New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-4 - Financial Eligibility › Section 360-4.9 - Post-eligibility utilization of income

Current through Register Vol. 46, No. 28, July 10, 2024
For a person in permanent absence status in a medical
				facility, after MA eligibility is established the person is subject to chronic
				care budgeting. Under chronic care budgeting, all income must be applied toward
				the cost of care in the facility, including income disregarded or considered
				unavailable for the purpose of determining MA eligibility. However, before any
				income is required to be applied to the person's cost of care, deductions will
				be made in the following order:
(a)
			   For an institutionalized person without a community spouse:
(1) A personal needs allowance of $50 will be
			   allotted to an applicant/recipient who is a resident of a residential health
			   care facility, as defined by article 28 of the Public Health Law, or who is in
			   permanent absence status in an acute care hospital certified under article 28
			   of the Public Health Law. A personal needs allowance of $35 will be allotted to
			   an applicant/recipient who is a resident of a psychiatric care facility,
			   developmental center, or related intermediate care facility regulated by
			   article 31 of the Mental Hygiene Law. A personal needs allowance equal to the
			   amount of a reduced veteran's pension pursuant to
			   38
			   U.S.C. 5503(f), but not to
			   exceed $90, will be allotted to an applicant/recipient who receives such
			   pension or who has elected a greater compensation benefit under
			   38 CFR
			   3.701 in lieu of such pension.
(2) An amount will be deducted to cover
			   third-party health insurance premiums.
(3) An amount will be set aside to meet any
			   maintenance needs of dependent members of the applicant's/recipient's former
			   family household. The amount deducted will be the amount needed to bring the
			   income of the family up to the MA standard or the public assistance standard of
			   need, whichever is higher.
(4) An
			   amount will be deducted to cover any expenses incurred for medical care,
			   services, supplies, or remedial care for the institutionalized individual not
			   subject to payment under this Title or by a third party.
(5) The following income received by an
			   applicant/recipient in a residential health care facility is not required to be
			   applied toward the cost of medical care:
(i)
			   money received as the result of a legal action against the residential health
			   care facility because of improper and/or inadequate treatment;
(ii) income necessary to achieve a plan of
			   self-support, as described in section
			   360-4.6(a)(2)(xx) 
			   of this Subpart;
(iii) SSI benefits
			   paid under section 1611(e)(1)(E) of the Social Security Act;
(iv) reparation payments received from the
			   Federal Republic of Germany;
(v)
			   benefits paid to eligible Japanese-Americans and Aleuts under the Federal Civil
			   Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution
			   Act;
(vi) payments made from the
			   Agent Orange Settlement Fund or any other fund established pursuant to the
			   settlement in the In re Agent Orange product liability litigation, and payments
			   received from court proceedings brought for personal injuries sustained by
			   veterans resulting from exposure to dioxin or phenoxy herbicides in connection
			   with the war in Indochina in the period of January 1, 1962 through May 7,
			   1975;
(vii) payments made by the
			   Austrian government under paragraphs 500 to 506 of the Austrian General Social
			   Insurance Act provided that the payments remain identifiable as such;
			   and
(viii) income equal to the
			   amount of a reduced pension pursuant to
			   38
			   U.S.C. 5503(f), for a
			   veteran's surviving spouse who receives such a pension; such income will count
			   toward the personal needs allowance described in paragraph (1) of this
			   subdivision.