NY Soc Serv L § 366-A (2021)
2021 New York Laws SOS - Social Services Article 5 - Assistance and Care Title 11 - Medical Assistance for Needy Persons 366-A - Applications for Assistance; Investigations; Reconsideration.

§ 366-a. Applications for assistance; investigations; reconsideration. 1.  Any  person  requesting  medical  assistance  may  make  application therefor by a written application to the social services official of the county in which the applicant resides or is found or to  the  department of  health or its agent; a phone application; or an on-line application. Notwithstanding any provision of  law  to  the  contrary,  an  in-person interview  with the applicant or with the person who made application on his or her behalf shall not be required as part of  a  determination  of initial or continuing eligibility pursuant to this title.   1-a. Every person making application for medical assistance, and every person  on whose behalf an application is made, shall, if interested, be given the New York state department of health model  health  care  proxy form  by  the person taking the application, except where doing so would impede the immediate provision of health care services.   2. (a) Upon  receipt  of  such  application,  the  appropriate  social services official, or the department of health or its agent shall verify the eligibility of such applicant. In accordance with the regulations of the  department  of  health,  it  shall  be  the  responsibility  of the applicant to provide information and  documentation  necessary  for  the determination of initial and ongoing eligibility for medical assistance. If   an   applicant   or   recipient  is  unable  to  provide  necessary documentation, the social services official or the department of  health or  its agent shall promptly cause an investigation to be made. Where an investigation is necessary, sources of  information  other  than  public records  will  be  consulted  only  with  permission of the applicant or recipient. In the event that such  permission  is  not  granted  by  the applicant  or  recipient, or necessary documentation cannot be obtained, the social services official or the department of health  or  its  agent may  suspend  or  deny  medical  assistance until such time as it may be satisfied as to the applicant's or recipient's eligibility therefor.  (b)  Notwithstanding  the  provisions  of  paragraph   (a)   of   this subdivision,  an  applicant or recipient may attest to the amount of his or her accumulated resources, unless  such  applicant  or  recipient  is seeking  medical  assistance  payment  for  long term care services. For purposes of this paragraph, long term care  services  shall  mean  care, treatment,  maintenance,  and  services  described  in  paragraph (b) of subdivision 1 of section three hundred sixty-seven-f of this title, with the  exception  of  short  term  rehabilitation,  as  defined   by   the commissioner of health.  (c)   Notwithstanding   the   provisions  of  paragraph  (a)  of  this subdivision, an applicant or recipient providing  written  documentation of  income eligibility of a child for free or reduced breakfast or lunch through the school meal program certified by the  child's  school  shall meet the evidentiary requirement necessary to document income.   * (d)   Notwithstanding  the  provisions  of  paragraph  (a)  of  this subdivision, an applicant or  recipient  whose  eligibility  under  this title  is  determined  without  regard  to  the  amount  of  his  or her accumulated resources may  attest  to  the  amount  of  interest  income generated  by  such  resources  if the amount of such interest income is expected  to  be  immaterial  to  medical  assistance  eligibility,   as determined  by  the  commissioner  of  health.  In the event there is an inconsistency between the  information  reported  by  the  applicant  or recipient  and  any  information  obtained by the commissioner of health from other  sources  and  such  inconsistency  is  material  to  medical assistance  eligibility,  the  commissioner of health shall request that the applicant or recipient provide adequate documentation to verify  his or her interest income.   * NB There are 2 par (d)'s    * (d)  The  commissioner  of  health  may  verify  the accuracy of the information  provided  by  the  applicant  or  recipient   pursuant   to paragraphs  (b)  and  (c)  of  this  subdivision, by matching it against information to which the commissioner of health  has  access,  including under  subdivision  eight  of  this  section.  In  the event there is an inconsistency between the  information  reported  by  the  applicant  or recipient  and  any  information  obtained by the commissioner of health from other  sources  and  such  inconsistency  is  material  to  medical assistance  eligibility,  the  commissioner of health shall request that the applicant or recipient provide adequate documentation to verify  his or her resources.   * NB There are 2 par (d)'s   3.  Upon  the receipt of such application, and after the completion of any investigation that shall be deemed necessary, the appropriate social services official or the department of health or its agent shall  (a) decide whether the applicant is eligible for  and  should  receive medical  assistance,  the  amount thereof and the date on which it shall begin, which shall be  the  date  of  the  application  or,  subject  to applicable  department regulations, such earlier or later date as may be deemed reasonable;  (b) notify the applicant in writing of the decision,  and  where  such applicant  is  found eligible, provide a tamper resistant identification card containing a photo image of  the  applicant  for  use  in  securing medical   assistance   under  this  title  provided,  however,  that  an identification card need not contain a photo image  of  a  person  other than  an  adult  member  of  an  eligible  household  or a single-person eligible household. The department is not required to provide, but shall seek practical methods for providing, a card  with  such  picture  to  a person  when  such person is homebound or is a resident of a residential health care facility, or  an  in-patient  psychiatric  facility,  or  is expected to remain hospitalized for an extended period. The commissioner shall  have the authority to define categories of recipients who are not required to have a photo identification card where such  card  would  be limited, unnecessary or impracticable.  (c)  with respect to a person determined eligible for assistance under this title by  the  federal  social  security  administration  under  an agreement  between the department and the secretary of health, education and welfare pursuant to section  three  hundred  sixty-three-b  of  this title  issue  a  medical  assistance  identification card which shall be valid for periods determined by the local social services official,  but not to exceed six months.   4.  Every  applicant  or  recipient  shall  promptly advise the public welfare district of any change in his  financial  condition  or  income, number  of wage earners and members in the family unit on such forms and in such manner as the department by regulation  may  prescribe.  In  the event  that  any  applicant or recipient shall no longer be eligible for medical assistance, he shall promptly  return  his  identification  card issued  pursuant to the provisions of this article to the public welfare district.   5.  (a)  All  continuing  assistance  under  this   title   shall   be reconsidered  from  time to time, or as frequently as may be required by the regulations of the department. After such further  investigation  as the  social  services  official may deem necessary or the department may require, the assistance may be modified or withdrawn if it is found that the recipient's circumstances have changed sufficiently to warrant  such action.  The  assistance may be cancelled for cause, and payment thereof may be suspended for cause for such periods as may be deemed  necessary,  subject to review by the department as provided in section twenty-two of this chapter.  (b)   The   commissioner   shall   develop   a   simplified  statewide recertification form for use in  redetermining  eligibility  under  this title. The form may include requests only for such information that is:  (i)  reasonably  necessary  to  determine  continued  eligibility  for medical assistance under this title; and  (ii) subject to change since  the  date  of  the  recipient's  initial application.  (c)  The  regulations  required  by  paragraph (a) of this subdivision shall provide that:  (i) the redetermination of eligibility will be made based on  reliable information  possessed  or  available to the department of health or its agent,  including  information  accessed  from  databases  pursuant   to subdivision eight of this section;  (ii)  if  the  department  of  health  or its agent is unable to renew eligibility based  on  available  information,  the  recipient  will  be requested  to  supply  any such information as is necessary to determine continued eligibility for medical assistance under this title; and  (iii) for persons whose medical assistance  eligibility  is  based  on modified  adjusted  gross  income,  eligibility must be renewed at least once every twelve months, unless the department of health or  its  agent receives  information about a change in a recipient's circumstances that may affect eligibility.   * (d)  An  in-person  interview   with   the   recipient   shall   not automatically  be  required  as part of a redetermination of eligibility pursuant to this subdivision unless the department of health  determines otherwise.   * NB There are 2 par (d)'s   * (d)  The  commissioner  of  health  shall verify the accuracy of the information provided by an applicant or recipient by matching it against information to which the commissioner of health  has  access,  including under  subdivision  eight  of this section. In the event the information reported  by  the  recipient  is  not  reasonably  compatible  with  any information  obtained  by  the commissioner of health from other sources and such incompatibility is material to medical assistance  eligibility, the  commissioner  of  health  shall  request that the recipient provide adequate documentation to verify  his  or  her  place  of  residence  or income, as applicable. In addition to the documentation of residence and income  authorized  by  this  paragraph,  the  commissioner of health is authorized to periodically require a reasonable sample of recipients  to provide  documentation  of  residence and income at recertification. The commissioner of health shall consult with the medicaid inspector general regarding income and residence  verification  practices  and  procedures necessary to maintain program integrity and deter fraud and abuse.   * NB There are 2 par (d)'s   6.  Notwithstanding any other provisions of this chapter or other law, the investigations, decisions and actions required to be made  or  taken by  a  public welfare official pursuant to this section shall be made or taken only  by  the  chief  executive  officer  of  the  public  welfare department  of  a  public  welfare  district,  or by an employee of such welfare department designated by such chief executive officer.   7. Local social services  districts  shall  be  authorized,  with  the approval  of  the department, to station local social services employees at  federal  social  security  offices  for  the  purpose  of  providing information  and  referral  services  relating  to medical assistance to eligible persons.    8. (a) Notwithstanding subdivisions two  and  five  of  this  section, information  concerning  income  and  resources  of  applicants  for and recipients of medical assistance may  be  verified  by  matching  client information  with  information  contained  in  the wage reporting system established  by  section one hundred seventy-one-a of the tax law and in similar systems operating in other geographically contiguous states,  by means  of  an  income verification performed pursuant to a memorandum of understanding with the department of taxation and  finance  pursuant  to subdivision  four  of  section one hundred seventy-one-b of the tax law, and, to the extent required by federal law, with  information  contained in  the  non-wage  income  file maintained by the United States internal revenue service, in the beneficiary  data  exchange  maintained  by  the United  States  department  of  health  and  human  services, and in the unemployment insurance benefits file. Such matching  shall  provide  for procedures  which  document significant inconsistent results of matching activities. Nothing in this  section  shall  be  construed  to  prohibit activities  the department reasonably believes necessary to conform with federal requirements under section one thousand one hundred thirty-seven of the social security act.  (b) Any verification  response  by  the  department  of  taxation  and finance  pursuant  to  paragraph  (a) of this subdivision shall not be a public record  and  shall  not  be  released  except  pursuant  to  this paragraph.    Information  disclosed pursuant to this paragraph shall be limited  to  information  necessary  for  verification.  Information  so disclosed  shall  be  kept  confidential  by  the  party  receiving such information. Such information shall be expunged within a reasonable time to be determined by the commissioner and the department of taxation  and finance.   9.  (a) Every applicant for or recipient of medical assistance who has dependent  children  shall  be  informed  in  writing  at  the  time  of application  and  at the time of any action affecting his or her receipt of such assistance of the availability of:  (i) medical assistance without cash assistance under this title;  (ii) transitional medical assistance under paragraphs (a), (b) and (c) of subdivision four of section three hundred sixty-six of this title;  (iii) the expanded  eligibility  provisions  for  pregnant  women  and children  under  paragraphs  (m),  (n), (o), (p) and (q), (s) and (t) of subdivision four of section three hundred sixty-six of this title;  (iv) medical assistance for aged,  blind  or  disabled  persons  under subdivision one of section three hundred sixty-six of this title;  (v)  family  health  plus under section three hundred sixty-nine-ee of this article; and,  (vi) child health plus under title one-A of article twenty-five of the public health law.  (b) Every applicant for or recipient of medical assistance who has  no dependent  children  shall  be  informed  in  writing  at  the  time  of application and at the time of any action affecting his or  her  receipt of such assistance of the availability of:  (i) medical assistance without cash assistance under this title;  (ii)  the  expanded  eligibility  provisions  for pregnant women under paragraphs (m) and (o) of subdivision  four  of  section  three  hundred sixty-six of this title;  (iii)  medical  assistance  for  aged, blind or disabled persons under subdivision one of section three hundred sixty-six of this title; and,  (iv) family health plus under section three hundred  sixty-nine-ee  of this article.  (10)  As  a  condition  for  the  provision  of medical assistance for nursing facility services, the application of  an  individual  for  such  assistance,  including  any  recertification  of  eligibility  for  such assistance, shall disclose a description of any interest the  individual or  community  spouse has in an annuity or similar financial instrument, regardless  of  whether  the  annuity is irrevocable or is treated as an asset.  Such  application  or  recertification  form  shall  include   a statement  that  the  state  of New York becomes a remainder beneficiary under such annuity or similar financial  instrument  by  virtue  of  the provision of such medical assistance.   11.  (a)  Notwithstanding  any  inconsistent provision of law, rule or regulation, the commissioner of health is authorized  to  (i)  establish standards  and  procedures  for  express  lane  enrollment  and  renewal implemented in accordance with section 1902(e)(13) of the federal social security act, including but not limited to reliance on a finding made by an express lane agency, as defined in section 1902(e)(13)(F) and (H)  of the  federal social security act, to determine whether a child meets one or more of the eligibility criteria for medical assistance; (ii) specify such standards and procedures  in  the  medical  assistance  state  plan established  under  title  XIX  of  the federal social security act; and (iii) waive any information and documentation requirements set forth  in this  section necessary to implement express lane eligibility; provided, however, information and documentation required pursuant to section  one hundred twenty-two of this chapter may not be waived.  (b)  Subject  to federal approval, such standards and procedures shall specify that information and  documentation  regarding  citizenship  and immigration  status  collected by an express lane agency and provided to the commissioner for the purpose of express lane eligibility may be used to satisfy the requirements of section one hundred  twenty-two  of  this chapter.  (c)  Such  standards  and  procedures shall also include a process for determining enrollment error rates and implementing  corrective  actions as  required  by  section  1902(e)(13)(E) of the federal social security act.  (d) For purposes of a  medical  assistance  eligibility  determination made  in  accordance  with  this subdivision, a child shall be deemed to satisfy the income eligibility criteria for  medical  assistance  if  an express lane agency, as defined in section 1902(e)(13)(F) and (H) of the federal   social  security  act  and  specified  in  the  standards  and procedures established pursuant to paragraph (a)  of  this  subdivision, has  determined that: the child's family has income that does not exceed a screening threshold amount,  as  determined  by  the  commissioner  of health,  equal  to  a percentage of the federal poverty line (as defined and annually revised by the United States department of health and human services) that exceeds by thirty percentage points  the  highest  income eligibility  level  applicable  to  a  family of the same size under the medical assistance program.   12.  The  commissioner  shall   develop   expedited   procedures   for determining  medical  assistance  eligibility for any medical assistance applicant with an immediate need for personal care or consumer  directed personal  assistance  services  pursuant to paragraph (e) of subdivision two of section three hundred sixty-five-a of this title or section three hundred sixty-five-f of this title, respectively. Such procedures  shall require that a final eligibility determination be made within seven days of the date of a complete medical assistance application.