2023 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.