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 360-5.10 - Medically determined drug addicts and alcoholics

(a) For the purposes of MA disability, an individual will be medically determined to be a drug addict or alcoholic only if he/she is under a disability in accordance with section 360-5.3 of this Subpart, and drug addiction and alcoholism is a contributing factor to a finding of disability. An individual who is under a disability independent of his/her drug addiction or alcoholism will not be medically determined to be a drug addict or alcoholic, for the purpose of MA disability.

(b) Treatment required for medically determined drug addicts and alcoholics. No disabled person will be categorically eligible for MA if he/she is medically determined to be a drug addict or alcoholic, unless he/she is undergoing treatment that is appropriate for his/her condition as a drug addict or alcoholic at an approved institution or facility, so long as such treatment is available and the person demonstrates that he/she is complying with the terms, conditions and requirements of such treatment.

(c) What constitutes appropriate treatment. Appropriate treatment is a recognized medical or other professional procedure for the individual's condition as a drug addict or alcoholic and carried out at, or under the supervision of, an approved treatment facility. This treatment may include medical examination and treatment, psychiatric, psychological and vocational counselling, or other appropriate services. It may be furnished through one or more facilities as part of an individualized treatment plan intended to insure that the individual is receiving treatment appropriate to his/her specific needs.

(d) Institutions or facilities which can provide this treatment. An institution or facility that furnished medically recognized treatment for drug addiction or alcoholism, and is licensed to operate such a program by the State, is approved to provide treatment. This definition includes, but is not limited to, Division of Substance Abuse Services facilities and alcoholic services from the Department of Mental Hygiene.

(e) Availability of treatment. Whether treatment is available to a particular individual depends on the existence of an obtainable treatment vacancy in an approved institution or facility; the condition and circumstances of the individual; the treatment required and the location of the treatment institution or facility, or the services or resources provided by the institution or facility. In determining the availability of treatment, consideration will also be given to the individual's general health, including his/her mobility and capacity to comprehend the essential specification of appropriate treatment, and also the availability and cost of public and private transportation. If an individual is not undergoing treatment for drug addiction or alcoholism because he/she is required to pay therefor at the time of his/her application, and no appropriate facility providing appropriate treatment is available to him/her without charge, such individual will not be categorically ineligible for MA only for the reasons of his/her failure to undergo appropriate treatment. If it is the agency's opinion, based on the above criteria, that treatment is not feasible for a particular individual, this individual would be exempt from required treatment in order to maintain his/her disability status.