2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 369 - Application of Other Provisions.

§  369.  Application  of  other  provisions. 1. All provisions of this
chapter not inconsistent with this title shall be applicable to  medical
assistance  for  needy  persons  and  the  administration thereof by the
social services districts.
2. (a) Notwithstanding any inconsistent provision of this  chapter  or
other law, no lien may be imposed against the property of any individual
prior to his or her death on account of medical assistance paid or to be
paid on his or her behalf under this title, except:
(i)  pursuant  to  the  judgment  of  a  court  on account of benefits
incorrectly paid on behalf of such individual, or
(ii) with respect to the real property of  an  individual  who  is  an
inpatient   in  a  nursing  facility,  intermediate  care  facility  for
individuals  with   developmental   disabilities,   or   other   medical
institution,  who  is  not reasonably expected to be discharged from the
medical institution and to return  home,  and  who  is  required,  as  a
condition of receiving services in such institution under the state plan
for  medical  assistance,  to  spend for costs of medical care all but a
minimal amount of  his  or  her  income  required  for  personal  needs;
provided,  however,  any  such  lien will dissolve upon the individual's
discharge from the medical institution and return home; in addition,  no
such  lien  may  be  imposed  on  the  individual's  home  if one of the
following persons is lawfully residing in the home:
(A) the spouse of the individual;
(B) a child of the individual who is under twenty-one years of age  or
who is blind or permanently and totally disabled; or
(C) a sibling of the individual who has an equity interest in the home
and  who  was  residing  in  the  home for a period of at least one year
immediately before the date of the individual's admission to the medical
institution.
(b) (i) Notwithstanding any inconsistent provision of this chapter  or
other law, no adjustment or recovery may be made against the property of
any individual on account of any medical assistance correctly paid to or
on behalf of an individual under this title, except that recoveries must
be pursued:
(A) upon the sale of the property subject to a lien imposed on account
of  medical assistance paid to an individual described in clause (ii) of
paragraph  (a)  of  this  subdivision,  or  from  the  estate  of   such
individual; and
(B)  from  the estate of an individual who was fifty-five years of age
or older when he or she received  such  assistance,  provided  that  for
individuals  whose  eligibility  for  medical  assistance  was  based on
paragraph (b) of subdivision one of section three hundred  sixty-six  of
this  title,  recovery shall be limited to medical assistance consisting
of nursing facility services, home  and  community-based  services,  and
related hospital and prescription drug services.
(ii)  Any  such  adjustment  or  recovery shall be made only after the
death of the individual's surviving spouse, if any, and only at  a  time
when the individual has no surviving child who is under twenty-one years
of  age  or  is  blind  or  permanently  and totally disabled, provided,
however, that nothing herein contained shall be  construed  to  prohibit
any  adjustment or recovery for medical assistance furnished pursuant to
subdivision three of section three hundred sixty-six of this chapter.
(iii) In the case  of  a  lien  on  an  individual's  home,  any  such
adjustment or recovery shall be made only when:
(A)  no sibling of the individual who was residing in the individual's
home for a period of at least one year immediately before  the  date  of
the  individual's  admission  to  a  medical  institution referred to in
subparagraph (ii) of paragraph (a) of subdivision two of  this  section,

and  is  lawfully residing in such home and has lawfully resided in such
home on a continuous basis since the date of the individual's  admission
to the medical institution, and
(B)  no  child  of the individual who was residing in the individual's
home for a period of at least two years immediately before the  date  of
the  individual's  admission  to  a  medical  institution referred to in
subparagraph (ii) of paragraph (a) of subdivision two of  this  section,
and  who  establishes  to  the  satisfaction of the state that he or she
provided care to such individual  which  permitted  such  individual  to
reside  at  home rather than in an institution, and is lawfully residing
in such home and has lawfully resided in such home on a continuous basis
since the date of the individual's admission to the medical institution.
(c) Nothing contained in this subdivision shall be construed to  alter
or affect the right of a social services official to recover the cost of
medical  assistance provided to an injured person in accordance with the
provisions of section one hundred four-b of this chapter.
(d) Where a recovery or adjustment is made pursuant to this title with
respect to a case in a federally-aided category of medical assistance, a
part of the net amount resulting from such recovery or adjustment  shall
be  paid  or  credited to the federal government pursuant to federal law
and the regulations of  the  federal  department  of  health  and  human
services.
3.   The  department  and  any  social  services  district  is  hereby
authorized to maintain an action subject to sections one hundred one and
one hundred four of this chapter  to  collect  from  either  a  trustee,
creator,  or  creator's  spouse  any  beneficial  interest of either the
creator or creator's spouse in any  trust,  other  than  a  testamentary
trust, to reimburse such department or district for the costs of medical
assistance furnished to, or on behalf of, a creator or creator's spouse.
For  the  purpose  of  this  subdivision, the beneficial interest of the
creator or creator's  spouse  includes  the  income  and  any  principal
amounts  to  which  the  creator  or  creator's  spouse  would have been
entitled by the terms of such trust by right or in the discretion of the
trustee, assuming the full exercise of discretion by the trustee for the
distribution of  the  maximum  amount  to  either  the  creator  or  the
creator's spouse.
4.   Any   inconsistent   provision  of  this  chapter  or  other  law
notwithstanding, all information received by social services and  public
health  officials  and  service  officers  concerning applicants for and
recipients of medical assistance may  be  disclosed  or  used  only  for
purposes   directly   connected   with  the  administration  of  medical
assistance for needy persons.
5. The requirements of this section with respect  to  adjustments  and
recoveries of medical assistance correctly paid shall be waived in cases
of  undue  hardship,  as  determined  pursuant to the regulations of the
department in accordance with criteria established by the  secretary  of
the federal department of health and human services.
6.  For purposes of this section, the term "estate" means all real and
personal property and other  assets  included  within  the  individual's
estate and passing under the terms of a valid will or by intestacy.
7.   Notwithstanding  any  provision  of  law  to  the  contrary,  the
department shall, when it determines necessary program features  are  in
place,  assume sole responsibility for commencing actions or proceedings
in accordance with the provisions of this section, sections one  hundred
one,  one hundred four, one hundred four-b, paragraph (a) of subdivision
three of section three hundred sixty-six, subparagraph one of  paragraph
(h)  of  subdivision  four  of  section  three  hundred  sixty-six,  and
paragraph (b) of subdivision two of section three hundred  sixty-seven-a

of  this  chapter,  to  recover the cost of medical assistance furnished
pursuant  to  this  title  and  title  eleven-D  of  this  article.  The
department  is  authorized to contract with an entity that shall conduct
activities  on  behalf  of  the department pursuant to this subdivision.
Prior to assuming such responsibility from a social  services  district,
the  department  of  health  shall,  in  consultation with the district,
define the scope of the  services  the  district  will  be  required  to
perform  on  behalf  of  the  department  of  health  pursuant  to  this
subdivision.