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
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 360-4.9
Current through Register Vol. 46, No. 39, September 25, 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.
(b) For an institutionalized spouse, as defined in section 360-4.10(a)(7) of this Subpart, the deductions set forth in section 360-4.10(b)(4) of this Subpart and in paragraphs (a)(2) and (5) of this section will be made.
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.
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