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 360-7 - Payment For Services
Section 360-7.11 - Medical assistance liens and recoveries
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 360-7.11
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Liens. The social services district may not impose any lien against a person's property prior to his or her death for MA paid or to be paid on his or her behalf except:
(1) based upon a court judgment for benefits
incorrectly paid; or
(2) against
claims and suits for personal injuries, to recover the amount of MA furnished
to a person on and after the date the person incurred the injuries;
or
(3) with respect to the real
property of a person who is an in-patient in a nursing facility, intermediate
care facility for the mentally retarded, or other medical institution, and who
is not reasonably expected to be discharged from the medical institution and
return home, provided that:
(i) any such lien
will dissolve upon the person's discharge and return home; and
(ii) no lien may be imposed on the person's
home if the person's spouse, child under 21 years of age, certified blind or
certified disabled child of any age, or sibling who has an equity interest in
the home and who resided in the home for at least one year immediately before
the date of the person's admission to the medical institution, is lawfully
residing in the home.
(b) Adjustments and recoveries.
(1) A social services district may make no
adjustment or recovery for MA correctly paid except from:
(i) the estate of a person who was 65 years
of age or older when he or she received MA; or
(ii) the sale of real property subject to a
lien imposed pursuant to paragraph (a)(3) of this section, or from the estate
of such a person; or
(iii) a
legally responsible relative of an MA recipient, and then only the amount of MA
granted, provided the relative has sufficient income and resources which he or
she fails or refuses to make available. The amount of income and resources
required to be contributed by a legally responsible relative is determined
under Subpart 360-4 of this Part.
(2) An adjustment or recovery under
subparagraph (1)(i) or (ii) of this subdivision may be made from a person's
estate only after the death of the person's surviving spouse, and only when the
person has no surviving child who is under 21 years of age or who is certified
blind or certified disabled.
(3) In
addition to the limitations set forth in paragraph (2) of this subdivision, in
the case of a lien on a person's home, no adjustment or recovery may be made
when:
(i) a sibling of the person resided in
the home for at least one year immediately before the date of the person's
admission to the medical institution, and has lawfully resided in the home on a
continuous basis since the date of admission; or
(ii) a child of the person resided in the
home for a period of at least two years immediately before the date of the
person's admission to a medical institution, provided care to such person which
permitted the person to reside at home rather than in an institution, and has
lawfully resided in the home on a continuous basis since the date of
admission.
(4) A social
services district may maintain an action pursuant to sections 101 and
104 of the Social Services Law to collect
from a trustee, grantor, or grantor's spouse any beneficial interest of the
grantor or grantor's spouse in any trust established other than by will, to
reimburse such district for the amount of MA granted to, or on behalf of, a
grantor or grantor's spouse. The beneficial interest of the grantor or
grantor's spouse includes any income and principal amounts to which the grantor
or grantor's spouse would be entitled under the terms of the trust, by right or
in the discretion of the trustee, assuming the full exercise of discretion by
the trustee.
(5) If an MA recipient
receives an insurance settlement for personal injuries which includes an amount
for medical bills, the social services district may recover from such amount
the cost of MA provided for the treatment of the injuries.
(6) A social services district may maintain
an action under the Debtor and Creditor Law to set aside any transaction which
appears to have been made for the purpose of qualifying a person for MA or for
avoiding a lien or recovery of MA paid on behalf of an MA recipient.
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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