N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-2.2

Current through Register Vol. 46, No. 45, November 2, 2024

Section 360-2.2 - Applying for MA

(a)ADC and HR applicants.

Persons applying for ADC or HR on the State-prescribed form are not required to make a separate application for MA.

(1) Persons determined to be eligible for ADC or HR are automatically eligible for MA if they meet the general conditions for MA eligibility in section 360-3.2 of this Part.

(2) Persons determined to be ineligible for ADC or HR will have their MA eligibility determined separately, unless they have stated in writing that they do not want their MA eligibility determined.

(b)SSI applicants.

(1) Persons determined to be eligible for SSI from the Social Security Administration are automatically eligible for MA if they meet the general conditions for MA eligibility in section 360-3.2 of this Part. No separate application for MA is required.

(2) Persons determined to be ineligible for SSI must make a separate application if they wish to have MA eligibility determined, assuming they have not already done so.

(c)Title IV-E children.

(1) A child receiving foster care maintenance payments pursuant to title IV-E of the Social Security Act or on whose behalf a title IV-E adoption assistance agreement is in effect is automatically eligible for MA. The child must be living in the state and meet the general conditions of MA eligibility in section 360-3.2 of this Part. No separate application for MA is required.

(2) If a child is determined ineligible under title IV-E, a separate application must be made in order to have MA eligibility determined, assuming this has not already been done.

(d)Application for MA only.

(1) Persons may apply for MA without applying for ADC, HR, or SSI. Persons may also apply for MA separately from an application for SSI. Such applicants must complete and sign a State-prescribed form in ink. Spouses living together and applying for MA together must both sign the State-prescribed application form. The form may be completed and signed by anyone the applicant designates to represent him/her in the application process. The completed form must be returned to the social services district in the county in which the applicant lives.

(2)

(i) HR eligibility will be determined for MA applicants who:

(a) are not eligible under the assistance programs listed in section 360-3.3(a)(2)-(6) of this Part; and

(b) do not meet the requirements, other than financial, for medically needy status in section 360-3.3(b) of this Part.

(ii) Generally, eligibility for MA on the basis of HR eligibility will be determined according to Parts 352 and 370 of this Title. Exceptions to this general rule are set forth below.

(a) A homestead, as defined in section 360-1.4(f) of this Part, is exempt from consideration in determining eligibility.

(b) Lump-sum and windfall payments will be counted as income in the month received. Any portion of such payments remaining in subsequent months will be counted as an available resource.

(c) A child's savings account of under $500 accumulated from gifts from nonlegally responsible relatives or from the child's own wages will be disregarded in determining eligibility.

(d) The provisions of section 352.23(b)(6) of this Title regarding the sale of real property do not apply. If the value of the total resources of the applicant/recipient is over the maximum resource level, the applicant/recipient will be ineligible for MA.

(e)Recertification.

Social Services districts must redetermine an MA recipient's eligibility at least once every 12 months and whenever there is a change in the recipient's circumstances that may affect eligibility. The district may redetermine eligibility more frequently.

(1) MA recipients who are not eligible for ADC, HR, SSI, title IV-E, or the adoption assistance benefits described in section 360-3.3(a)(6) of this Part must apply for recertification on a State-prescribed form each time MA eligibility is redetermined.

(2) MA recipients who are eligible for ADC, HR, SSI, title IV-E, or the adoption assistance benefits described in section 360-3.3(a)(6) of this Part will continue to be eligible for MA as long as they are eligible under the other program. No application for recertification is required when MA eligibility is redetermined.

(f)Personal interview for applicants and recipients.

(1) The social services district must conduct a personal interview with anyone applying for MA or for recertification of MA, except as provided in paragraphs (2) and (3) of this subdivision. If the applicant/recipient cannot be interviewed due to his/her physical or mental condition, the person who applied on his/her behalf must be interviewed. The district must conduct the interview before making any decision concerning an applicant's/recipient's eligibility for MA. The district does not have to conduct a personal interview when the application for MA is made on behalf of a child in the custody of the State Division for Youth or of a local commissioner of social services. At the interview, an applicant/recipient or his/her representative must be told about the following:

(i) the general eligibility requirements of the MA program;

(ii) the applicant's/recipient's responsibility to provide all information necessary to determine eligibility;

(iii) the applicant's/recipient's and the social services district's responsibility to explore all the facts concerning the applicant's/recipient's eligibility;

(iv) the kinds of information or documents the applicant/recipient must provide to show eligibility, the time when the information and documents must be submitted, and the applicant's/recipient's responsibility to obtain information or documents whenever possible;

(v) the social services district's responsibility to undertake necessary investigation to determine the applicant's/recipient's eligibility;

(vi) the applicant's/recipient's responsibility to inform the district immediately of all changes in circumstances; and

(vii) the availability of other assistance or services for which the applicant/recipient may be eligible.

(2)

(i) Social services districts may request a waiver of the personal interview requirement for recertification for aged, certified blind or certified disabled recipients. The request must be sent in writing, by certified mail, to the State Commissioner of Social Services. The request must state the intended duration of the waiver and other conditions the local social services commissioner finds relevant. The local social services commissioner must sign the request. A waiver request may be granted if the social services district demonstrates that alternative procedures have been established to verify that recipients continue to meet all eligibility requirements for MA. The department may require follow-up reports from the social services district to insure that continuing eligibility is being accurately determined. The waiver may be withdrawn or modified, if, through the department's monitoring efforts, it is determined that the statewide medical assistance eligibility error rate may be adversely affected.

(ii) The local social services official will be notified in writing within 45 days of the approval, partial approval or denial of the waiver. If the waiver is denied, the department will inform the district of the reasons for the denial. The department's failure to act within the specified time period does not constitute an automatic approval of the waiver.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-2.2