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 ยง 360-2.2
Current through Register Vol. 46, No. 39, September 25, 2024
(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.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
