Appendix A: Determining Medical Assistance Eligibility and Payment Toward the Cost of LTC Facility Services

Income Limits

NMP-SSI Related Monthly Special Gross Income Limit--Effective 1/1/2025 (300% of Federal Benefit Rate)

$2,901.00

NMP-SSI Related Monthly Special Gross Income Limit-- Effective 1/1/2024 (300% of Federal Benefit Rate)

$2,829.00

MNO 6-Month Limit - 1 Person

$2,550.00

SSI Monthly 1 Person Limit -- Effective 1/1/2025

$989.10

Deductions

 

FSA

 

Dependent Child Maintenance Limit (No CS)

Schedule 1

$215.00

 

Schedule 2

$205.00

 

Schedule 3

$195.00

 

Schedule 4

$174.00

Disabled/Blind Child Maintenance Limit (SSI Limit)

(No CS) - Effective 1/1/2025

$989.10

Disabled/Blind Child Maintenance Limit (SSI Limit)

(No CS) - Effective 1/1/2024

$965.10

Low Income Subsidy Benchmark-Effective 1/1/2025

$48.36

Low Income Subsidy Benchmark-Effective 1/1/2024

$40.16

LIFE Capitated Rate

LIFE Capitated Rate for MA only (Non-Dual) Recipients- Effective 1/01/2023-6/30/2025

$5,204.81

LIFE Capitated Rate for MA only (Non-Dual) Recipients- Effective 7/01/2021-6/30/2022

$5,053.21

LIFE Capitated Rate for Dual Eligible Recipients- Effective 1/01/2023-6/30/2025

$3,944.22

LIFE Capitated Rate for Dual Eligible Recipients- Effective 7/01/2021-6/30/2022

$3,829.34

 

 

Determining Payment toward the Cost of LTC Facility Services: Spousal Impoverishment Provisions

 

Deductions

Personal Needs Allowance Deduction
(No therapeutic activity earnings) -Effective 1/1/2025

$60.00

Personal Needs Allowance Deduction 
(No therapeutic activity earnings) 7/1/2007-12/31/2024
$45.00

Shelter Cost -Effective 10/1/2024:

Heating Standard (2024)

$758.00

Heating Standard (5/1/2023-9/30/2023)

$750.00

Non-Heating Standard (2024)

$402.00

Non- Heating Standard (2023)

$401.00

Homeless Standard (2024)

$190.00

Homeless Standard (2023)

$180.00

Limited SUA (2024)

$72.00

Limited SUA (2023)

$70.00

Phone only  (2022 - 2024)

$34.00

Phone only  (2021)

$33.00

 

 

Monthly Maintenance Needs Allowance

 

 Minimum Monthly Maintenance Needs Allowance (MinMMNA)

Effective 7/1/2024

$2,555.00

Minimum Monthly Maintenance Needs Allowance (MinMMNA)  Effective 7/1/2023

$2,465.00

Maximum Monthly Maintenance Needs Allowance (MaxMMNA)  Effective 1/1/2025

$3,948.50

Maximum Monthly Maintenance Needs Allowance (MaxMMNA)  Effective 1/1/2024

$3,853.50

Excess Monthly Shelter Standard  Effective 7/1/2024

$767.00

Excess Monthly Shelter Standard  Effective 7/1/2023

$740.00

Dependent Living with Community Spouse Allowance  Effective 7/1/2023

$2,465.00

Dependent Living with Community Spouse Allowance  Effective 7/1/2022

$2,289.00

 

 

 

Protected Share

 

Maximum Protected Share          Effective 1/1/2025

$157,920.00

Maximum Protected Share          Effective 1/1/2024

$154,140.00

Minimum Protected Share           Effective 1/1/2025

$31,584.00

Minimum Protected Share           Effective 1/1/2024

$30,828.00

 

 

                              Private Pay Rates

 

Determining a Penalty Period      Effective 1/1/2025

 

Average Monthly Private Pay Rate

 $12,160.58

Average Daily Private Pay Rate

$399.80

Determining a Penalty Period Effective 1/1/2024

 

Average Monthly Private Pay Rate

$11,547.69

Average Daily Private Pay Rate

$379.65

 

 

Equity Limits

 

 

Excess Home Equity Limit                                   Effective  1/1/2025

$730,000

Excess Home Equity Limit                                  Effective  1/1/2024

$713,000

 

 

Updated December 23, 2024, replacing June 3, 2024