2006 New York Code - Applications For Assistance; Investigations; Reconsideration.

 
    § 366-a. Applications for assistance; investigations; reconsideration.
  1.  Any  person  requesting  medical  assistance  may  make  application
  therefor in person, through another in his behalf  or  by  mail  to  the
  social  services official of the county, city or town, or to the service
  officer of the city or town in which the applicant resides or is  found.
  In  addition,  in the case of a person who is sixty-five years of age or
  older and is a patient in a state hospital for tuberculosis or  for  the
  mentally  disabled,  applications  may be made to the department or to a
  social services official designated as  the  agent  of  the  department.
  Notwithstanding any provision of law to the contrary, in accordance with
  department  regulations, when an application is made by mail, a personal
  interview shall be conducted with the applicant or with the  person  who
  made  application in his behalf when the applicant cannot be interviewed
  due to his physical or mental condition.
    2. (a) Upon  receipt  of  such  application,  the  appropriate  social
  services  official,  or  the  department of health or its agent when the
  applicant is a patient in a state hospital for  the  mentally  disabled,
  shall  verify  the eligibility of such applicant. In accordance with the
  regulations of the department of health, it shall be the  responsibility
  of  the applicant to provide information and documentation necessary for
  the  determination  of  initial  and  ongoing  eligibility  for  medical
  assistance.  If an applicant or recipient is unable to provide necessary
  documentation,  the  public  welfare  official  shall  promptly cause an
  investigation to be made. Where an investigation is  necessary,  sources
  of  information  other  than  public records will be consulted only with
  permission of the  applicant  or  recipient.  In  the  event  that  such
  permission  is  not  granted by the applicant or recipient, or necessary
  documentation cannot be obtained, the social services  official  or  the
  department of health or its agent may suspend or deny medical assistance
  until  such  time  as  it  may  be  satisfied  as  to the applicant's or
  recipient's  eligibility  therefor.  To  the  extent  practicable,   any
  interview conducted as a result of an application for medical assistance
  shall  be  conducted  in  the  home  of the person interviewed or in the
  institution in which such person is receiving medical assistance.
    (b)  Notwithstanding  the  provisions  of  paragraph   (a)   of   this
  subdivision,  an  applicant or recipient may attest to the amount of his
  or her accumulated resources, unless  such  applicant  or  recipient  is
  seeking  medical  assistance  payment  for  long term care services. For
  purposes of this paragraph, long term care  services  shall  mean  care,
  treatment,  maintenance,  and  services  described  in  paragraph (b) of
  subdivision 1 of section three hundred sixty-seven-f of this title, with
  the  exception  of  short  term  rehabilitation,  as  defined   by   the
  commissioner of health.
    (c)  The  commissioner  of  health  may  verify  the  accuracy  of the
  information provided by the applicant or recipient pursuant to paragraph
  (b) of this subdivision, by matching it against information to which the
  commissioner of health has access, including under subdivision eight  of
  this  section.  In  the  event  there  is  an  inconsistency between the
  information reported by the applicant or recipient and  any  information
  obtained  by  the  commissioner  of  health  from other sources and such
  inconsistency  is  material  to  medical  assistance  eligibility,   the
  commissioner  of  health  shall  request that the applicant or recipient
  provide adequate documentation to verify his or her resources.
    3. Upon the receipt of such application, and after the  completion  of
  any investigation that shall be deemed necessary, the appropriate public
  welfare official, or the department or its agent when the applicant is a
  patient  in  a  state  hospital  for  tuberculosis  or  for the mentally
  disabled, shall
    (a) decide whether the applicant is eligible for  and  should  receive
  medical  assistance,  the  amount thereof and the date on which it shall
  begin, which shall be  the  date  of  the  application  or,  subject  to
  applicable  department regulations, such earlier or later date as may be
  deemed reasonable;
    (b)  notify  the  applicant in writing of the decision, and where such
  applicant is found eligible, provide a tamper  resistant  identification
  card  containing  a  photo  image  of  the applicant for use in securing
  medical  assistance  under  this  title  provided,  however,   that   an
  identification  card  need  not  contain a photo image of a person other
  than an adult  member  of  an  eligible  household  or  a  single-person
  eligible household. The department is not required to provide, but shall
  seek  practical  methods  for  providing,  a card with such picture to a
  person when such person is homebound or is a resident of  a  residential
  health  care  facility,  or  an  in-patient  psychiatric facility, or is
  expected to remain hospitalized for an extended period. The commissioner
  shall have the authority to define categories of recipients who are  not
  required  to  have  a photo identification card where such card would be
  limited, unnecessary or impracticable.
    (c) with respect to a person determined eligible for assistance  under
  this  title  by  the  federal  social  security  administration under an
  agreement between the department and the secretary of health,  education
  and  welfare  pursuant  to  section  three hundred sixty-three-b of this
  title issue a medical assistance  identification  card  which  shall  be
  valid  for periods determined by the local social services official, but
  not to exceed six months.
    4. Every applicant or  recipient  shall  promptly  advise  the  public
  welfare  district  of  any  change in his financial condition or income,
  number of wage earners and members in the family unit on such forms  and
  in  such  manner  as  the department by regulation may prescribe. In the
  event that any applicant or recipient shall no longer  be  eligible  for
  medical  assistance,  he  shall  promptly return his identification card
  issued pursuant to the provisions of this article to the public  welfare
  district.
    5.   (a)   All   continuing  assistance  under  this  title  shall  be
  reconsidered from time to time, or as frequently as may be  required  by
  the  regulations  of the department. After such further investigation as
  the social services official may deem necessary or  the  department  may
  require, the assistance may be modified or withdrawn if it is found that
  the  recipient's circumstances have changed sufficiently to warrant such
  action. The assistance may be cancelled for cause, and  payment  thereof
  may  be suspended for cause for such periods as may be deemed necessary,
  subject to review by the department as provided in section twenty-two of
  this chapter.
    (b)  The   commissioner   shall   develop   a   simplified   statewide
  recertification  form  for  use  in redetermining eligibility under this
  title. The form shall include requests only for  such  information  that
  is:
    (i)  reasonably  necessary  to  determine  continued  eligibility  for
  medical assistance under this title; and
    (ii) subject to change since  the  date  of  the  recipient's  initial
  application.
    (c)  A  personal interview with the recipient shall not be required as
  part of a redetermination of eligibility pursuant to this subdivision.
    6. Notwithstanding any other provisions of this chapter or other  law,
  the  investigations,  decisions and actions required to be made or taken
  by a public welfare official pursuant to this section shall be  made  or
  taken  only  by  the  chief  executive  officer  of  the  public welfare
  department of a public welfare district,  or  by  an  employee  of  such
  welfare department designated by such chief executive officer.
    7.  Local  social  services  districts  shall  be authorized, with the
  approval of the department, to station local social  services  employees
  at  federal  social  security  offices  for  the  purpose  of  providing
  information and referral services  relating  to  medical  assistance  to
  eligible persons.
    8.  Notwithstanding  subdivision  two  of  this  section,  information
  concerning income and resources of  applicants  for  and  recipients  of
  medical  assistance  may be verified by matching client information with
  information contained  in  the  wage  reporting  system  established  by
  section  one  hundred  seventy-one-a  of  the  tax law and, with similar
  systems operating in other geographically contiguous states, and, to the
  extent required by federal law with the non-wage income file  maintained
  by the United States internal revenue service, with the beneficiary data
  exchange  maintained by the United States department of health and human
  services, and  with  the  unemployment  insurance  benefits  file.  Such
  matching   shall  provide  for  procedures  which  document  significant
  inconsistent results of matching activities.  Nothing  in  this  section
  shall  be  construed  to  prohibit  activities the department reasonably
  believes necessary to conform with federal  requirements  under  section
  one thousand one hundred thirty-seven of the social security act.
    9.  (a) Every applicant for or recipient of medical assistance who has
  dependent  children  shall  be  informed  in  writing  at  the  time  of
  application  and  at the time of any action affecting his or her receipt
  of such assistance of the availability of:
    (i) medical assistance without cash assistance under this title;
    (ii) transitional medical assistance under paragraphs (a), (b) and (c)
  of subdivision four of section three hundred sixty-six of this title;
    (iii) the expanded  eligibility  provisions  for  pregnant  women  and
  children  under  paragraphs  (m),  (n), (o), (p) and (q), (s) and (t) of
  subdivision four of section three hundred sixty-six of this title;
    (iv) medical assistance for aged,  blind  or  disabled  persons  under
  subdivision one of section three hundred sixty-six of this title;
    (v)  family  health  plus under section three hundred sixty-nine-ee of
  this article; and,
    (vi) child health plus under title one-A of article twenty-five of the
  public health law.
    (b) Every applicant for or recipient of medical assistance who has  no
  dependent  children  shall  be  informed  in  writing  at  the  time  of
  application and at the time of any action affecting his or  her  receipt
  of such assistance of the availability of:
    (i) medical assistance without cash assistance under this title;
    (ii)  the  expanded  eligibility  provisions  for pregnant women under
  paragraphs (m) and (o) of subdivision  four  of  section  three  hundred
  sixty-six of this title;
    (iii)  medical  assistance  for  aged, blind or disabled persons under
  subdivision one of section three hundred sixty-six of this title; and,
    (iv) family health plus under section three hundred  sixty-nine-ee  of
  this article.
    * (10)  As  a  condition  for  the provision of medical assistance for
  nursing facility services, the application of  an  individual  for  such
  assistance,  including  any  recertification  of  eligibility  for  such
  assistance, shall disclose a description of any interest the  individual
  or  community  spouse has in an annuity or similar financial instrument,
  regardless of whether the annuity is irrevocable or  is  treated  as  an
  asset.   Such  application  or  recertification  form  shall  include  a
  statement that the state of New York  becomes  a  remainder  beneficiary
  under  such  annuity  or  similar  financial instrument by virtue of the
  provision of such medical assistance.
    * NB Effective July 1, 2006