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 360-2.2 - Applying for MA
Universal Citation: 18 NY Comp Codes Rules and Regs § 360-2.2
Current through Register Vol. 47, No. 12, March 26, 2025
(a) ADC and HR applicants.
Persons applying for ADC or HR on the State-prescribed form are not required to make a separate application for MA.
(1) Persons determined to be eligible for ADC
or HR are automatically eligible for MA if they meet the general conditions for
MA eligibility in section
360-3.2 of this Part.
(2) Persons determined to be ineligible for
ADC or HR will have their MA eligibility determined separately, unless they
have stated in writing that they do not want their MA eligibility
determined.
(b) SSI applicants.
(1) Persons
determined to be eligible for SSI from the Social Security Administration are
automatically eligible for MA if they meet the general conditions for MA
eligibility in section
360-3.2 of this Part. No separate
application for MA is required.
(2)
Persons determined to be ineligible for SSI must make a separate application if
they wish to have MA eligibility determined, assuming they have not already
done so.
(c) Title IV-E children.
(1) A child receiving
foster care maintenance payments pursuant to title IV-E of the Social Security
Act or on whose behalf a title IV-E adoption assistance agreement is in effect
is automatically eligible for MA. The child must be living in the state and
meet the general conditions of MA eligibility in section
360-3.2 of this Part. No separate
application for MA is required.
(2)
If a child is determined ineligible under title IV-E, a separate application
must be made in order to have MA eligibility determined, assuming this has not
already been done.
(d) Application for MA only.
(1)
Persons may apply for MA without applying for ADC, HR, or SSI. Persons may also
apply for MA separately from an application for SSI. Such applicants must
complete and sign a State-prescribed form in ink. Spouses living together and
applying for MA together must both sign the State-prescribed application form.
The form may be completed and signed by anyone the applicant designates to
represent him/her in the application process. The completed form must be
returned to the social services district in the county in which the applicant
lives.
(2)
(i) HR eligibility will be determined for MA
applicants who:
(a) are not eligible under
the assistance programs listed in section
360-3.3(a)(2)-(6)
of this Part; and
(b) do not meet
the requirements, other than financial, for medically needy status in section
360-3.3(b) of
this Part.
(ii)
Generally, eligibility for MA on the basis of HR eligibility will be determined
according to Parts 352 and 370 of this Title. Exceptions to this general rule
are set forth below.
(a) A homestead, as
defined in section
360-1.4(f) of
this Part, is exempt from consideration in determining eligibility.
(b) Lump-sum and windfall payments will be
counted as income in the month received. Any portion of such payments remaining
in subsequent months will be counted as an available resource.
(c) A child's savings account of under $500
accumulated from gifts from nonlegally responsible relatives or from the
child's own wages will be disregarded in determining eligibility.
(d) The provisions of section
352.23(b)(6) of
this Title regarding the sale of real property do not apply. If the value of
the total resources of the applicant/recipient is over the maximum resource
level, the applicant/recipient will be ineligible for MA.
(e) Recertification.
Social Services districts must redetermine an MA recipient's eligibility at least once every 12 months and whenever there is a change in the recipient's circumstances that may affect eligibility. The district may redetermine eligibility more frequently.
(1) MA recipients who are not eligible for
ADC, HR, SSI, title IV-E, or the adoption assistance benefits described in
section 360-3.3(a)(6) of
this Part must apply for recertification on a State-prescribed form each time
MA eligibility is redetermined.
(2)
MA recipients who are eligible for ADC, HR, SSI, title IV-E, or the adoption
assistance benefits described in section
360-3.3(a)(6) of
this Part will continue to be eligible for MA as long as they are eligible
under the other program. No application for recertification is required when MA
eligibility is redetermined.
(f) Personal interview for applicants and recipients.
(1) The social services
district must conduct a personal interview with anyone applying for MA or for
recertification of MA, except as provided in paragraphs (2) and (3) of this
subdivision. If the applicant/recipient cannot be interviewed due to his/her
physical or mental condition, the person who applied on his/her behalf must be
interviewed. The district must conduct the interview before making any decision
concerning an applicant's/recipient's eligibility for MA. The district does not
have to conduct a personal interview when the application for MA is made on
behalf of a child in the custody of the State Division for Youth or of a local
commissioner of social services. At the interview, an applicant/recipient or
his/her representative must be told about the following:
(i) the general eligibility requirements of
the MA program;
(ii) the
applicant's/recipient's responsibility to provide all information necessary to
determine eligibility;
(iii) the
applicant's/recipient's and the social services district's responsibility to
explore all the facts concerning the applicant's/recipient's
eligibility;
(iv) the kinds of
information or documents the applicant/recipient must provide to show
eligibility, the time when the information and documents must be submitted, and
the applicant's/recipient's responsibility to obtain information or documents
whenever possible;
(v) the social
services district's responsibility to undertake necessary investigation to
determine the applicant's/recipient's eligibility;
(vi) the applicant's/recipient's
responsibility to inform the district immediately of all changes in
circumstances; and
(vii) the
availability of other assistance or services for which the applicant/recipient
may be eligible.
(2)
(i) Social services districts may request a
waiver of the personal interview requirement for recertification for aged,
certified blind or certified disabled recipients. The request must be sent in
writing, by certified mail, to the State Commissioner of Social Services. The
request must state the intended duration of the waiver and other conditions the
local social services commissioner finds relevant. The local social services
commissioner must sign the request. A waiver request may be granted if the
social services district demonstrates that alternative procedures have been
established to verify that recipients continue to meet all eligibility
requirements for MA. The department may require follow-up reports from the
social services district to insure that continuing eligibility is being
accurately determined. The waiver may be withdrawn or modified, if, through the
department's monitoring efforts, it is determined that the statewide medical
assistance eligibility error rate may be adversely affected.
(ii) The local social services official will
be notified in writing within 45 days of the approval, partial approval or
denial of the waiver. If the waiver is denied, the department will inform the
district of the reasons for the denial. The department's failure to act within
the specified time period does not constitute an automatic approval of the
waiver.
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