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State to Allow Certain MLTC Enrollees to Keep More Income for Housing

Medicaid recipients who can be safely discharged into the community from a nursing home and
who enroll in a Managed Long Term Care (MLTC) plan will soon be able to keep more of their
income for housing costs.

Effective Oct. 15, 2012, eligible recipients will have their Medicaid eligibility determined under a
“special income standard” which will allow them to retain more of their budgeted income to
help pay for housing expenses. The amount will vary regionally based on where the individual
resides. A recipient may be eligible for this special income standard if he/she is at least 18 years
of age; has been a resident of a nursing home for at least 30 days during which Medicaid
covered the care; has enrolled in a MLTC plan; and has a housing expense such as rent or a
mortgage. Recipients who are married and participate in a Program of All Inclusive Care for the
Elderly (PACE) are ineligible for this program if spousal impoverishment rules are already used
to determine their Medicaid eligibility.

This change, part of the first phase of Medicaid redesign, is intended to eliminate a barrier to
community placement by allowing eligible Medicaid recipients to retain additional income
under Medicaid rules to pay for housing. The federal government recently approved this
change, which we understand will be covered in greater detail in the October issue of DOH’s
Medicaid Update.