Basics of New York Medicaid Law

Medicaid is a joint Federal/State program which pays for the costs of medical care, including nursing home care, for individuals that meet certain criteria. The following terms are important for an understanding of the basics of New York Medicaid law:

• “Institutionalized Individual” – An individual who is an in-patient in a nursing facility, or who is an in-patient in a medical facility and is receiving a level of care provided in a nursing facility.
• “Community Spouse” – The spouse of an Institutionalized Individual who is living “in the community,” or outside of an institution.
• “Nursing facility” – A nursing home as defined by the public health law, or an intermediate care facility for the mentally impaired.
• “Uncompensated value of an asset” – The fair market value of an asset that has been transferred, minus the amount of the compensation received in exchange for the asset.
• “Community Spouse Resource Allowance” (CSRA) – The amount of resources that a community spouse may retain. The CSRA is one-half the couple’s available resources as of the date of institutionalization, up to the federal maximum of $120,900.00 for 2017, but not less than the New York State minimum of $74,820.00.
• “Minimum monthly maintenance needs allowance” (MMMNA) – The minimum amount of monthly income, generated by either spouse, that the Community Spouse is entitled to retain for his or her monthly expenses. The MMMNA is $3,022.50 per month for 2017.
• “Regional rate” – The monthly rate set by The Department of Health for approximating the cost of nursing home care in a particular region. This rate determines the periods of ineligibility for Medicaid, if a Medicaid applicant makes an “uncompensated” transfer of assets within the five years prior to the application. This rate is revised each year in January, based on average costs of nursing home care in that region. In the “Rochester Region,” which includes Monroe, Wayne, Livingston, and Ontario Counties, the monthly regional rate is now $11,237.00 (2017).  In the “Western Region,” which includes Erie, Genesee, Niagara, Orleans, and Wyoming Counties, the regional rate is $10,078.00 (2017).  In the “Central Region,” which includes Madison, Oneida, Onondaga, and Oswego Counties, the regional rate is $9,511.00 (2017).