NEW YORK STATE OFFICE FOR THE AGING

NEW YORK STATE OFFICE FOR THE AGING

2 Empire State Plaza, Albany, NY 12223-1251

Andrew M. Cuomo, Governor

An Equal Opportunity Employer

Greg Olsen, Acting Director

PROGRAM INSTRUCTION

Number:

21-PI-04

Supersedes: 20-PI-05

Expiration Date:

DATE:

April 21, 2021

TO:

Area Agency on Aging Directors

SUBJECT: 2021 Financial Levels for EISEP and CSE Client Cost Share and Potential Medicaid Eligibility Determination

..................................................................................................................................

ACTION REQUESTED: Effective April 1, 2021 all Area Agencies on Aging (AAAs) and their contractors must:

Use the figures in this Program Instruction (PI) in conducting client financial assessments to determine cost sharing amounts for Expanded In-home Services for the Elderly Program (EISEP) services and Community Services for the Elderly Program (CSE) funded EISEP-like services, and to determine potential Medicaid eligibility of individuals being assessed for services through these programs.

COVID ? 19 Related Guidance:

Based upon Governor Cuomo's Executive Order No. 202, declaring a disaster emergency in all 62 counties of the State of New York as of March 7, 2020, and amendments included in Executive Order No. 202.18, dated April 16, 2020, certain regulatory requirements relating to client contacts under EISEP continue to temporarily be suspended. This is a temporary suspension made to allow for the provision of necessary and appropriate services to those impacted by Coronavirus (COVID-19) and to limit contact between staff and service recipients.

Specifically, for the duration of the suspension of section 6654.6 of Title 9 of the New York Code of Rules and Regulations, to the extent necessary, new clients may be provided services under the EISEP without paying the cost share requirement until such time as a comprehensive assessment is conducted and a cost share amount, if applicable, can be determined.

In recognition of the temporary suspension of certain assessment requirements as explained in 20-PI-04, and that it may not be feasible to obtain the necessary information to determine a cost-share amount, new EISEP clients may be provided services without being required to pay cost-sharing. The suspension of this requirement is in effect until NYSOFA informs AAAs that it is discontinued.

PURPOSE:

o To inform AAAs of the 2021 financial levels that must be used in determining client cost sharing and potential Community Medicaid eligibility for individuals being assessed to receive EISEP or CSE-funded EISEP-like services.

o To share guidance related to conducting financial assessments while under Executive Order 202 and subsequent amendments.

o To transmit the Client Cost Sharing Thresholds and Schedules ? Effective April 1, 2021.

o To transmit an updated copy of the Financial Information Form (FIF) for use in determining client cost sharing and potential Community Medicaid eligibility. The financial information contained within this PI is used to update the FIF is available in the Statewide Client Data System.

o To reissue the English version of the approved EISEP and CSE Client Agreement form. This form is available in alternate languages within the Statewide Client Data System.

BACKGROUND:

The New York State Office for the Aging (NYSOFA) regulations governing EISEP and CSE-funded EISEP-like services require that income thresholds and cost share schedules be adjusted to reflect changes in the Consumer Price Index for all items between the third quarters of the preceding two calendar years. The regulations also prohibit AAAs from providing EISEP or CSE-funded services to individuals who can receive the same or similar services under other governmental funding sources, including Medicaid. Therefore, each year NYSOFA provides AAAs with updated information on income and resource allowances under Medicaid, as well as the updated figures relevant for determining client cost sharing. As of 2018, (18-PI-09) NYSOFA changed the effective date for the EISEP and CSE-funded income thresholds and cost share schedules from January 1 to April 1 to align with the State Fiscal year and to reflect the most current rates.

A revised EISEP or CSE Client Agreement form was issued in 2019 as part of 19-PI-09. The EISEP and CSE Client Agreement form was distributed in English, Spanish, Chinese, Russian, Korean, Haitian Creole, and Bengali. Those forms are available in the Statewide Client Data System and remain the approved forms for statewide utilization. An English version of the EISEP or CSE Client Agreement form is contained within this Program Instruction.

2

SUMMARY OF CHANGES: The FIF has been updated to reflect current income and housing adjustment thresholds. The following figures reflect the changes:

o Income Thresholds are $1,610.00 and $2,178.00 per month for an individual and couple, respectively; and

o Housing Adjustment Thresholds are $644.00 and $871.00 per month for an individual and couple, respectively; and

o Maximum Housing Adjustment Thresholds are $644.00 and $871.00 per month for an individual and couple, respectively.

The income and resource levels provided in the Community Medicaid Pre-screen (Section 5) of this PI have been updated to reflect the amounts established by the New York State Department of Health (NYSDOH) for determining Community Medicaid eligibility. The 2021 levels are:

o Income levels are $884.00 and $1,300.00 per month for an individual and couple, respectively; and

o Resource levels are $15,900.00 and $23,400.00 for an individual and couple, respectively.

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Expanded In-home Services for the Elderly Program

CLIENT COST SHARING THRESHOLDS AND SCHEDULES Effective April 1, 2021

A. Monthly Income Thresh olds INDIVIDUAL = $1,610.00 COUPLE = $2,178.00

B. Housing Adjustm e nt Thresholds

1) To be eligible f or a housing adjustment, average monthly housing expenses must be more than the following:

INDIVIDUAL = $644.00 COUPLE = $871.00

2) The amount of the housing adjustment cannot be more than the following maximum amounts:

INDIVIDUAL = $644.00 COUPLE = $871.00

C. Cost Share Rate Schedule

Individual

Adjusted Income and Maximum Monthly Fee (Section 3, Part 3, Question 11)

$0 $1 to $57 to $114 to $170 to $227 to $283 to $340 to $396 to $453 to $509 to $566 to $622 to $679 to $735 to $792 to $848 to $905 to $961 to $1,018 to *More than

$56 $113 $169 $226 $282 $339 $395 $452 $508 $565 $621 $678 $734 $791 $847 $904 $960 $1,017 $1,073

$1,073

Fee Rate

Couple

Adjusted Income and Maximum Monthly Fee (Section 3, Part 3, Question 11)

0%

$0

5%

$1 to

10%

$77 to

15%

$154 to

20%

$230 to

25%

$307 to

30%

$383 to

35%

$459 to

40%

$536 to

45%

$612 to

50%

$689 to

55%

$765 to

60%

$841 to

65%

$918 to

70%

$994 to

75% $1,071 to

80% $1,147 to

85% $1,223 to

90% $1,300 to

95% $1,376 to

*More

100% than

4

$76 $153 $229 $306 $382 $458 $535 $611 $688 $764 $840 $917 $993 $1,070 $1,146 $1,222 $1,299 $1,375 $1,452

$1,452

Fee Rate

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%

100%

PROGRAMS AFFECTED:

Title III-D

Title III-E

EISEP

NSIP

Other:

Title III-B CSE Title V

CONTACT PERSON: (For staff use only) Eileen Griffin

Email: EISEP@aging.

Title III-C-1 WIN

HIICAP

Title III-C-2 Energy

LTCOP

TELEPHONE: (518) 408-1652

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FOR OFFICE USE ONLY BY CASE MANAGER

Expanded In-Home Services for the Elderly Program Financial Information

1

1. Name:

____

Last

First

M.I.

For a married couple when both are participating, enter name of second person:

Case

Information

Name:

_

_____

Last

First

M.I.

2. Initial Assessment Reassessment

3. Sources of Inf ormation (Check all that are applicable)

Person(s)

Spouse

Financial Records

Other (specify)

4. Person(s) will provide no f inancial inf ormation Skip to Sections 4, then Client Agreement Section-Agreement to Pay Full Cost, No Financial Information

5. Financial Assessment Prepared by:

/

Name

Date

2

1. Source

1.

Monthly

Income

a. Social Security

a.

b. Supplemental Security Income: (SSI) b.

c. Pension/Retirement Income:

c.

(Private/Gov't, veterans' benefits,

annuities, IRAs, etc.)

d.

d. Interest: (Monthly Income)

e.

e. Dividends: (Monthly Average)

f.

f . Salary/Wages

g.

g. Other (Specify)

h.

h. Other (Specify)

Amount of Monthly Income

A. Person (Individual or

Couple/1Client)

B. Person's Sp o us e

C. Co up l e/Both

Cl i en ts

2. 2. Total Monthly Income (total sum of lines a.-h.)

3. Total Monthly Income of Couple/1 Client

3.

(Sum of 2A 2B)

4. Amount of non-client spouse's income not

4.

available f or mutual needs

5. Net Monthly Income Available:

5.

(Line 3 minus Line 4)

6

 Check if person receives SSI and is automatically Medicaid certified. Refer to LDSS.

Check if person's care plan includes no EISEP or CSE-funded EISEP-like services, other than case management. SKIP to Section 5.

Check if Monthly Income is below the income threshold (for an individual, Line 2, Column A is $1,610.00 or less; for a couple, Line 2 Column C or Line 5, combined Columns A & B is $2,178.00 or less). Skip to Section 4, Line 1, and enter "0" as Fee Rate.

3

Housing Expenses & Income Adjustment

1. Monthly rent or mortgage payment

2. Other monthly expenses allowable as adjustments, paid f rom person's or spouse's Income but not included in rent or mortgage Payment:

a. Electricity................................................. b. Other heating & cooking fuels....................... c. Telep h o n e in stallation & lo cal usag e.............. d. Water & sewage........................................ e. Property taxes.......................................... f. School taxes............................................ g. Other (Specify)........................................ h. Total (Lines 2a through 2g)........................

3. Total allowable housing expense (Lines 1 + 2h)

4. Housing adjustment threshold

5. Excess housing expenses (Line 3 minus 4)

6. Maximum adjustment

7. Net Monthly Income (from Section 2, Line 2 or 5)

8. Adjustment (Enter either Line 5 or Line 6, whichever is less)

9. Monthly income af ter deduction of excess housing costs (Line 7 minus Line 8)

10. Amount of income threshold

11. Adjusted Income and Maximum Monthly Fee (Line 9 minus Line 10)

A. Individual 3.

4.

-$644.00

5.

6.

$644.00

7.

8.

9.

10. $1,610.00 11.

Amount B. Couple -$871.00 $871.00

$2,178.00

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Fee rate f or service(s) or items (f rom cost share rate schedule based on Section 3, line 11 or instructions at

4 bottom of Section 2)

%

Cost Share

Calculation 2. Services(s) Recurring Monthly

A

Service

B

# of Units Each Time Service is Provided

C

# of Times/Month

D

Unit Cost

E

Monthly Cost

2.a. Total Cost for one month

$

3. Service(s) Recurring Other than Monthly

A

Service

B

# of Units Each Time Service is

Pro v i d ed

C

Unit Cost

D

Co s t

E

F

Frequency Monthly Cost

3.a. Total Cost for one Month

4. One Time Services, Goods and/or Items

A

Serv i c e/Go o d /Item

B

Total Cost

C

Months Remaining in Care Plan*

$

D

Monthly Cost

4.a. Total Cost for one Month

$

*Based on when service/good/item is expected to be received.

5. Total Monthly Cost

a) (Sum of Section 4: 2.a., 3.a., & 4.a.)

$

b) Fee Rate (Section 4: Line 4.1, above)

____________%

c) Fee f or one month (Total cost X rate)

$

d) Maximum monthly fee (Section 3: Line 11)

$

e) Estimated monthly cost share: (Use the lesser amount among c or d above)

$

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