reglab/statecodes huggingface dataset:
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 360-2 - Application Process › Section 360-2.3 - Investigation of eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			   Generally.
(1) The social services district
			   has a continuing obligation to collect, verify, record and evaluate factual
			   information concerning an MA applicant's/recipient's eligibility for
			   MA.
(2) The MA applicant/recipient
			   has a continuing obligation to provide accurate and complete information on
			   his/her income, resources, and other factors that affect eligibility. The
			   applicant/recipient must also provide information on the income and resources
			   of a nonapplying legally responsible relative, even if the relative is not
			   living with the applicant/recipient; if the applicant/recipient does not
			   possess this information, he/she must cooperate with the social services
			   district in obtaining it. An applicant/recipient will not have eligibility
			   denied or discontinued solely because he/she does not possess and cannot obtain
			   information about the income or resources of a nonapplying legally responsible
			   relative who is not living with him/her.
(3) The applicant/recipient is the primary
			   source of eligibility information. When an applicant/recipient is unable to
			   document the information provided, the social services district must conduct an
			   investigation to verify such information. The social services district must
			   also conduct such an investigation if it believes that information provided by
			   an applicant/recipient is inaccurate. The district may examine records, other
			   than public records, only with the applicant's/recipient's permission. If the
			   applicant/recipient refuses such permission and the social services district is
			   unable to verify information through public records, the applicant/recipient
			   will be informed that the district is unable to determine MA eligibility. The
			   application then will be denied, or eligibility will be discontinued.
(4) Part 351 of this Title sets forth
			   additional requirements which must be met in the investigation
			   process.
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 360-2 - Application Process › Section 360-2.4 - Decision

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Time frames.
(1) Except as provided in paragraphs (2) and
			   (3) of this subdivision, the social services district must determine an
			   applicant's eligibility for MA within 45 days of the date of the MA
			   application.
(2) If an applicant's
			   MA eligibility is dependent on disability status, the social services district
			   will determine MA eligibility within 90 days of application. If a decision is
			   not reached within 90 days, the applicant must be sent a statement explaining
			   why.
(3) The district will
			   determine eligibility within 30 days of the date of the MA application if an
			   applicant is:
(i) a pregnant woman or an
			   infant younger than one year of age whose household income does not exceed 200
			   percent of the applicable Federal poverty level.
(ii) a child at least one year of age but
			   younger than 19 years of age whose household income does not exceed 133 percent
			   of the applicable Federal poverty level.
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 360-2 - Application Process › Section 360-2.5 - Notification of acceptance/denial

Current through Register Vol. 46, No. 28, July 10, 2024
The social services district must notify applicants
				promptly on State-prescribed forms of MA eligibility decisions.
(a) Notice of acceptance. The social services
			   district will provide eligible applicants with a notice on a State-prescribed
			   form accepting the MA application. The notice will explain what MA care and
			   services are authorized. It must also list any limitations. The notice must
			   clearly indicate when only part of the cost of a particular service will be
			   allowed. If an applicant is liable for part of the cost of care, the district
			   will supply information on allowed costs to the applicant's service
			   provider.
(b) Notice of denial. The
			   social services district must provide ineligible applicants with a notice on a
			   State-prescribed form denying the application. The notice of denial must be
			   adequate, as defined in section
			   358-2.2  of this
			   Title.
(c) If an applicant is
			   denied MA on the basis of a denial of an application for ADC or HR, a single
			   notice may be sent advising the applicant of both determinations. The notice
			   must separately and adequately advise the applicant of the determination of MA
			   ineligibility.
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 360-2 - Application Process › Section 360-2.6 - Changes in circumstances affecting classification or eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If an MA
			   recipient's circumstances change, the social services district must take action
			   within 30 days to:
(1) change the recipient's
			   classification, when the change affects Federal financial
			   participation;
(2) discontinue
			   eligibility, when the change affects the recipient's eligibility; or
(3) provide the proper category of
			   assistance, when the change affects the recipient's category of
			   assistance.
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 360-2 - Application Process › Section 360-2.7 - Termination of MA; notification of discontinuance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When a social services district
			   determines that a recipient is no longer eligible for MA, MA will be
			   terminated. The effective date of discontinuance will be the date the recipient
			   becomes ineligible, or a later date if necessary in order to provide the
			   recipient with timely notice of the discontinuance, as required by section
			   358-3.3  of
			   this Title. Except as limited by the provisions of this subdivision, the
			   effective date of discontinuance may be any day during the month.
(b) The social services district must send a
			   notice of discontinuance on a State-prescribed form to an MA recipient if it
			   determines that the recipient has become ineligible for MA. The notice of
			   discontinuance must be adequate, as defined in section
			   358-2.2  of this
			   Title.
(c) If the recipient's MA
			   benefits are being stopped for the same reason that his/her ADC or HR benefits
			   are being stopped a single notice may be sent advising the recipient of both
			   actions. The notice must separately and adequately advise the recipient of the
			   proposed discontinuance of MA.
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 360-2 - Application Process › Section 360-2.8 - Right to a conference

Current through Register Vol. 46, No. 28, July 10, 2024
An MA applicant/recipient who disagrees with a decision
				of the social services district concerning his/her case may request a
				conference, as described in Part 358 of this Title. At the conference the
				applicant/recipient will meet with a district representative having the
				authority to change the district's decision. The district representative will
				review the district's decision, answer any questions the applicant/recipient
				has, and will consider any information the applicant/recipient presents. A
				request for a conference is not a request for a fair hearing and does not
				entitle the applicant/recipient to aid continuing pending the outcome of the
				conference. The applicant/recipient may still request a fair hearing, even if a
				conference has been requested. However, the deadline for requesting a fair
				hearing will remain the same whether or not a conference is
				requested.
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 360-2 - Application Process › Section 360-2.9 - Right to a fair hearing

Current through Register Vol. 46, No. 28, July 10, 2024
An MA applicant or recipient may request a fair hearing
				if he/she disagrees with a social services official's decision, action or
				failure to act. A fair hearing is the procedure which an applicant or recipient
				can use to appeal certain decisions of a social services district to the State
				Commissioner of Social Services. A complete explanation of how to request a
				fair hearing, the grounds for requesting a fair hearing, and the fair hearing
				process is found in Part 358 of this Title.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
This Subpart contains:
(a) the conditions of MA
			   eligibility;
(b) categories of
			   persons eligible for MA;
(c)
			   categories of persons who may not receive MA;
(d) conditions under which temporary
			   residents of the State can receive MA and conditions under which State
			   residents absent from their social services districts can receive MA;
(e) conditions under which certain
			   hospitalized persons will be granted up to 60 days of presumptive MA
			   eligibility; and
(f) eligibility
			   requirements for catastrophic illness benefits for persons not otherwise
			   eligible for MA.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.2 - Conditions of eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
All applicants for and recipients of MA must meet their
				requirements in this section to be eligible for MA.
(a) Applicants/recipients must assign to the
			   department:
(1) any rights to payment for
			   medical care from a third party; and
(2) rights to support specified by a court or
			   administrative order to be used for medical care.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.3 - Who is eligible for MA

Current through Register Vol. 46, No. 28, July 10, 2024
Generally, an applicant is eligible for MA if he/she
				meets the conditions listed in section
				360-3.2 
				of this Subpart and belongs to one of the groups listed below:
(a) Persons who are categorically needy. An
			   applicant is categorically needy if:
(1)
			   he/she is eligible for or receiving HR; or
(2) he/she is eligible for or receiving ADC;
			   or
(3) he/she is eligible for or
			   receiving SSI and/or State supplementary payments; or
(4) he/she is a child receiving foster care
			   maintenance payments under title IV-E of the Social Security Act and living in
			   the State; or
(5) he/she is a child
			   living in the State on whose behalf an adoption assistance agreement is in
			   effect under title IV-E of the Social Security Act, whether or not adoption
			   assistance payments are provided for under the agreement or are being made
			   pursuant to title IV-E; or
(6)
			   he/she is an adopted child under age 21 provided that:
(i) there is a legally executed adoption
			   assistance agreement in place between an authorized agency and the adoptive
			   parents (other than an adoption assistance agreement subject to the provisions
			   of title IV-E of the Social Security Act);
(ii) the child has a special need for medical
			   or rehabilitative care that would have precluded placement with adoptive
			   parents unless MA were provided to the child; and
(iii) the child was in receipt of MA in the
			   three-month period prior to the adoption agreement being entered into, or the
			   child would have been eligible for MA during such period if only the child's
			   own income and resources were considered in determining eligibility.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.4 - Who is excluded from receiving MA

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A person may not receive MA if he/she is:
(1) a resident of a public institution, as
			   defined in section
			   360-1.4(1) 
			   of this Part unless the public institution is:
(i) an emergency shelter for the homeless, in
			   which case MA is available:
(a) to persons
			   eligible for or receiving HR; and
(b) to medically needy aged, certified blind
			   or certified disabled applicants/recipients for up to six months in any period
			   of nine consecutive months;
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.5 - MA for State residents outside their district of residence

Current through Register Vol. 46, No. 28, July 10, 2024
State residents who are outside their district of
				residence at the time of application or after eligibility is established will
				be provided MA under certain circumstances. The applicant/recipient must be in
				the United States, the Commonwealth of Puerto Rico, the Virgin Islands, Guam or
				Canada. MA will be provided to the same extent as it is to eligible persons
				within the district if:
(a) residents
			   of the district customarily use medical facilities in the other district, state
			   or area; or
(b) there are limited
			   medical services available in the district of residence and the social services
			   district gives prior approval; or
(c) emergency medical attention is needed as
			   a result of accident or sudden illness.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.6 - Eligibility of persons temporarily in the State

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A person who is not a State resident but
			   is temporarily in the State and requires immediate medical care not otherwise
			   available, will be eligible for MA if:
(1) the
			   person did not enter the State solely to obtain such medical care;
			   and
(2) the person applies for MA
			   and meets the eligibility requirements except for State residence, United
			   States citizenship, or status as an alien permanently residing in the United
			   States under color of law.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.7 - Presumptive eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any
			   person applying for MA will be presumed eligible for such assistance for a
			   period of up to 60 days from the date of transfer from a general hospital to a
			   certified home health agency or long term home health care program if:
(1) the applicant is receiving acute care in
			   such hospital;
(2) a physician
			   certifies that the applicant no longer requires acute hospital care, but still
			   requires medical care which can be provided by a certified home health agency
			   or a long term home health care program;
(3) the applicant or his/her representative
			   states that the applicant does not have insurance coverage for the required
			   medical care and that such care cannot be afforded;
(4) it reasonably appears that the applicant
			   is eligible for MA; and
(5) it
			   reasonably appears that the amount expended by the department and the social
			   services district for care and services provided by a certified home health
			   agency or long term home health care program during the period of presumed
			   eligibility would be less than the amount which would be expended for continued
			   acute hospital care.
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 360-3 - ELIGIBILITY REQUIREMENTS › Section 360-3.8

Current through Register Vol. 46, No. 28, July 10, 2024
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 360-4.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To be eligible
			   for MA under section
			   360-3.3(b) 
			   of this Part as a medically needy person, or to have MA eligibility extended
			   under some provisions of section
			   360-3.3(c) 
			   of this Part, a person must meet certain financial requirements. A person who
			   meets these requirements is financially eligible for MA. This Subpart explains
			   procedures and principles used to determine financial eligibility.
(b) How the process works.
(1) Except as provided in paragraph (2) of
			   this subdivision, financial eligibility will be determined as follows:
(i) The size of the applicant's/recipient's
			   MA household will be determined.
(ii) All income and resources available to
			   the applicant/recipient during the period for which eligibility is being
			   determined will be identified.
(iii) Certain amounts and types of income and
			   resources will be disregarded. The remainder is the applicant's/recipient's net
			   available income and resources.
(iv) The applicant's/recipient's net
			   available income and resources will be compared to the eligibility standards
			   for his/her MA household size. The applicant/recipient is financially eligible
			   if the amounts of his/her net available income and resources do not exceed the
			   appropriate standards. A financially eligible applicant who also meets all
			   other eligibility requirements will be eligible to receive MA.
(v) An applicant whose net available
			   resources are above the resource standards will be ineligible for MA until
			   he/she incurs medical expenses equal to or greater than the excess
			   resources.
(vi) Generally, an
			   applicant whose net available income is above the income standard for his/her
			   MA household size will be ineligible for MA until he/she incurs medical
			   expenses equal to or greater than the excess income.
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 360-4.2 - Size of MA household

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
			   needy individuals under 21, pregnant women, persons ineligible for ADC solely
			   because their incomes and resources exceed ADC eligibility standards, and
			   parents described in section
			   360-3.3(b) 
			   of this Part, an MA household is all MA applicant(s)/recipient(s) who live
			   together in a single dwelling who apply for or receive MA as a unit, and any
			   legally responsible relative who does not receive HR. ADC, or SSI and resides
			   with an applicant/recipient. Any person who receives HR, ADC, or SSI will not
			   be included as a member of an MA household, and the income and resources of
			   such a person will not be considered when social services districts determine
			   the MA eligibility of the applicant(s)/recipient(s).
(b) For adults who are aged, certified blind
			   or certified disabled, an MA household is the aged, blind or disabled person
			   and his or her spouse who lives with him or her if the spouse is:
(1) also aged, certified blind or certified
			   disabled, or
(2) has remaining
			   income after allocation which is equal to or greater than the difference
			   between the medically needy income standard for one, and the medically needy
			   income standard for two. For other aged, certified blind or certified disabled
			   adults who live with their spouses, an MA household consists of one person for
			   income purposes, but consists of two persons for resource purposes. For all
			   other aged, certified disabled, or certified blind applicant(s)/recipient(s),
			   an MA household consists of one person.
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 360-4.3 - Available income

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Available
			   income of an MA applicant/recipient will be determined as follows:
(1) All earned and unearned income received
			   during the month will be considered. In determining the amount of earned and
			   unearned income, allowable business expenses will be deducted, as described in
			   subdivisions (c) and (d) of this section.
(2) Certain types of in-kind income will be
			   deducted as described in subdivision (e) of this section.
(3) Income deemed available from legally
			   responsible relatives will be added, as described in subdivision (f) of this
			   section.
(4) Income allocated to
			   dependent family members will be deducted. The amount remaining after the
			   calculations in paragraphs (1) through (4) of this subdivision are made, is the
			   applicant's/recipient's available income.
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 360-4.4 - Available resources

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			   Resources means property of all kinds, including real and personal property. It
			   includes both tangible and intangible property.
(b) An applicant's/recipient's available
			   resources include:
(1) all resources in the
			   control of the applicant/recipient. It also includes any resources in the
			   control of anyone acting on the applicant's/recipient's behalf such as a
			   guardian, conservator, representative or committee;
(2) certain resources transferred for less
			   than fair market value, as explained in subdivision (c) of this
			   section;
(3) all or part of the
			   equity value of certain income-producing property, as explained in subdivision
			   (d) of this section;
(4) certain
			   resources of legally responsible relatives, as explained in section
			   360-4.3(f) 
			   of this Subpart; and
(5) certain
			   resources of an MA-qualifying trust, as explained in section 360- 4.5 of this
			   Subpart.
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 360-4.5 - Availability of assets held in trust

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Inter vivos trusts created before August
			   11, 1993. In determining the initial or continuing eligibility of any person
			   applying for or receiving MA, there must be included in the amount of income
			   and resources considered available to such person the maximum amount of
			   payments that may be permitted to be distributed under the terms of an
			   MA-qualifying trust, assuming the full exercise of discretion by the trustee or
			   trustees. For purposes of this subdivision, an MA-qualifying trust is a trust
			   or similar legal device established by a person or by his/her spouse (the
			   grantor or grantors) other than by will, under which the grantor may be the
			   beneficiary of all or part of the payments from the trust and under which one
			   or more trustees are permitted to exercise any discretion with respect to the
			   distribution to the grantor.
(1) This section
			   applies without regard to:
(i) whether the
			   MA-qualifying trust is irrevocable or is established for purposes other than to
			   enable a grantor to qualify for MA; or
(ii) whether the trustee actually exercise
			   discretion with respect to the distribution of payments to the
			   grantor.
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 360-4.7 - Standard exemptions

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Resources.
All resources available to the household of a pregnant
				woman, an infant younger than one year of age, a child at least one year of age
				but younger than six years of age whose household income does not exceed 133
				percent of the applicable Federal poverty line set forth in section
				360-4.7(b)  of
				this Subpart, or a child born after September 30, 1983 who is at least six
				years of age but younger than 19 years of age and whose household income does
				not exceed 100 percent of the applicable Federal poverty line set forth in
				section 360-4.7(b)  of
				this Subpart, are exempt from consideration in determining whether such
				pregnant woman, infant, or child is medically needy. The following resources
				are exempt from consideration in determining whether any other MA
				applicant/recipient is medically needy:
(1) a homestead which is essential and
			   appropriate to the needs of the household. Homestead is defined in section
			   360-1.4(f)  of
			   this Part.
(i) For persons under 21 years of
			   age and persons ineligible for ADC solely because their income and resources
			   are above eligibility limits, a homestead loses its exempt status if the owner
			   is in a medical facility in permanent absent status, as defined in section
			   360-1.4(k)  of
			   this Part, and no spouse, child under 21 years of age, certified blind or
			   certified disabled child, or other dependent relative is living in the
			   home.
(ii) For persons who are 65
			   years of age or older, certified blind or certified disabled, a homestead loses
			   its exempt status if the owner moves out of the home without the intent to
			   return, and no spouse, child under 21 years of age, certified blind or
			   certified disabled child, or other dependent relative is living in the
			   home.
(iii) As set forth in section
			   360-4.4(c)(2)  of
			   this Part, transfers of homesteads to certain persons may result in
			   ineligibility for MA coverage of certain care, services, and supplies,
			   including nursing facility services.
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 360-4.8 - Determination of financial eligibility; effect of excess income and resources on eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			   Financial eligibility.
(1) Except as provided
			   in paragraphs (2), (3), (4) and (5) of this subdivision, an applicant/recipient
			   is financially eligible for MA if his or her net available income and net
			   available resources do not exceed the appropriate standards. The standards are
			   found in section
			   360-4.7  of
			   this Subpart.
(2)
(i) A pregnant woman is financially eligible
			   for MA if her net available income does not exceed the highest of the following
			   three items: the applicable MA standard; the applicable PA standard of need; or
			   100 percent of the applicable poverty line listed in section
			   360-4.7(b) 
			   of this Subpart.
(ii) A pregnant
			   woman is financially eligible for comprehensive prenatal care services
			   available under the Prenatal Care Assistance Program, as listed in Public
			   Health Law, section 2522, if her net available income exceeds
			   the highest of the three items listed in subparagraph (i) of this paragraph but
			   does not exceed 185 percent of the applicable poverty line listed in section
			   360-4.7(b) 
			   of this Subpart.
(3) An
			   infant younger than one year of age is financially eligible for MA if his or
			   her net available household income does not exceed 185 percent of the
			   applicable Federal poverty line set forth in section
			   360-4.7(b) 
			   of this Subpart.
(4) A child at
			   least one year of age but younger than six years of age is financially eligible
			   for MA if his or her net available household income does not exceed 133 percent
			   of the applicable Federal poverty line set forth in section 360-47(b) of this
			   Subpart.
(5) A child born after
			   September 30, 1983 who is at least six years of age but younger than 19 years
			   of age is financially eligible for MA if his or her net available household
			   income does not exceed 100 percent of the applicable Federal poverty line set
			   forth in section
			   360-4.7(b) 
			   of this Subpart.
(6)
			   Applicants/recipients who are financially eligible under paragraphs (1) through
			   (5) of this subdivision will be authorized to receive MA if they also meet the
			   nonfinancial eligibility requirements. The nonfinancial eligibility
			   requirements are found in Subpart 360-3 of this Part.
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 360-5 - Eligibility Based On Disability › Section 360-5.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
This Subpart sets forth requirements relating to the
				determination of MA eligibility based on disability status, and defines terms
				used in the disability determination process.
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 360-5 - Eligibility Based On Disability › Section 360-5.3 - Medical criteria for disability determination

Current through Register Vol. 46, No. 28, July 10, 2024
The medical criteria to be used in determining
				disability for MA eligibility is the same medical criteria set forth in Federal
				regulations for determining disability for social security and SSI
				purposes.
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 360-5 - Eligibility Based On Disability › Section 360-5.4 - Reapplication

Current through Register Vol. 46, No. 28, July 10, 2024
Reapplication for MA as disabled is processed as any
				other reapplication.
(a) When an
			   individual reapplies after he/she has been certified as disabled by an MA-only
			   disability review team, group I or group II, and his/her case is closed for
			   reasons unrelated to a change in disability (e.g., increased pension or other
			   benefits), there is no need for a disability review team evaluation unless:
(1) 12 months or more have elapsed since date
			   of last case closing;
(2) the
			   individual has, in the interim, engaged in a useful occupation; and
(3) the individual has, in the interim, had a
			   significant change in treatment such as major surgery, a stay in a
			   rehabilitation center or a period of diagnostic hospitalization.
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 360-5 - Eligibility Based On Disability › Section 360-5.5 - Examination

Current through Register Vol. 46, No. 28, July 10, 2024
The cost of examinations, consultations, completion of
				medical forms, and tests requested by MA-only disability review teams must be
				paid by the local agency. Reimbursement is available for these services as an
				administrative expense in accordance with section
				609.5(b) 
				of this Title.
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 360-5 - Eligibility Based On Disability › Section 360-5.6 - Grandfathered cases

Current through Register Vol. 46, No. 28, July 10, 2024
Recipients of MA only who were determined disabled
				under the AABD program (prior to January 1, 1974) will continue to be
				considered disabled for MA purposes as long as there is no break in their
				eligibility for the program. Recipients determined disabled prior to January 1,
				1974 as a group II, upon review, must have their continuing eligibility
				determined based on the medical criteria in effect at the time of the initial
				review.
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 360-5 - Eligibility Based On Disability › Section 360-5.7 - Pending of disability cases

Current through Register Vol. 46, No. 28, July 10, 2024
Disability status must be determined within 90 days of
				the date of application. This time standard applies except in unusual
				circumstances (e.g., where the agency cannot reach a decision because of
				failure or delay on the part of the applicant or an examining physician, or
				because of some administrative or other emergency that could not be controlled
				by the agency). This pending period for acting on applications or
				redeterminations of eligibility must not be used as a waiting period before
				granting MA. Furthermore, if it is necessary to pend a case beyond this 90-day
				period, this will not be a basis for denying MA to an applicant or for
				terminating assistance.
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 360-5 - Eligibility Based On Disability › Section 360-5.8 - Effective date of disability

Current through Register Vol. 46, No. 28, July 10, 2024
The effective date of disability must be established by
				the MA-only disability review team. Such date must be either the date on which
				the client met the disability criteria of this section, or three months prior
				to the month of application for MA only or public assistance if the
				applicant/recipient was disabled during this three-month
				period.
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 360-5 - Eligibility Based On Disability › Section 360-5.9 - Trial work period

Current through Register Vol. 46, No. 28, July 10, 2024
Persons determined to be disabled may be entitled to a
				trial work period during which they retain their disability status.
(a) Definition of services. For the purposes
			   of this section, the term services means activity in employment or
			   self-employment which is performed for remuneration or gain or is determined to
			   be a type normally performed for remuneration or gain. Inasmuch as the trial
			   work provision is intended to give a disabled beneficiary the opportunity to
			   test his/her ability to work and hold a job, minor work activity may generally
			   be disregarded. Therefore, work activity in employment in a month will
			   constitute services only if it is actually or usually performed for
			   remuneration or gain amounting to more than $50, either in cash or in-kind.
			   Work activity in self-employment will be determined to be services only where
			   net earnings in a calendar month are more than $50 for a month or the
			   self-employed person spends more than 15 hours in that month in the work
			   activity. In some self-employed cases, it may not be possible to isolate from
			   the total net earnings the net earnings for each particular month of
			   self-employment. When this occurs, divide the net earnings for the particular
			   work period by the months of self-employment to find net earnings per month.
			   Cases where remuneration for employment is in the form of commissions should be
			   handled in a similar manner.
(b)
			   Activity which does not constitute services for purpose of charging trial work
			   period months. Activity performed by a beneficiary for which payment in excess
			   of $50 a month is made does not constitute services if the activity, although
			   resembling services in employment for remuneration or gain, is:
(1) part of a prescribed program of medical
			   therapy;
(2) carried out in a
			   hospital under the supervision of medical and administrative staff;
(3) not performed in an employer-employee
			   relationship; or
(4) not normally
			   performed for remuneration or gain.
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 360-5 - Eligibility Based On Disability › Section 360-5.11 - Evaluation of disability

Current through Register Vol. 46, No. 28, July 10, 2024
Factors other than medical should be taken into
				consideration, where appropriate, in making a determination of disability
				status. These additional factors include the age of the individual, education
				and training, and previous work history. The determination of disability must
				encompass an evaluation of a combination of the individual's medical and social
				factors.
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 360-5 - Eligibility Based On Disability › Section 360-5.12 - Determination of blindness status

Current through Register Vol. 46, No. 28, July 10, 2024
The agency is responsible for the completion of all
				appropriate forms and the securing of medical evidence to be utilized in the
				determination of an applicant's/recipient's visual status. This material must
				be forwarded as expeditiously as possible to the Commission for the Blind and
				Visually Handicapped. The commission must make the determination of visual
				status. Notification will be returned to the agency.
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 360-6 - Entitlement To Medical Assistance › Section 360-6.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
This Subpart contains:
(a) the steps to be taken by the social
			   services district after finding an applicant eligible for MA;
(b) a description of the MA identification
			   card to be used in obtaining MA care and services;
(c) the right of a recipient to choose a
			   qualified provider of care and services;
(d) a description of where care and services
			   may be provided; and
(e)
			   restrictions of recipient utilization of care and services.
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 360-6 - Entitlement To Medical Assistance › Section 360-6.2 - Authorization for MA

Current through Register Vol. 46, No. 28, July 10, 2024
(a) When a
			   social services district finds an applicant eligible, it will prepare an
			   authorization for MA for the applicant and eligible applying members of the
			   applicant' s household. No initial authorization may be effective for more than
			   one year from the date of application. No reauthorization will be effective for
			   more than one year.
(b)
			   Identification cards.
(1) The department will
			   issue an MA identification card to every MA recipient with the exception of:
(i) persons residing in residential health
			   care facilities licensed pursuant to article 28 of the Public Health
			   Law;
(ii) persons residing in
			   developmental centers operated by the Office of Mental Retardation and
			   Developmental Disabilities;
(iii)
			   persons residing in psychiatric centers operated by the Office of Mental
			   Health;
(iv) persons residing in
			   residential treatment facilities required to have an operating certificate
			   issued by the Commissioner of Mental Health pursuant to section 31.02 (a)(4)  of the Mental
			   Hygiene Law; and
(v) foster care
			   children placed with authorized child care agencies, as defined in subdivision
			   10 of section 371  of the Social Services Law, that are
			   receiving MA per diem payments.
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 360-6 - Entitlement To Medical Assistance › Section 360-6.3 - Free choice by recipient guaranteed

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Once authorized, MA recipients are
			   entitled to obtain MA care and services from any provider enrolled in the MA
			   program who is both qualified and agrees to provide the care and services.
			   Exceptions to this provision are found in section
			   360-6.4 
			   of this Subpart.
(b)
(1) A social services district must offer to
			   persons eligible for MA the option of membership in any health maintenance
			   organization or other entity which offers comprehensive health services plans
			   to persons residing within the district. This option must be provided unless
			   the district is granted a waiver by the commissioner on the grounds that the
			   organization or entity is not geographically accessible to eligible recipients
			   who reside within the district, the capitation rate is above the expected
			   average fee-for-service cost within the district, or the entity refuses to
			   enter into a contract with the district.
(2) Persons who, prior to becoming eligible
			   for MA, are enrolled in a health maintenance organization or other entity
			   offering a comprehensive health services plan must be offered the option of
			   continuing that enrollment.