SSI-related budgeting, meaning they are either Disabled, Aged 65+ or Blind (DAB).    NYS DOH 2010-ADM-01 p. 4.

The State Department of Health has issued policy guidance to local districts in detailing the implementation of this new rule.  SEE:

An applicant in 2010 might still have a resource limit for their retroactive coverage period, if that period included any month in 2009. 

Does this mean that a someone with $1,000,000 in the bank but who has low income can apply for Medicaid, if s/he is under age 65 and not blind or disabled? 

NO, because interest and dividends earned on savings count as "income" for  people under age 65, who are NOT blind or disabled (S/CC and AFDC-related groups)

But interest and dividends earned by DAB (Disabled, Aged, Blind) people do NOT count as "income."  If saved into the following month after receipt, interest counts as a resource.  There are some exceptions for interest on certain resources that have time-limited exemptions, like retroactive Social Security lump sums.  See Income Disregards chart, p. 1, section on unearned income.

Distributions on IRAs count as income for ALL Medicaid recipients, regardless of age or disability, but only if the distributions are taken on a regular periodic basis.   If the distributions are irregular, they are not treated as periodic payments. "The non-periodic distributions are considered a conversion of a resource and not countable income. In this situation, the retirement fund is treated as an available, countable resource.”  DOH MRG p. 316 (updated June 2010).  But  people under 65 who are not disabled should no longer have to start taking periodic payments from their IRAs to qualify for Medicaid, since IRAs are an asset and there is no limit on assets for this population.  If people in the SIngle/Childless Couple category do take out irregular non-periodic withdrawals, at least two 2011 fair hearing decisions state that the withdrawals are not counted as income.  FH # 5773586M (Chemung Co. July 6, 2011, Rep:  Karen Gooderum, Chemung Co. Neighborhood Legal Services), redacted copy available online at  FH # 5696948L (Onondaga Co. June 14, 2011, Rep:  Maureen Kieffer Legal Services of Central New York); MRG p. 316.  

The state is currently updating the application forms and recertification forms for these programs.  The GIS instructs local districts that while old applications are in use, they should not seek resource information for adults who no longer have a resource test.

Resource Attestation - May not attest to resources if you are seeking home care or other long-term care services:  

Those who still have a resource limit (SSI-related or Disabled, Aged 65+ or Blind) have an option of "attesting" to the amount of their resources, rather than verifying the amount with documentation. They may "attest" only if they are not seeking long-term care services.  For this purpose, long-term care services include all home care programs as well as nursing home care.   NYS DOH 2010-ADM-01 at p. 3.   See 04ADM-06 - Attestation of Resources  (as updated by 2010 changes) and HRA Attestation Chart of services that require documentation, rather than merely attestation of resources.  

  • Must file HOME EQUITY Statement with application, showing that equity in home is below $750,000 or that an exception exists to equity limit because of spouse or other specified  family members living in the home.   In NYC, use MAP 2050J

If an individual in a category that has no resource limit needs nursing home care, the rules are complicated.  This means people under age 65 and over age 21, who have not been determined disabled.

  • Short-term Rehabilitation or Temporary Nursing Home Placement  -- There is no resource test.  NYS DOH 2010-ADM-01 at p. 8.

  • Permanent Nursing Home Placement -- There is no resource test until a disability determination is made, at which time resources in the look back period must be verified.   NYS DOH 2010-ADM-01 at p. 8.  If nursing home resident is married, spousal impoverishment protections apply if likely to remain more than 30 days.   Id.  

Advocacy tips for people who are SSI-related (aged, blind or disabled) and also fall into a second Medicaid category.  An SSI-related applicant/recipient:

  • ...who is  also eligible for AFDC-related budgeting may use whichever method is more beneficial in applying for Family Health Plus or Medicaid.  If they opt for AFDC-related budgeting, they will not be subject to the resource test.  For example, a disabled individual who also takes care of a child under age 21 can use either SSI-related or AFDC-related budgeting.  If they choose the latter, they will have no resource test.    NYS DOH 2010-ADM-01 at p. 5. 

  • ...may not use S/CC budgeting, even if it is more advantageous.   Id.   

  • .. who is  certified disabled or blind and under age 65, who does not yet have Medicare,  may qualify for Family Health Plus with no resource test  NYS DOH 2010-ADM-01 at p. 2.

This article was authored by the Health Law Unit of the Legal Aid Society.

The Legal Aid Society

Attached files
item ResourceDisregards.pdf (66 kb) Download
item IncomeDisregards.pdf (106 kb) Download

Also read
item NYS Medicaid Application Form (updated 2021) for Age 65+ or Disabled or Blind - New Supp A NYC 2021

External links
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.health.state.ny.us/health_care/medicaid/publications/docs/gis/09ma027.pdf
http://health.wnylc.com/health/client/images/icons/article_out.svg http://www.health.state.ny.us/health_care/medicaid/publications/docs/adm/10adm-1.pdf

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