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2013 Medicaid Regional Rates

Effective January 1, 2013, regional rates for calculating transfer penalty periods for 2013 were increased from 2012. The regional rates are:

These rates are based on average nursing home costs in each of the seven regions in New York State (i.e., Long Island, NYC, Northern Metropolitan, Rochester, Northeastern, Western, and Central (See below for the list of counties that make up each region).

What this means for families planning for Medicaid eligibility is the following. If a man, living in Suffolk County, transfers his sole asset, a bank account worth $120,340.00 to his only child, he will be ineligible for chronic care Medicaid benefits for ten (10) months ($120,340.00 transfer divided by $12,034.00 (regional rate for Long Island)). Despite what many have been led to believe, Medicaid does not attempt to take this transferred money from this family. Instead, what Medicaid does is deny the application of this father when he applies for benefits. Presumably, he is in a nursing home and in need of skilled nursing care. Again, Medicaid does not take this money, but effectively says to the family, “we are not paying his nursing home bills for ten moths, you pay it.” Usually, this results in the son spending the money that was recently transferred to him.

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