On October 16th, the Social Security Administration released its
cost-of-living adjustment
(COLA) for 2013. And the U.S. Department of Labor Bureau of Labor Statistics has recently released
the consumer price index figures for September. These important numbers will impact tens
of millions of seniors in 2013.
Increase in Social Security and
SSI benefit payments
Monthly Social Security and Supplemental Security Income (SSI) benefits
for nearly 62 million Americans will increase 1.7 percent in 2013. The 1.7
percent COLA will begin for more than 56 million Social Security beneficiaries with
payments they receive in January 2013. Increased payments to more than 8 million SSI
beneficiaries will begin on December 31, 2012.
The Social Security Administration also released the SSI Federal PaymentStandards (Federal Benefit Rate) for 2013 as follows:
- Individual: $710/mo. (an increase from $698/mo. in 2012)
- Couple: $1,066/mo. (an increase from $1,048/mo. in 2012)
Increase in Aging Waiver
Program Income Limit
The Federal Benefit Rate (FBR) is used to determine qualification for many Medicaid
funded benefit programs including the Pennsylvania
Department of Aging (PDA) Aging Waiver program. The income limit for this home
Waiver program is equal to 300% of the SSI Federal Benefit rate for an
individual.
This means that effective January 1, 2013 the new income ceiling
should be:
- $2,130 per month = Aging Waiver Program Income Limit for 2013
The Aging Waiver program is a vital support that can allow frail seniors to live in their homes rather than an institution. But it is difficult for individuals with income above this 300% FBR limit to qualify. However, it
is possible in some cases. If you are above the income limit but would like to
qualify for home Waiver services, discuss the qualification rules with an
experienced elder law attorney.
New Protected Resource and Maximum
Income Levels for the Community Spouse
The Federal Government has also published the consumer price index for
all urban consumers, all items, U.S. city average (the CPI-U) for the month of September
2012. Using these figures it is possible to project some 2013 numbers that are
critical to planning for married couples where one spouse is seeking Medicaid funded
long term care benefits.
In general, when your spouse is in a nursing home or needs home care
under the Aging Waiver program, he or she will not qualify for Medicaid
benefits until your combined savings are reduced to a certain level. That permitted level of so-called
"available resources" varies with each situation. For nursing facility residents, the general
rule is that the community spouse can keep ½ of the amount of available
resources that were owned by the couple on the date of admission to the nursing
facility. However, this standard protected
"Community Spouse Resource Allowance" is subject to a ceiling and a
floor.
In addition to being allowed to keep the resource allowance, the
community spouse is also entitled to have a certain level of income called the Monthly
Maintenance Needs Allowance. The income allowance is also subject to a ceiling
and a floor. If the community spouse
does not have the required level of income, the spouse may be allowed to keep
some of the institutional spouse's income.
If the income diverted from the institutionalized spouse is still
insufficient, the community spouse may be able to keep additional resources.
These community spouse resource and income allowances are adjusted
annually. Although the new figures have
not yet been announced by the Centers for Medicare and Medicaid Services, by
law they are based on the consumer price index for all urban consumers
published by the Bureau of Labor Statistics (the CPI-U) for September
of the prior year.
Thus, I can project that effective January 1, 2013, the new standard community
spouse allowances should be as follows:
·
Minimum Community Spouse Resource Allowance = $23,184.
·
Maximum Community Spouse Resource Allowance = $115,920.
·
Maximum Community Spouse Monthly Income
Allowance = $2,898.
Note: The current Minimum Monthly Income Allowance remains at $1,891.25
- it will be adjusted on July 1, 2013.
Readers should also note that a Community Spouse can often protect
resources in excess of the above amounts through a number of planning techniques including the purchase of a Medicaid Annuity. (Be sure to consult an experienced elder law attorney before
purchasing a Medicaid Annuity.)
Probably more than you want to
know
Those readers who want to dig deeper into how the community spouse
figures are determined can check the federal law at 42 U.S.C. § 1396r-5(f)(2)). That statute established the initial community
spouse resource allowance at levels of $12,000 minimum and $60,000 maximum for
1989 based on the CPI-U for September 1988.
It provided that these levels be increased by the same percentage as the
percentage increase in the CPI-U between September 1988 and the September
before the calendar year involved.
The CPI-U
for September 1988 was 119.8. The CPI-U for September 2012
was 231.407. This means that the CPI-U has increased 93.1611% over the
period. I’ve rounded this percentage to 93.2%.
As a result, the new community
spouse figures for 2013 should be:
- $12,000 + $11,184 = $23,184 - Minimum Resource Allowance for 2013
- $60,000 + $55,920 = $115,920 – Maximum Standard Resource Allowance for 2013
The statute also established an initial maximum monthly
maintenance needs allowance of $1,500 a month. (See 42 U.S.C. § 1396r-5(d)(3)(C)). This
figure is increase in the same manner, as follows:
- $1,500 + $1,398 = $2,898 – Maximum Monthly Maintenance Needs Allowance for 2013
The figures ultimately announced by the Centers for Medicare and Medicaid
Services could be a little different than those above due to rounding. But the
above projections should be pretty close, if not spot on.
Thanks to my friend, fellow Elder Law Attorney Robert Clofine of York, Pennsylvania, for being the first to make note of these updated figures.
Thanks to my friend, fellow Elder Law Attorney Robert Clofine of York, Pennsylvania, for being the first to make note of these updated figures.
Further Reading:
The
Medicaid Long Term Care Eligibility Fact Sheet, Marshall, Parker and
Associates.
Pennsylvania Care Management (provides
Medicaid Annuities in Pennsylvania).
Historical CPI-U figures can be found online at ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt.