You asked for a comparison of the Medicaid spend down rules for nursing home residents in New York and Connecticut.

SUMMARY

New York and Connecticut have similar spend down rules allowing individuals to qualify for Medicaid when they need nursing home care. New York's asset and income levels are higher than Connecticut's. When a nursing home resident has a spouse living in the community (referred to as a "community spouse"), both states protect the maximum amount of assets and income allowed by federal Medicaid law. We have enclosed OLR Report 99-R-1023, which explains the spousal share rules in greater detail (http://cgalites/ps99/rpt/olr/htm/99-r-1023.htm).

Both states also have Long Term Care Partnership programs that allow those who buy state-approved long term care insurance who later need Medicaid to pay for their care costs to keep more of their property. In Connecticut, assets up to the value of insurance benefits provided under the policy are disregarded. The New York program allows people to qualify for Medicaid without an asset test after their policy's minimum benefit duration period expires (three years of nursing home care, six years of home care, or a combination of the two).

ASSETS

In Connecticut, a single individual without an approved long term care policy must spend down his or her countable assets to $1,600 ($2,400 for a two-person household) to qualify for Medicaid. Assets include cash, bank accounts, stocks, bonds, and other kinds of property specified in state and federal law and regulations. Items excluded include a burial plot worth up to $5,400, life insurance of any amount if it has no cash surrender value, and the cash surrender value of life insurance if the face value is less than $1,500. The applicant's house is not counted if he is expected to return home shortly, or if his spouse, minor or disabled adult child, or in some circumstances, his sibling lives there. If he is married and his spouse is living in the community, significantly more of the couple's assets (up to a maximum of $81,900) can be retained to support her, and the couple's car and household possessions are not counted.

New York's treatment of assets is similar to Connecticut's, but applicants become eligible with higher resources ($3,550 for single people and $5,150 for couples). The maximum amount that can be protected to support a community spouse is the same.

INCOME

In addition to spending down their assets, aged, blind and disabled applicants must also spend down until their incomes are small enough to qualify for Medicaid. The state disregards a portion of earned and unearned income to come up with a net monthly income figure. Connecticut law (and an approved Medicaid waiver of the federal law's less generous formula) sets the medical assistance income limit at 143% of the maximum cash welfare benefit amount in the region in which the applicant lives. (For most people, this is about $475 per month). (When an institutionalized applicant is single, he will meet Medicaid's income limit when his counted income is no more than the facility's private rate.)

As is the case with a married nursing home resident's assets, some of his income can be attributed to his community spouse if needed to bring her monthly income up to the "minimum monthly needs allowance" ("MMNA"). The MMNA is fixed by federal law at 150% of the federal poverty level for a two-person household (about $925 per month).

The state Medicaid plan also covers people categorized as "medically needy" and allows them to have higher amounts of income that they must use to pay their medical bills. Their assets cannot exceed the state plan's limits, and they must meet all other eligibility criteria.

New York has higher monthly income levels: $612 for an individual and $879 for a couple. (This is because its maximum cash benefit is more than Connecticut's.) Just as in Connecticut, the community spouse can receive some of her husband's income if hers is less than the MMNA. Similarly, New York's Medicaid plan also allows "medically needy" individuals to spend down excess income on medical bills.

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