us-ny/manual/doh/medicaid

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us-ny/manual/doh/medicaid · Axiom

(MRG) UPDATED: JUNE 2010 1 TABLE OF CONTENTS CATEGORICAL FACTORS CATEGORICAL FACTORS...................................................................................... 3 LEGALLY RECOGNIZED SAME-SEX MARRIAGES ............................................... 5 LOW INCOME FAMILIES (LIF) ................................................................................ 6 ADC-RELATED ........................................................................................................ 4 AGE OF CHILD ................................................................................................... 9 RELATIONSHIP OF CHILD TO CARETAKER RELATIVE.................................. 10 LIVING WITH SPECIFIED RELATIVE................................................................. 12 DEPRIVATION OF PARENTAL SUPPORT OR CARE ............................................ 15 DEATH OF A PARENT........................................................................................ 17 INCAPACITY ....................................................................................................... 18 CONTINUED ABSENCE ..................................................................................... 20 UN/UNDER EMPLOYED TWO PARENT HOUSEHOLD..................................... 23 SSI-RELATED.......................................................................................................... 24 AGE (65 OR OVER) ............................................................................................ 25 BLINDNESS ........................................................................................................ 27 DISABILITY ......................................................................................................... 29 SUBSTANTIAL GAINFUL ACTIVITY (SGA)........................................................ 38 TRIAL WORK PERIOD........................................................................................ 40 EMPLOYMENT SUBSIDIES................................................................................ 42 MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES.... 43 UNDER AGE 21 ....................................................................................................... 52 PREGNANCY/NEWBORNS………………………………………………………………..55

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(MRG) UPDATED: JUNE 2010 28 CATEGORICAL FACTORS SSI-RELATED BLINDNESS (4) When the A/R indicates on the application that s/he is in receipt of Social Security Disability benefits or other disability pension benefits based on his/her visual impairment. Verification Process: Verification of legal blindness for the purpose of establishing eligibility for Medicaid is certification from the Commission for the Blind and Visually Handicapped (CBVH). If the A/R is unable to provide his/her certification, the local district submits form LDSS-2353, "Eye Examination Clearance - Blind Applicant for Medicaid" to the Commission to determine if the A/R is registered. If the A/R is unknown to the Commission, a report of an eye examination by an ophthalmologist or an optometrist is submitted on the appropriate form (i.e., LDSS-3377 Rev. 2/82, Mandatory Eye Examination Report, Commission for the Blind and Visually Handicapped) to the Commission for certification. Documentation: Sufficient to establish an audit trail: (a) a copy of the certification of blindness from the Commission for the Blind and Visually Handicapped included in the case record; or (b) the date of certification, Commission Registration number and/or name of the official who signed the document. Disposition: If the A/R meets the above requirements, s/he is considered SSI- related and his/her income and resources are compared to the medically needy income levels in REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS and the resource levels also found in REFERENCE MEDICAID RESOURCE LEVELS to determine eligibility for Medicaid. Such persons are offered a choice between the SSI-related budgeting methodology and the ADC-related budgeting methodology, provided s/he meets the requirements for ADC. If the individual’s income eligibility is the same under both budget types and the individual is not eligible for, or does not wish to participate in Medicaid Buy-In for Working People with Disabilities (MBI-WPD), the individual must be given the ADC-related category of assistance, since benefits under this category are not limited based on resources. The A/R is advised of the benefits available through the SSI program. If s/he is interested, s/he is referred to the local SSA District Office for a determination of his/her SSI eligibility. Application for SSI is not a condition of eligibility for Medicaid.

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(MRG) UPDATED: JUNE 2010 31 CATEGORICAL FACTORS SSI-RELATED DISABILITY  More favorable budgeting that would enable a single adult or member of a childless couple (SCC) to obtain Medicaid or Family Health Plus if he/she does not meet the public assistance standard of need;  Budgeting that would enable an A/R who is otherwise financially ineligible to obtain full Medicaid benefits, with or without a spenddown;  Exclusion of an asset from a transfer penalty if the A/R has transferred the asset to an adult child who is determined to be disabled;  Exclusion of funds deposited in a pooled trust. An example of a financial benefit to the Medicaid program is the placement of an SCC A/R into a federally participating category which assists in meeting the cost neutrality provisions of the 1115 Managed Care Waiver. Disability determinations are completed for all A/Rs under the age of 65 who are citizens or qualified aliens not in the federal five year ban, and who appear to meet the Social Security Administration disability criteria. The A/R is given an informed choice between SSI-related budgeting and any other appropriate category when s/he is eligible under more than one category. Disability determinations are completed for Aliessa aliens (qualified aliens in the five year ban and PRUCOL aliens) only if a determination of disability will provide a Medicaid benefit for the A/R. There is no financial benefit to the Medicaid program, as federal financial participation cannot be obtained for these A/Rs, nor are they included in the federal 1115 waiver. Thus, if an Aliessa alien A/R is eligible for full Medicaid coverage without a disability determination, there is no requirement to perform a Medicaid disability review for the A/R. When a non-SSI-related Medicaid recipient dies, his/her case, medical condition and expenditures are reviewed for referral to the Medicaid Disability Review Team. The disability review process takes into consideration the severity and extent of the individual’s medical condition and resulting functional limitations. It may also take into account the individual’s

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(MRG) UPDATED: JUNE 2010 32 CATEGORICAL FACTORS SSI-RELATED DISABILITY age, education and previous work experience. All A/Rs who are potentially SSI-related as disabled persons or their representatives are informed of the disability category. The information includes, but is not limited to: (a) The disability review process; (b) The need for the individual to cooperate in securing detailed medical documentation from treating sources and the possible need for the individual to have an examination(s), consultation(s) and/or diagnostic test(s); (c) The need for the individual to provide social and functional information, such as education and details of their past work experience; (d) The time frames involved in the disability process; and (e) The potential benefit(s) to the individual of a disability certification, such as a different budgeting methodology, an increased Food Stamp benefit and the identification of medical and/or social resources that may assist the A/R. Each A/R who is potentially SSI-related as a disabled individual (or his/her representative) must complete a LDSS-1151 - "Disability Interview." Special emphasis is placed on the individual's education, special training if any, work experience during the past fifteen (15) years, disability related income, medical care received and the individual's functional capacity. Districts may not require an individual to come to the district for an interview. However, districts may complete the Disability Interview form (LDSS-1151) by telephone. To initiate the medical evidence packet, districts may mail the LDSS- 1151 and the district-specific Release of Medical Information form to the applicant or they may conduct a telephone interview to complete the LDSS-1151 form. If attempting to conduct the interview by telephone districts must make three attempts to contact the individual before resorting to the mail. When the LDSS-1151 form is returned to the district, it is important that the information on the form be reviewed by the district worker for completeness and the form is signed by the worker. If the form is not complete, it is the responsibility of the worker to contact the applicant and obtain the information before submitting the packet for a disability review.

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(MRG) UPDATED: JUNE 2010 34 CATEGORICAL FACTORS SSI-RELATED DISABILITY The local or State Medicaid Disability Review Team evaluates the medical evidence, considering such factors as the individual's age, education, work experience and residual functional capacity to determine if the A/R is disabled. The Medicaid Disability Review Team completes the LDSS-639: "Disability Review Team Certificate" for each potentially disabled A/R. The LDSS-639 contains the determination and the regulatory basis for that determination. It documents any request(s) for additional medical and/or social information, the effective date of disability and expiration date of disability, if applicable. The entire disability determination process is completed within 90-days of the initial application/recertification. If the process takes more than 90 days, on the 90th day the A/R is sent a written statement giving the reason for the delay. When the disability process is completed, the A/R is given a written notice of the determination, the reasons for it and the regulatory basis. (See OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION) There are two categories of disability: Group I includes persons who show no possibility of engaging in any substantial gainful work activity. They have a physical and/or mental impairment(s) which is disabling and considered irreversible. These cases have no disability end date on the LDSS-639 “Disability Review Team Certificate.” Group II includes individuals who have disabling impairments at the time of determination, but are expected to show an improvement in physical and/or mental status, enabling them to become capable of substantial gainful activity. Some reasons for improvement are: the condition is arrested; a remission occurs; therapeutic advances occur; and/or rehabilitation. NOTE: End dates for all Group II certifications must be tracked through WMS and medical evidence gathered for a continuing disability review prior to the Group II disability end date. When an individual re-applies after previously being certified disabled, another disability review is not necessary if the disability end date has not yet expired, unless: 12 months or more have elapsed since the date of the last case closing, or the individual has in the interim engaged in a useful occupation, or has had a significant change in treatment such as surgery or rehabilitation.

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(MRG) UPDATED: JUNE 2010 36 CATEGORICAL FACTORS SSI-RELATED DISABILITY (i) When the A/R appears to suffer from a physical and/or mental impairment. Some examples are difficulty walking, standing, breathing, concentrating, following instructions or remembering; (j) When the A/R indicates present or past employment at a sheltered workshop or participation in a rehabilitation program; (k) When the A/R indicates that s/he has outstanding medical bills during the three-month period prior to the date on which s/he became eligible for SSI; (l) When the NYS Department of Health identifies cases with potentially disabling diagnoses that have not previously been reviewed for disability. Verification: When the A/R is SSI-related because s/he receives SSI or RSDI, the A/R provides documentation of the Social Security Administration's determination of disability. A copy of the SSA benefit check is sufficient proof of disability since it shows the RSDI claim number. Certain alpha suffixes on the claim number identify the check as a disability payment (See INCOME SOCIAL SECURITY RETIREMENT, SURVIVORS AND DISABILITY INSURANCE/RAILROAD RETIREMENT AND VETERAN’S BENEFITS). Local districts contact the SSA office to determine the current alpha suffix for disability checks. When an A/R loses eligibility for SSI cash for reasons unrelated to his/her medical condition, generally a disability determination is not required. If the A/R lost eligibility prior to the date when SSA was to be reevaluating the A/R's medical condition, the A/R is considered disabled until his/her medical diary reexamination date. The local district contacts the SSA district office to obtain the medical diary reexamination date and the reason why SSI benefits were terminated. When the determination of disability is made by the local or State Medicaid Review Team, a copy of the most current LDSS-639: "Disability Review Team Certificate" is included in the case record. NOTE: End dates for all Group II certifications must be tracked through WMS and medical evidence gathered for a continuing disability review prior to the Group II disability end date.

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(MRG) UPDATED: JUNE 2010 37 CATEGORICAL FACTORS SSI-RELATED DISABILITY Documentation: Sufficient to establish an audit trail: (a) A copy of the RSDI award letter, RSDI check or sufficient identifying information (i.e., date of award, name of official signing the document); (b) A current LDSS-639 indicating Group I or Group II certificate of disability by the State or local Review Team; (c) The code indicating disability on the SDX; (d) An SSA 1610 completed by the SSA district office; or (e) A copy of the information from the Third Party Query System. Disposition: When an A/R is certified disabled, s/he is SSI-related. After following the appropriate budgeting procedures (See INCOME SSI-RELATED BUDGETING METHODOLOGY), his/her income is compared to the Medically Needy Income level or the Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS, LIVING ARRANGEMENT CHART). His/her resources are compared to the appropriate Medicaid resource level (See REFERENCE MEDICAID RESOURCE LEVELS). SSI-related A/Rs are offered a choice between SSI-related budgeting and ADC- related budgeting methodology, when they also meet ADC categorical requirements. If the individual’s income eligibility is the same under both budget types and the individual is not eligible for, or does not wish to participate in Medicaid Buy-In for Working People with Disabilities (MBI-WPD), the individual must be given the ADC-related category of assistance, since benefits under this category are not limited based on resources. The A/R is advised of benefits which may be available to him/her under the Social Security Disability (SSD) and/or Supplemental Security Income (SSI) programs. If s/he is interested, s/he is referred to the local Social Security District Office for a determination of SSI and/or SSD eligibility. The A/R is also informed of the possibility of receiving an increased Food Stamp benefit if an individual is certified disabled. When a PA or Medicaid recipient is certified disabled, the cost of his/her medical care and services may be claimed as SSI-related retroactively from the effective date of disability, subject to the two year federal claiming limitations.

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(MRG) UPDATED: JUNE 2010 44 CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES A. The Basic Coverage Group The Basic Coverage Group includes individuals who meet the following requirements:  The A/R is certified disabled (See CATEGORICAL FACTORS SSI-RELATED BLINDNESS AND SSI-RELATED DISABILITY AND ACCEPTABLE PROOF OF DISABILITY).  The A/R is at least 16 years of age, but under the age of 65.  The A/R is working and receiving financial compensation. There is no minimum number of hours that an individual must work per month, nor is there a minimum wage requirement. However, there must be work activity in each month that MBI-WPD coverage is sought, unless the individual has been granted a grace period.  The A/R has a net income at or below 250% of the FPL.  The A/R has non-exempt resources that do not exceed the appropriate Medicaid Resource Level. 1. Basic Coverage Group Work Requirements For the MBI-WPD program, work consists of engagement in a work activity for which financial compensation is received. The Basic Group has no minimum number of hours for such work activity. Proof of work activity includes: current pay stub(s); paycheck(s) or a detailed written statement from an employer. If these documents are not available, the individual’s income tax return, W-2 form, or records of bank deposits may be used. If an individual is not required to pay taxes, a sheltered workshop employee, for example, the applicant is not denied eligibility for the MBI-WPD program. A time-limited activity that prepares an individual for work, such as a training program, does not meet the work requirement because it is preparation for work. Once a training program is completed and employment secured, an individual may be eligible for the MBI-WPD program. Seasonal work may be considered work for the MBI-WPD program for the duration of the employment. If the work ends, a grace period may be granted if the individual continues to look for employment.

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(MRG) UPDATED: JANUARY 2011 45 CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES 2. Grace Periods for the Basic Coverage Group Grace periods for the Basic Coverage Group allow for lapses in work activity due to job loss or a change in medical condition that is through no fault of the individual. The Job Loss Grace Period and the Change in Medical Condition Grace Period provide coverage up to six months in a twelve-month period. Multiple grace periods are allowed in the twelve-month period but the sum of the grace periods may not exceed six months. The first day of the grace period starts the twelve-month period. Both types of grace periods require written verification, one from the employer for the job loss grace period and one from an acceptable medical source for the change in medical condition grace period. If the recipient has not secured employment by the end of the grace period, his or her eligibility for MBI-WPD ends and continued eligibility under other Medicaid programs must be evaluated. B. The Medical Improvement Group The Medical Improvement Group includes individuals who meet the following requirements:  The A/R is at least 16 years of age, but under the age of 65.  The A/R has a net income at or below 250% FPL.  The A/R has non-exempt resources that do not exceed the appropriate Medicaid resource level.  The A/R has lost eligibility under the Basic Coverage Group due to the direct and specific result of medical improvement. The A/R is no longer certified disabled, but continues to have a severe medically determined impairment. A recipient can only be added to the Medical Improvement Group by action of the State Disability Review Team at the time of a Continuing Disability Review (CDR).  The A/R is working and receiving financial compensation. The A/R in the Medical Improvement Group must be employed at least 40 hours per month and earn at least the federally required minimum wage. 1. Medical Improvement Group Work Requirements For the MBI-WPD program, work consists of engagement in a work activity for which financial compensation is received. For the Medical

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(MRG) UPDATED: JANUARY 2011 46 CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES Improvement Group, work activity must be at least 40 hours per month and paid at no less than the applicable federal minimum wage. Proof of work activity includes: current pay stub(s); paycheck(s) or a detailed written statement from an employer. If these documents are not available, the individual’s income tax return, W-2 form, or records of bank deposits may be used. If an individual is not required to pay taxes, a sheltered workshop employee, for example, the applicant is not denied eligibility for the MBI-WPD program. A time-limited activity that prepares an individual for work, such as a training program, does not meet the work requirement because it is preparation for work. Once a training program is completed and employment secured, an individual may be eligible for the MBI-WPD program. Seasonal work may be considered work for the MBI-WPD program for the duration of the employment. If the work ends, a grace period may be granted if the individual continues to look for employment. Any working individual who had coverage discontinued under the MBI- WPD Medical Improvement Group and is reapplying for the MBI-WPD program, must meet all of the requirements for the MBI-WPD Basic Coverage Group, including certification of disability, in order to participate in the program again. 2. Grace Periods for the Medical Improvement Group Grace periods for the Medical Improvement Group allow for lapses in work activity due to job loss or a change in medical condition that is through no fault of the individual. The Job Loss Grace Period and the Change in Medical Condition Grace Period provide coverage up to six months in a twelve-month period. Multiple grace periods are allowed in the twelve-month period but the sum of the grace periods may not exceed six months. The first day of the first grace period starts the twelve-month period. Both types of grace periods require written verification, one from the employer for the job loss grace period and one from an acceptable medical source for the change in medical condition grace period. If the recipient has not secured employment by the end of the grace period, his or her eligibility for MBI-WPD ends and continued eligibility under other Medicaid programs must be evaluated.

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(MRG) UPDATED: JUNE 2010 48 CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES Eligibility under the Medicaid Level The MBI-WPD program is the most advantageous program for an A/R who is found to meet the eligibility requirements for both Medicaid without a spenddown and the MBI-WPD program. This is because a person in the MBI-WPD program can medically improve without an adverse impact on eligibility while A/Rs who are in receipt of Medicaid under the Aid to Disabled program will lose such eligibility in the event they have medical improvement. In situations where the A/R is found to be eligible for Medicaid without a spenddown AND the MBI-WPD program, the A/R is encouraged to choose the most advantageous program, and must be given a copy of the Explanation of the MBI-WPD Program and have all questions answered regarding the program and its eligibility requirements so that he/she may make an informed choice between the two programs. Substantial Gainful Activity (SGA) and Transition to MBI-WPD New Medicaid applicants: If the gross earnings from work, minus Impairment Related Work Expenses (IRWES) (See INCOME IMPAIRMENT RELATED WORK EXPENSES) are greater than the SGA level (See CATEGORICAL FACTORS SUBSTANTIAL GAINFUL ACTIVITY and REFERENCE SUBSTANTIAL GAINFUL ACTIVITY), and the individual does not have acceptable certification of disability, a disability determination must be performed by the State Disability Review Team for the MBI- WPD program. If the gross earnings from work minus IRWES are less than the SGA level, the A/R is encouraged to participate in the MBI-WPD program, or the Medicaid Aid to the Disabled program, whichever is most beneficial. Medicaid renewals: If a certified disabled Medicaid A/R who is not participating in the MBI-WPD program reports an increase in income and the earnings from work minus IRWEs are greater than SGA, the individual must be transitioned to the MBI-WPD program.

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(MRG) UPDATED: JANUARY 2009 49 CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES If the gross earnings are less than SGA, the individual is encouraged to participate in the MBI-WPD program, or the Medicaid Aid to the Disabled program, whichever is most beneficial. Extended Period of Eligibility A/Rs who have lost SSDI benefits due to substantial work, following a nine-month trial work period, and who are entitled to a 36-month extended period of eligibility (EPE), may be enrolled in the MBI-WPD Basic Coverage Group for the duration of the EPE. IF all other eligibility requirements for the program are met a new disability determination is not necessary. Approximately 2-3 months prior to the end of the EPE, appropriate medical evidence must be obtained and submitted with a complete disability packet to the SDRT for a Continuing Disability Review (CDR). Documentation of the diagnosis(es) for which the applicant was determined disabled by SSA must be obtained in order for the CDR to be performed. Trial Work Period and Transition to MBI-WPD A/Rs in the Aid to the Disabled category of Medicaid may be granted a Trial Work Period (See CATEGORICAL FACTORS TRIAL WORK PERIOD) of up to 9 months to determine if the A/R can develop a consistent pattern of work. In such instances, care must be taken to transition the recipient to the MBI-WPD program before the Trial Work Period ends or the disability certificate expires. Subsequent Continuing Disability Reviews (CDRs) for these individuals must be performed by the State Disability Review Team (SDRT). SSI 1619 (b) Program and Transition to MBI-WPD An A/R who has lost eligibility for 1619 (b) due to excess income and/or resources may be enrolled in the MBI-WPD Basic Coverage Group without a disability determination if the SSI medical diary date has not yet expired and all other eligibility requirements are met. Approximately 2-3 months prior to the medical diary date, appropriate medical evidence from providers must be obtained and submitted to the SDRT for a CDR. Documentation of the diagnosis(es) for which the applicant was determined disabled by SSA must be obtained in order for a CDR to be performed.

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(MRG) UPDATED: JANUARY 2012 50 CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES Documentation: Applicants for the MBI-WPD program must provide proof of disability. Acceptable proof of disability includes the following:  A current disability certification by the State or local Disability Review Team (DRT);  a verification of receipt of Railroad Retirement benefits due to total and permanent disability;  A current disability certification by the Social Security Administration (SSA), for SSDI benefits; this may include a current award letter, proof of receipt of SSDI benefits such as a check or bank statement listing the benefit, or a Medicare card;  A current certification from the Commission for the Blind and Visually Handicapped (CBVH);  A current letter from SSA placing the individual in a SSDI Extended Period of Eligibility;  A current SSA letter informing the individual that he/she is no longer eligible for the 1619 (b) program (the SSA medical diary date is required). NOTE: Districts must track the disability end date for an MBI-WPD program recipient who is in an Social Security Disability Income (SSDI) 36 month Extended Period of Eligibility or who has transitioned to the MBI-WPD program from the SSA 1619(b) program. NOTE: End dates for all Group II certifications must be tracked through WMS and medical evidence gathered for a continuing disability review prior to the Group II disability end date. The DOH- 5029, “Medical Report for MBI-WPD MI CDR” must be used when gathering medical information for a Continuing Disability Review (CDR) for an individual in the MBI-WPD Medical Improvement (MI) Group. One DOH-5029 completed in its entirety, and signed and dated by an acceptable medical source is submitted to the State Disability Review Team for a determination of the individual’s continued MI eligibility. To be completed in its entirety, the treating physician must complete Part A of the form filling in all current diagnoses. Parts B, C and D must be completed if indicated (see instructions on the form. Acceptable medical sources are listed in the NYS “Medicaid Disability Manual”. If an acceptable medical source does not complete the DOH-5029 in its entirety and sign and date the form, the district must follow the instructions in the NYS “Medicaid Disability Manual” for gathering medical information for the CDR.

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MRG UPDATED: JUNE 2011 54 CATEGORICAL FACTORS UNDER AGE 21 Documentation: Sufficient to establish an audit trail: the date of birth, type of document, place and date of filing, and identifying numbers or the available document or name of the official who signed the document. Disposition: When determining eligibility for a child under age 21 the net income of the child's household after applying the appropriate budgeting methodology is compared to the income level (Medically Needy level, Medicaid Standard or federal poverty level as appropriate). (See INCOME MEDICALLY NEEDY LEVELS for discussion of income level and REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS) Treatment of the household's resources depends on the budgeting methodology used. (See REFERENCE MEDICAID RESOURCE LEVELS) NOTE: Effective for eligibility periods beginning on or after January 1, 2010 FHPlus and non-SSI-related Medicaid A/Rs will not have resources considered in determining eligibility. This change includes the following Medicaid categories: Single/Childless Couples (SCC), Low Income Families (LIF), ADC-related (including adults who spend down excess income to the Medicaid income level), children under 21 years of age when comparing income to the Medicaid income level (under age 21), and parents living with their dependent child(ren) under age 21 with income at or below the Medicaid income level (FNP Parents). SSI-related individuals residing with children under age 21 may be LIF or ADC-related. If the SSI-related individual, not seeking long-term care services, LTC services, is eligible as LIF or ADC there is no resource test. In determining eligibility, resources are never considered for pregnant women and infants under one year of age. Resources are also not considered for children over age one but under age 19 if income is at or below the appropriate poverty level. In addition, there is no resource test for applicants for the Family Planning Benefit Program, Medicaid Cancer Treatment Program, the Medicare Savings Program including the Qualified Individual Program (QI), Qualified Medicare Beneficiaries (QMB) and Specified Low Income Medicare Beneficiaries (SLIMB), AIDS Health Insurance Program (AHIP) and policy holders who have utilized the minimum required benefits under a total asset Partnership for Long-Term Care insurance policy. (See RESOURCES NEW YORK STATE PARTNERSHIP FOR LONG-TERM CARE)

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MRG UPDATED: JUNE 2010 56 CATEGORICAL FACTORS PREGNANCY/NEWBORNS the federal poverty level may be eligible for full Medicaid coverage. Pregnant women with household income greater than 100% of the federal poverty level and equal to or less than 200% of the federal poverty level may be eligible for perinatal care and are eligible for enrollment in Medicaid Managed Care. Perinatal care coverage provides most Medicaid covered care and services. (See OTHER ELIGIBILITY REQUIREMENTS PREGNANT WOMEN and REFERENCE COVERED SERVICES FOR PREGNANT WOMEN) A woman determined eligible for Medicaid for any day during her pregnancy remains eligible for Medicaid coverage for at least 60 days from the date the pregnancy ends, regardless of any changes in the family's income or household composition. Eligibility continues until the last day of the month in which the 60th day occurs. This eligibility period is granted in all instances where a Medicaid application was made prior to the end of the pregnancy and the pregnant woman was determined eligible for Medicaid. At the end of the 60-day period, the A/R's circumstances are re-evaluated. If the A/R is not found eligible for full Medicaid, the A/R is budgeted under FHP; if ineligible under FHP, eligibility is determined for FPBP, etc. When to Verify: When an A/R indicates she is pregnant; When an A/R indicates that she has recently given birth. Verification: A birth or pregnancy may be verified by: (a) Information from the New York State Medicaid New Born System. (b) Notification from a Managed Care Organization, Article 28 Pre- natal Care Providers, or other medical provider is acceptable; notification can be verbal or written. If notification is verbal, an appropriate notation is made in the case record with the name of the person and the organization providing the information and the date. (c) For a woman who has an established case (whether there is an unborn on the case or not), written or verbal notification of the birth from an immediate family member or medical provider, or, in exceptional circumstances, an alternate reliable individual or agency, is acceptable. If notification is verbal, an appropriate notation is made in the case record with the name

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MRG UPDATED: JUNE 2010 57 CATEGORICAL FACTORS PREGNANCY/NEWBORNS of the person and the organization providing the information and the date. (d) Any official government, medical or church record continues to be an acceptable form of documentation of birth. (e) Individuals who are initially eligible for Medicaid as a “deemed” newborn are considered to have provided satisfactory documentation of citizenship and identity, by virtue of being born in the United States, and will not be required to further document citizenship or identity at any subsequent Medicaid eligibility redetermination/renewal. NOTE: Verification is NOT required for name, date of birth, or social security number in order to provide the one-year extension for the newborn. Disposition: The eligibility of a pregnant woman is determined first under the LIF budgeting methodology. If ineligible under LIF budgeting, eligibility is determined using ADC-related budgeting methodology. If ineligible under ADC-related budgeting, the poverty levels are used for the pregnant woman and other children residing with her. This includes two-parent families. (See CATEGORICAL FACTORS UN/UNDEREMPLOYED TWO-PARENT HOUSEHOLDS) There is no resource test for pregnant women and newborns. Pregnant women are requested to voluntarily provide their social security number. However, pregnant women cannot be denied Medicaid for failure to provide an SSN. NOTE: Pregnant women have a right to apply for presumptive eligibility (See OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY) at the site of a provider. NOTE: When an LDSS is notified via WMS Report WINR 5225 (Upstate) or WINR 0796 (NYC), or through any other means that a baby has been born with a low birth weight designation (weighing less than 1200 grams at birth), and the mother is in a managed care plan, the LDSS must inform the health plan in writing within 5 days. The 5 day clock begins on the day that the district received such notification. Notification to the plan may be made in electronic form.

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MRG UPDATED: JUNE 2010 64 CATEGORICAL FACTORS FAMILY HEALTH PLUS (FHPlus) and FAMILY HEALTH PLUS PREMIUM ASSISTANCE PROGRAM (FHP-PAP) Description: FHPlus provides comprehensive managed care health insurance to low-income adults who have income above the current Medicaid levels. With few exceptions, adults cannot have private health insurance. All adults age 19-64 who apply for Medicaid and appear to be ineligible for reasons of excess income are evaluated for their potential eligibility for FHPlus. (See CATEGORICAL FACTORS PREGNANCY for treatment of pregnant women). The prescription drug benefit under the Family Health Plus Program is administered by the Medicaid Program, and not by the health plan. FHPlus recipients must use a NYS Common Benefit Identification Card (CBIC) to obtain pharmacy benefits. The Family Health Plus Premium Assistance program is available to A/Rs who have or have access to qualified and cost-effective employer sponsored health insurance (ESI) and who are otherwise eligible for Family Health Plus. An A/R with access to ESI is an individual whose employer offers health insurance benefits to its employees, and the individual is eligible for those benefits. For example, an employer may only offer benefits to employees who work full-time. In addition, the ability of the applicant to enroll in those benefits must be reasonable and uncomplicated. For example, if the employer is not cooperative in providing necessary plan information to the applicant or to the district, then the district would be unable to determine if “access” exists. Individuals in receipt of FHP-PAP shall have available to them health care services including: payment of the recipient’s share of the premium, co-insurance, any deductible amount, and the cost sharing obligations for the A/R’s employer-sponsored health insurance that exceed the amount of the person’s FHPlus co-payment obligations. The A/R will also receive services and supplies otherwise covered by the FHPlus program, but only to the extent that such services and supplies are not covered by the person’s employer sponsored health insurance. NOTE: Although COBRA coverage is not considered employer sponsored insurance, if the health insurance meets the standard benefit package and passes the FHP-PAP cost effectiveness test, such COBRA payments qualify for payment under the FHP-PAP.

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MRG UPDATED: JANUARY 2011 65 CATEGORICAL FACTORS FAMILY HEALTH PLUS (FHPlus) and FAMILY HEALTH PLUS PREMIUM ASSISTANCE PROGRAM (FHP-PAP) Policy: Applicants who meet the following criteria may be eligible for FHPlus:  are age 19 through 64,  are New York State residents,  meet certain citizenship/alien status requirements,  are ineligible for Medicaid based on income,  meet certain income requirements, and  are not employees or family members who are federal employees who are eligible for and have access to employer- sponsored health coverage. NOTE: Temporary or part-time public employees who are ineligible for employer-sponsored coverage may, if otherwise eligible, receive Family Health Plus. NOTE: Effective September 1, 2010, otherwise eligible employees of the State, county, municipal governments, as well as public school districts may enroll in Family Health Plus or the Family Health Plus Premium Assistance Program. The majority of Medicaid eligibility standards and rules apply for FHPlus applicants; however, there are several differences such as a higher income level. Photo ID requirements do not apply to FHPlus. Before eligibility for Family Health Plus can be established, the A/R must select a health plan. To avoid gaps in coverage in instances when the A/R changes from Medicaid eligibility to Family Health Plus eligibility, a daily benefit-package flip process will be applied in all local departments of social services. Every month, on the Monday prior to the monthly primary pulldown, a systemic identification of current recipients authorized for Family Health Plus who are not enrolled in a health plan for the following month will be reported to the district on a Potential FHP Auto Assignment Report. On the Wednesday prior to the monthly pulldown, the recipient will be auto-assigned to a FHPlus plan for the first of the following month. Auto-assignments are done based on the following criteria:  If the recipient has a history of enrollment within the past year with a Medicaid Managed Care or FHPlus quality plan, the individual will be assigned to that plan;  If only one FHPlus plan operates in the district, the individual will be assigned to that plan;

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MRG UPDATED: JUNE 2010 67 CATEGORICAL FACTORS MEDICAID CANCER TREATMENT PROGRAM: BREAST, CERVICAL, COLORECTAL AND PROSTATE CANCER (MCTP) Description: The Medicaid Cancer Treatment Program for Breast and/or Cervical Cancer provides full Medicaid coverage to individuals who meet the established criteria to qualify for the Centers for Disease Control and Prevention (CDC) screening under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Medicaid Cancer Treatment Program for Colorectal and/or Prostate Cancer provides full Medicaid coverage for individuals who are screened and/or diagnosed by the Cancer Services Program Partnerships (CSPP) or a CSPP provider and meet established criteria. Individuals must be in need of treatment for these types of cancers or pre-cancerous conditions. Coverage is available for all medically necessary Medicaid services for the period of time the individual needs treatment. In New York State cancer screening is conducted by the New York State Department of Health’s Cancer Services Program (through the Cancer Services Program Partnerships (CSPP). The income standard for the CDC screening program is 250% of the FPL. There is no resource test. A list of CSPP is available on the Department of Health’s website at http://www.health.state.ny.us/nysdoh/cancer/center/partnerships.htm. or By calling the Cancer Services Program at 1-866-442-2262. Policy: Individuals who meet the following criteria are eligible for the Medicaid Treatment Program for Breast and/or Cervical Cancer:  have been screened by their local CSPP and diagnosed as needing treatment for breast and/or cervical cancer or a precancerous condition;  are uninsured (no creditable coverage);  are New York State residents;  are U.S. citizens or aliens with satisfactory immigration status; and  are ineligible for Medicaid under any of the mandatory categorical groups (i.e., pregnant women, parents of a dependent child, Low Income Families, or the disabled).

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MRG UPDATED: JUNE 2010 70 CATEGORICAL FACTORS CHILD HEALTH PLUS Description: The federal Balanced Budget Act (BBA) of 1997 (Public Law 105-33) created the State Children’s Health Insurance Program as Title XXI of the Social Security Act (Child Health Plus in New York State). Policy: Title XXI provides health care coverage to low-income children who are currently uninsured. Pursuant to Title XXI, New York State enhanced its existing Child Health Plus program. Any child who is determined financially ineligible for Medicaid is referred to Child Health Plus (CHPlus). References: Public Health Law – Title 1-A of Article 25 Dept. Reg. 360-4.8 ADMs 10 OHIP/ADM-4 98 OMM/ADM-8 91 ADM-18 91 ADM-11 89 ADM-40 Interpretation: As part of the process of applying for CHPlus children are screened to ascertain whether they appear to be Medicaid eligible. Any applying children who appear to be Medicaid eligible will be required to apply for Medicaid. This process also applies to children who are currently enrolled in CHPlus and appear potentially Medicaid eligible at the time of annual CHPlus recertification. State law requires significant outreach efforts for both CHPlus and Medicaid. These efforts include public education campaigns and the designation of community-based enrollers who will assist children applying for and enrolling in CHPlus or Medicaid, whichever is appropriate. The enroller will submit applications to the local department of social services (LDSS). If an LDSS receives an application for a child who is ineligible for Medicaid due to excess income or immigration status and a plan selection has been made, the LDSS must, on a daily basis, mail the application and documentation, including a copy of the ineligible Medicaid budget for cases denied for excess income, directly to the selected CHPlus plan. If a plan selection has not been made and there is only one CHPlus plan in the county, the application and supporting documentation is mailed directly to that plan. If a plan selection was not made and there are multiple CHPlus plans available in the county, the LDSS must send the application and supporting information to the Corning Tower, Room 1619, Empire State Plaza, Albany, New York 12237.

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MRG UPDATED: JANUARY 2012 72 CATEGORICAL FACTORS CHILDREN IN FOSTER CARE coverage while s/he remains in the facility. (See OTHER ELIGIBILITY REQUIREMENTS STATE AND FEDERAL CHARGES OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES) When this situation occurs, it is likely that OMH or OPWDD will contact the local district to request that the child’s county Medicaid coverage be terminated so that the State can establish coverage. Districts must cooperate with OMH and/or OPWDD so that appropriate coverage can be established expeditiously. When a Title IV-E child in foster care moves out of state, the state where the child resides is responsible for providing Medicaid. If a child who is receiving Title IV-E payments from another state resides in New York State, and application for Medicaid is filed with the local district in which the child resides. The child’s name, date of birth, social security number, third party health insurance information and verification of Title IV-E is documented in the case record and a New York State Medicaid case is opened. The provisions of categorical eligibility cease to apply when a child in foster care is placed in permanent absence status in a medical facility as defined in 18NYCRR 360-1.4. For persons in permanent absence status, chronic care budgeting is used to determine eligibility. IV-D referrals or determinations of good cause must be made as appropriate. Support from parents of a certified blind or disabled child is not sought when the child is expected to be living separate and apart from his/her parents for 30 days or more. When a child in foster care is discharged, a separate Medicaid eligibility determination must be performed based on the child’s living arrangements at discharge (residence in the community). Continuous coverage provisions apply. However, a child who is discharged from foster care who is a citizen or who is in satisfactory immigration status and is in receipt of Title IV-E kinship guardian assistance payments (KinGAP) must be provided with Medicaid without regard to their income and resources. The local social services district making the KinGAP payment is the district of fiscal responsibility.

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MRG UPDATED: JUNE 2011 75 CATEGORICAL FACTORS MEDICARE SAVINGS PROGRAM NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels. The A/R may spend down income to become eligible for Medicaid. The A/R may also spend down income to become eligible for Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLIMB). However, the Medicare premium cannot be applied in whole or in part to reduce excess income. At the time of application, the applicant is encouraged to make a choice to apply the Medicare Premium to their spenddown to attain Medicaid eligibility OR to forego Medicaid eligibility for eligibility in the Medicare Savings Program. The advantages and disadvantages of both programs must be fully explained. An A/R may switch between spenddown and Medicare Savings Program; however, in the interest of accuracy and administrative efficiency, the A/R is encouraged to select and remain in one of the two programs. Eligibility for the MSPs must be determined even if an applicant does not indicate that he or she is applying for the MSP on the DOH-4220 or LDSS-2921. NOTE: The ACCESS NY Supplement A does not have to be completed if the person is applying for MSP only. If applicants are applying for MSP-only they may complete DOH-4328 (Medicare Savings Program Application). There is no resource test for persons applying solely for MSP and who are not Qualified Disabled and Working Individuals (QDWI). However, if they are also applying for Medicaid with a spenddown, or they do not know what program to apply for, they must apply using the DOH-4220. The Low Income Subsidy (LIS) program, also known as “Extra Help”, is administered by the Social Security Administration (SSA) to help low income Medicare beneficiaries pay for prescription drug costs associated with their Medicare Part D benefits. (See RESOURCES THIRD PARTY RESOURCES) Section 113 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) states that an application to SSA for the LIS program for Medicare Part D benefits will be used to initiate an application for benefits under the MSP.

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MRG UPDATED: JUNE 2011 76 CATEGORICAL FACTORS MEDICARE SAVINGS PROGRAM To comply with this requirement, eligible applications transmitted from SSA with a net income below 135% of the current Federal Poverty Level (FPL) will be accepted through an automated process. AUTOMATED APPLICATIONS ACCEPTED: Eligible applications from SSA that have net income below 135% of the Federal Poverty Level (FPL) will be automatically opened as a Qualifying Individual (QI) case; those with net incomes below 120% of the FPL will be opened as a Specified Low Income Medicare Beneficiary (SLIMB) case and those with net incomes below 100% FPL will be opened as a Qualified Medicare Beneficiary (QMB) case. All cases will be opened with an effective date based on the date of application to SSA.  The begin date for Medicare Part A and B coverage will be the first day of the month of application to SSA for LIS  The MSP begin date for SLIMB and QI will be the first day of the month of application to SSA for LIS.  The MSP begin date for QMB will be the first day of the month following the month of application to SSA for LIS. All individuals determined eligible through the automated process will be sent an acceptance notice by the State through the Client Notice System (CNS). The acceptance notice will inform the individual of their MSP category and will include the revised “Medicare Savings Program Request for Information” form. This form is designed to: collect additional demographic and financial information not collected on the LIS application; to collect information about other health insurance premiums; report income information; report a change in circumstance; and, request consideration for retroactive MSP coverage as applicable. Individuals found eligible for QMB will be issued a non-photo Common Benefit Identification Card (CBIC). Individuals found eligible for SLIMB and QI are not issued a CBIC. Financial information provided by the recipient may affect the MSP level of benefits the individual is entitled to receive. In such instances verification of income and/or value of health insurance premiums must be provided and evaluated prior to changing the MSP level.

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MRG UPDATED: FEBRUARY 2005 82 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS (3) A person who was eligible for Medicaid under LIF in at least three of the six months immediately preceding ineligibility, when this ineligibility resulted from the collection or increase in child or spousal support. The person remains eligible for four calendar months, beginning with the month following the month in which s/he became ineligible. (4) Any certified blind or certified disabled person who is a qualified severely impaired individual will continue to be eligible for Medicaid despite earnings that demonstrate his or her ability to engage in substantial gainful activity under the SSI program. A person is a qualified severely impaired individual if: (i) s/he was eligible for Medicaid and received SSI benefits, State supplementary payments, or benefits under section 1619(a) of the Social Security Act in the month preceding the first month in which the provision of this paragraph are applied; and (ii) the Social Security Administration has determined that: (a) the person continues to be blind or to have a disabling physical or mental impairment; (b) the person continues to meet all other requirements for SSI eligibility except for earnings; (c) the lack of Medicaid coverage would seriously inhibit the person’s ability to continue or to obtain employment; and (d) the person’s earnings are insufficient to provide a reasonable equivalent of the SSI, Medicaid, and publicly funded attendant care benefits that would be available to the person if s/he were not employed. (5) A woman eligible for Medicaid during any month of her pregnancy retains eligibility until at least 60 days after the termination of the pregnancy. The 60-day continuation of Medicaid eligibility begins on the last day of the pregnancy and ends on the last day of the month in which the 60th day occurs. To receive the 60-day post partum extension, the woman must have applied for Medicaid prior to the end of her pregnancy.

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MRG UPDATED: JUNE 2010 83 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS (6) A woman eligible for Medicaid during any month of her pregnancy is eligible for 24 months of coverage under the Family Planning Extension Program (FPEP). The 24-month extension is applied at the end of the 60-day postpartum continuation. Women who qualify may receive a full range of family planning services, exclusive of abortions, from one of the participating providers (Title X Clinics) for 26 months after the end of their pregnancy regardless of changes in income. If a woman does not recertify for Medicaid after the 60-day postpartum extension, she is still eligible for FPEP for 24 months. Eligibility for the FPEP is based on the woman's self- declaration of pregnancy and evidence of Medicaid coverage at the time of her pregnancy. Claims payment is made outside of the Medicaid Management and Information System (MMIS). FPEP coverage is not reflected on WMS. All women being considered for FPEP must first be considered for eligibility under the FPBP/MA programs. FPEP is only for the women defined above who are ineligible for FPBP/MA due to unsatisfactory immigration status and/or income in excess of 200%. (7) An infant, born to a woman eligible for and receiving Medicaid at the time of the infant's birth, is eligible for Medicaid until the end of the month in which the child turns age one. When a woman applies for Medicaid within three months after giving birth and it is determined that she was eligible at the time of the birth, the infant is eligible for this one-year extension. An infant born to a woman eligible for and receiving FHPlus on the date of the infant's birth is eligible for Medicaid until the end of the month in which the child turns age one. (8) An infant eligible for Medicaid, based on his/her household income being equal to or below 200% of the poverty level, and receiving medically necessary inpatient care and services on his/her first birthday will remain eligible for inpatient coverage until the end of his/her inpatient stay. (9) A child eligible for Medicaid, based on his/her household income being equal to or below the poverty level standard for his/her age, and receiving medically necessary inpatient care and services on his/her nineteenth birthday will remain eligible for inpatient coverage until the end of his/her inpatient stay.

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MRG UPDATED: NOVEMBER 2007 85 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS (14) A refugee or a Cuban-Haitian entrant eligible under the Refugee Assistance Program (RAP) who becomes ineligible as a result of increased earnings from employment remains Medicaid eligible for the duration of the RAP eligibility period (currently eight (8) months from the date of entry into the United States). (See OTHER ELIGIBLITY REQUIREMENTS STATE AND FEDERAL CHARGES REFUGEES AND CUBAN-HAITIAN ENTRANTS) (15) Children under the age of 19 are guaranteed coverage for up to 12 months. Each time eligibility is determined, (i.e., at initial determination, and at every recertification or redetermination), children up to the age of 19 who are found fully eligible for Medicaid will be provided coverage for 12 months from the date of the determination or redetermination or until their 19th birthday, whichever is sooner, regardless of any changes in income or circumstances. This also applies to children in families who are in Public Assistance cases and receiving Medicaid. It does not apply to children whose immigration status entitles them only to coverage for emergency medical treatment, to children eligible with a spenddown; or to children only eligible using the SSI-related budgeting methodology. IV-E Foster Care children are also eligible for continuous coverage, including children in the custody of the Office of Children and Family Services (OCFS) in IV-E eligible settings. Medicaid for all children in Foster Care should be authorized for 12 months from the initial determination, or 12 months from re- determination. State regulations require that Services review Foster Care cases every 6 months. Medicaid should be re- authorized for 12 months each time a Service case is re- determined and eligibility is confirmed. (16) An individual enrolled in a Managed Care Organization (MCO) is guaranteed six months of Medicaid coverage for the capitated benefits offered through the MCO even if he or she loses Medicaid eligibility. The six-month period of eligibility starts on the recipient’s effective date of enrollment in an MCO and continues through the end of the sixth month. Enrollees who are no longer Medicaid eligible and are in guaranteed eligibility status receive pharmacy services through the fee-for- services program and family planning services through free

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MRG UPDATED: JUNE 2010 86 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS access policy which allows recipients to access services on a fee-for-service basis as well as in the plan (if capitated). This guarantee does not apply to a recipient who: is incarcerated; dies; moves out of State or requests that his/her case be closed; is a pregnant woman with a net available income in excess of the medically needy income, but at or below 200% of the poverty level. (See REFERENCE MEDICALLY NEEDY INCOME LEVELS) Recipients receiving coverage under a guarantee who have excess income and SSI-related recipients who have resources spend down to gain Medicaid eligibility for services outside of their plans. (See INCOME EXCESS and RESOURCES EXCESS RESOURCES) (17) Children age 18 up to age 21 who are final-discharged from foster care and remain in New York State are eligible for Medicaid until the end of the month in which they turn 21. The Medicaid case for the child must contain necessary documentation including identity, citizenship/immigration status, residency, etc.. If it is determined, based on the address received from the foster care worker, that the child is residing in a different county, the “from district” must authorize Medicaid coverage for an initial 12 month period following the foster care discharge. Once authorized, the child’s case can be transferred to the new district of residence using the provisions outline in 08 OHIP/LCM-1, “Continued Medicaid Eligibility for Recipients Who Change Residency (Luberto v.Daines)”. If it is beneficial, a child who moves back into the Medicaid household of his/her legally responsible parent(s) after discharge from foster care may be included in the household budget of the other family members. However, if including the child in the household is not beneficial, the child must remain eligible on his/her own case until his/her 21st. birthday. This section also describes the following Medicaid provisions:  Separate Medicaid Determinations (Rosenberg/Stenson);  Section 249E of the Public Health Law 92-603;  Pickle Eligible (formerly 503 cases);  Disabled Adult Children (DAC); and  Transitional Medicaid (TMA).

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MRG UPDATED: NOVEMBER 2007 89 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS SECTION 249E OF THE PUBLIC LAW 92-603 Description: Under Section 249e of Public Law 92-603 A/Rs are entitled to have the amount of their October 1972 social security increase disregarded in the determination of eligibility if they meet the following criteria: (1) in August of 1972, they were entitled to Retirement, Survivors and Disability Insurance (RSDI) benefits and eligible for or in receipt of cash assistance under ADC or AABD; or (2) in August of 1972, they were entitled to RSDI benefits and would have been eligible for ADC or AABD, except that they were in a medical institution or intermediate care facility; and (3) they currently meet the categorical requirements for SSI (aged, certified blind/disabled) or ADC-related persons. Policy: To determine if an A/R is eligible under 249e: (1) determine the amount of the A/R's RSDI benefit in August 1972. This is done by multiplying the A/R's current RSDI benefit by a figure derived from the present and prior percentage increases in RSDI since August 1972. This figure will change each time there is an RSDI cost of living increase. The figure to use to calculate the amount of A/R’s RSDI benefit can be found in REFERENCE SECTION 249E. (2) using the amount of the August 8, 1972 RSDI benefit and other information provided by the A/R, determine if s/he was eligible for ADC or AABD in August 1972 and was terminated due to the 20% SSA increase of October 1972; if yes, (3) determine the A/R's current eligibility, disregarding the 20% Social Security increase received in October 1972. To determine the amount of the current Social Security benefit being considered, multiply the A/R's current RSDI benefit by a figure computed from the present and prior percentage increases in RSDI since 1972. This figure will change each time there is an RSDI cost of living increase. This factor can be found in REFERENCE SECTION 249E.

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MRG UPDATED: AUGUST 1999 96 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS DISABLED ADULT CHILD (DAC) BENEFICIARIES individual would be eligible for SSI (SSI income and resource levels) by disregarding the DAC benefit or increase(s) in the benefit, s/he remains eligible for Medicaid under the DAC provision. NOTE: When determining Medicaid eligibility for individuals who have been identified as DACs, districts first determine eligibility under the DAC provision, even if the individual appears to have income under the medically needy level. If eligibility cannot be established under the DAC provision, SSI-related budgeting procedures apply. When a Medicaid recipient eligible under the DAC provision has an increase in either income (other than the DAC benefit) or resources that would have resulted in a loss of SSI eligibility, the recipient will also lose DAC status for Medicaid. By budgeting the DAC benefit, the individual may be subject to a spenddown requirement. If the income and/or resources are reduced to the point where the individual would again be entitled to SSI benefits except for the increase in or entitlement to the DAC benefit, the individual would again become eligible for Medicaid under the DAC provision. Individuals who are eligible for Medicaid under the DAC provision are evaluated for QMB eligibility. The individual's actual gross income (without disregarding the DAC benefit) is used when determining QMB eligibility (See 89 ADM-7). Regardless of QMB eligibility, individuals who are eligible for Medicaid under the DAC provision are eligible for Medicaid payment of Medicare Part B premiums as is done for the original buy-in groups including SSI recipients and persons qualifying under Sections 503 (Pickles) and 1619(b) of the Social Security Act (Public Law 99-509). NOTE: In determining the amount of income available for the cost of care under chronic care budgeting, (See INCOME CHRONIC CARE BUDGETING METHODOLOGY FOR INSTITUTIONALIZED SPOUSES and CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS) DAC benefits are considered available income and added to all other sources of available income.

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MRG UPDATED: JANUARY 2012 98 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS TRANSITIONAL MEDICAID (TMA) Interpretation: The TMA extension is for twelve (12) full months. If the recipient is entitled to TMA, the twelve months of TMA begins the first of the month immediately following the month in which the recipient lost eligibility under LIF in either a Temporary Assistance or Medicaid case. However, if the recipient becomes ineligible for Medicaid under LIF at the end of the month and, because of the ten-day notice requirement, his/her case is closed during the first ten (10) days of the following month, the twelve (12) month TMA extension begins the first day of the month in which the notice period ends. NOTE: Eligibility is not evaluated under FHPlus, Medically Needy or expanded levels until the twelve month authorization period has ended. Generally, there are only three (3) reasons for terminating the TMA extension prior to the end of the full twelve (12) months: (1) There is no longer a dependent child in the household. For TMA purposes, a dependent child is a person under the age of 21 who is living with his/her parent/caretaker relative. This child may or may not be an active member of the Temporary Assistance or Medicaid case. This also includes children temporarily living outside of their home; or (2) A court of law has found that the person received social services benefits fraudulently; or (3) The family no longer resides in New York State. Disposition: When terminating TMA because there is no longer a dependent child in the household, a timely and adequate notice is sent. (See OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION DISCONTINUANCE OR REDUCTION TIMELY NOTICE) If the end of the notice period occurs during the month in which the local district learned that the dependent child is no longer in the household, TMA is terminated at the end of that month. If the notice period extends into the following month, TMA is discontinued at the end of the notice period. The availability of third party health insurance (TPHI) coverage is pursued. Enrollment in employer group health insurance is not a condition of eligibility for TMA. However, if a TMA recipient is enrolled

(glossary)New York Medicaid Reference Guide: Glossary#

(glossary)(page-1)Page 1#

UPDATED: JANUARY 2012

GLOSSARY

(MRG) ACTIVE MILITARY DUTY - The term “active military duty” applies to individuals in current full-time service in the Army, Navy, Air Force, Marine Corps, or Coast Guard. Members of the National Guard are not included in this definition.

ADULT DAY HEALTH CARE – Non-residential medically supervised services for individuals with physical or mental impairment who need health maintenance and restorative services to enhance their ability to remain in the community.

AFFIDAVIT – A written statement of facts made voluntarily and under oath.

AID TO DEPENDENT CHILDREN (ADC) – Also known as Aid to Families with Dependent Children (AFDC). It is the pre-TANF federally funded entitlement program which provided cash assistance to eligible needy families that include a minor child deprived of parental support or care because of the death, incapacity, continued absence of either parent, or the unemployment/underemployment of the parent who is the principal wage earner; and the caretaker relative of such child. This program was replaced by the Family Assistance program. Medicaid continues to have ties to AFDC. Medicaid eligibility under the Low Income Families program can be no more restrictive than eligibility under AFDC as it existed on 7/16/96. Medicaid also includes a group of individuals who meet the categorical requirements of AFDC but exceed the financial standards of AFDC.

AID TO DEPENDENT CHILDREN (ADC) - RELATED - A medically needy category for children and their caretaker relatives.

ALIEN - An alien is a person who was not born in this country and who is not a naturalized citizen.

ANNUITIES - An annuity is an investment vehicle whereby an individual establishes a right to receive fixed for periodic payments, either for life or a term of years.

APPLICATION - An action by which a person indicates, in writing on the State- prescribed form, his/her desire either to receive assistance and/or care or to have his/her eligibility considered by a local social services official.

ASSESSMENT - A review by the local social services district of the total countable resources of a couple, and/or the income of a couple and family members as of the date of the request for assessment or at the time of application for Medicaid. This includes the review and documentation of the total value of the couple's countable resources, a determination of the community spouse resource allowance, community spouse monthly income allowance, and/or family member allowance(s), and the methods of computing these allowances.

ASSET - Includes all income and resources of an individual, and of the individual’s spouse, including income or resources to which the individual or the individual’s spouse is entitled but which are not received because of action by: the individual or the individual’s spouse; a person with legal authority to act in place of or on behalf of the individual or the individual’s spouse; a person acting at the direction or upon the

(glossary)(page-2)Page 2#

UPDATED: JANUARY 2012

GLOSSARY

(MRG) request of the individual or the individual’s spouse; or by a court or administrative body with legal authority to act in place of or on behalf of the individual or the individual’s spouse or at the direction or upon the request of the individual or the individual’s spouse.

ASSET PROTECTION – The total asset protection or dollar-for-dollar protection from Medicaid resource spenddown requirements available under the Medicaid Extended Coverage feature of Partnership plans. NOTE: When the term “asset” is used by the Partnership (e.g., in promotional materials, e-learning, etc.) it only includes a resource. It does not include income.

ASSISTED LIVING PROGRAM (ALP) - Program that serves individuals who are medically eligible for nursing home placement, yet who are not in need of the highly structured, medicalized environment of a nursing facility and whose needs could be met in a less restrictive and lower cost residential setting.

BATTERED - The term “battered” applies to an individual based on the fact that s/he was battered, abused or subjected to extreme cruelty, in the U.S., by a U.S. citizen or lawful permanent resident spouse or parent and who has an approved or pending petition/application (I-130, I-360) with USCIS that has been granted, or has been found prima facie eligible for relief under the Violence Against Women Act of 1994 (P.L. 103-322) and/or has credible proof of abuse/battery.

BLIND – “Blind” has the same definition given to such term in Section 1614 (a) (2) of the Social Security Act.

BLINDNESS - The total lack of vision or residual vision being no better than 20/200 or less in the better eye with a corrective lens or restriction of the visual fields or other factors which affect the usefulness of vision.

BREAST AND CERVICAL CANCER – The Breast and/or Cervical Cancer Treatment Program (BCCTP), now a part of the Medicaid Cancer Treatment Program (MCTP), provides full Medicaid coverage to individuals who meet the established criteria to qualify for the Centers for Disease Control and Prevention (CDC) screening under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

BUDGETING - The process which is used to determine the value of a client’s income and as appropriate, resources and whether or not they are below the allowable exemption levels.

BURIAL TRUSTS - Irrevocable pre-need funeral agreements with a funeral director or other entity to meet the expenses associated with burial for Medicaid applicants/recipients and certain family members of the A/R. The agreement can include burial spaces as well as the services of the funeral director. Burial spaces are conventional gravesites, crypts, vaults, mausoleums, caskets, urns or other repositories which are customarily and traditionally used for the remains of the deceased persons, plus the cost of opening and closing a grave.

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CASH VALUE OF LIFE INSURANCE - Amount which the insurer will pay upon cancellation of the policy before death or maturity. This value usually increases with the age of the policy.

CERTIFIED HOME HEALTH AGENCY (CHHA) – Provides nursing services, home health aide services, medical supplies, equipment and appliances and at least one of the following services: physical therapy, speech/language pathology, occupational therapy, social work services and nutritional services.

CHILD - For Medicaid purposes, a person under the age of 21 unless otherwise specified.

CHILD ASSISTANCE PROGRAM (CAP) – The CAP program, originally a demonstration program, is now available in any social services district that requests to participate in the program and receives Office of Temporary and Disability Assistance (OTDA) approval. The CAP program provides a cash benefit and supportive services program designed to foster the federal and State welfare reform goals of work and self-sufficiency. Some of the key program features are an intensive case management component, and enhanced earnings disregard and potential Transitional Medicaid eligibility, and an eligibility threshold designed to reduce recidivism.

CHILD HEALTH PLUS - The federal Balanced Budget Act (BBA) of 1997 (Public Law 105-33) created the State Children’s Health Insurance Program as Title XXI of the Social Security Act (known as Child Health Plus in New York State). Child Health Plus is not a Medicaid (Title XIX) Program.

CHILD SUPPORT – The legal obligation of a non-custodial parent to contribute to the economic maintenance of his/her child; the payments under that obligation.

CHILD SUPPORT ENFORCEMENT - Obtaining payment of a child support or medical support obligation through administrative or judicial means.

CHRONIC CARE BUDGETING - A budgeting procedure used for individuals who are in permanent absence status. Chronic care budgeting begins on the first day of the calendar month following the month in which the A/R is determined to be in permanent absence status.

CITIZEN - A person who was born in the United States or who has been naturalized.

COLORECTAL AND PROSTATE CANCER TREATMENT PROGRAM - A part of the Medicaid Cancer Treatment Program. The Medicaid Cancer Treatment Program for Colorectal and/or Prostate Cancer provides full Medicaid coverage for individuals who are screened and/or diagnosed by the Cancer Services Program Partnerships (CSPP) or a CSPP provider and meet established criteria.

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GLOSSARY

(MRG) COMMUNITY-BASED LONG-TERM CARE SERVICES – Community-based long- term care services include: adult day health care (medical model); limited licensed home care; certified home health agency service, hospice in the community; hospice residence program; personal care services; personal emergency response services; private duty nursing; Consumer Directed Personal Assistance Program; Assisted Living Program, managed long-term care in the community; residential treatment facility; and non-waiver services in a home and community-based waiver program.

COMMUNITY SPOUSE - A person who is the spouse of an institutionalized person, and who is residing in the community and not expected to receive home and community-based services provided pursuant to a waiver under Section 1915(c) of the Social Security Act for at least 30 consecutive days.

COMMUNITY SPOUSE MONTHLY INCOME ALLOWANCE - The amount by which the minimum monthly maintenance needs allowance for the community spouse exceeds the otherwise available monthly income of the community spouse, unless a greater amount is established pursuant to a fair hearing or a court order for support of the community spouse.

COMPREHENSIVE MEDICAID CASE MANAGEMENT - A process which assists selected Medicaid eligible individuals to access necessary medical, social, psychosocial, educational, financial and other services in accordance with goals contained in a written case management plan mutually agreed upon by the case manager and the client. State initiatives are: AIDS Institute Case Management; Office of Mental Health Supportive Case Management and Intensive Case Management; Office for People with Developmental Disabilities Case Management; Early Intervention Case Management; and School Supportive Health Services Program Case Management. Local Initiatives: Teen Age Services Act (TASA) Case Management; CONNECT; Onondaga County Case Management; and Neighborhood Based Alliance Case Management.

CONSUMER DIRECTED PERSONAL ASSISTANCE (CDPAP) - A program that enables Medicaid recipients, who are eligible for home care services, and who accept responsibility, to have greater flexibility and freedom of choice in obtaining needed services.

CONTIGUOUS PROPERTY - Land adjoining the homestead, which is not an integral part of the homestead and can be separately, liquidated.

CONTINUOUS PERIOD OF INSTITUTIONALIZATION - At least 30 consecutive days of care in a medical institution and/or nursing facility, or at least 30 consecutive days of receipt of home and community-based waiver services or a combination of institutional and home and community-based waiver services for at least 30 consecutive days. A continuous period is presumed to cease upon discharge from the medical institution/facility or discontinuance of home and community-based waiver services unless the individual returns to care within 30 days or there is adequate medical documentation that s/he will return to care within 30 days.

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GLOSSARY

(MRG) COUNTABLE RESOURCES - Available resources which are not disregarded.

CUSTODIAL PARENT - Person with primary physical custody as granted by valid agreement between the parties or by court order or decree and with whom the child lives; may be parent, other relative, or someone else.

CUSTODY ORDER - Legal determination that establishes with whom a child shall live.

DEFAULT JUDGMENT - Decision made by the court when the defendant fails to respond.

DEFAULT ORDER - A child support order issued when the non-custodial parent fails to appear in court after having received a summons.

DELINQUENT SUPPORT- Also referred to as ARREARS - Support not paid on time or in full.

DEPARTMENT OF HOMELAND SECURITY (DHS) - The Homeland Security Act of 2002 transferred INS functions to the new Department of Homeland Security (DHS). Immigration enforcement functions were placed within the Directorate of Border and Transportation Security (BTS), either directly, or under Customs and Border Protection (CBP) (which includes the Border Patrol and INS Inspections) or Immigration and Customs Enforcement (ICE) (which includes the enforcement and investigation components of INS such as Investigations, Intelligence, Detention and Removals).

DISABLED – “Disabled” has the same meaning given to such term in Section 1614 (a) (3) of the Social Security Act, which states that an individual shall be considered to be disabled if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

DISABILITY - The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.

DISABILITY REVIEW TEAM – Responsible to review the medical and vocational information to determine whether an individual meets the SSI definition of disabled and can be categorized as SSI-related. The State or local disability review team consists of a physician or psychological consultant, and another person who is qualified to interpret and evaluate medical reports to determine the individual’s capacity to perform work activities.

DISREGARDS OF INCOME - Income that is not considered in determining eligibility for Medicaid.

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GLOSSARY

(MRG)

DOLLAR-FOR-DOLLAR ASSET PROTECTION (DDAP) – The amount of assts that is disregarded, up to the amount paid in benefits after using the Dollar-for-Dollar 50 or Dollar-for-Dollar 100 Asset plan, in determining a qualified Partnership policyholder’s eligibility for Medicaid Extended Coverage.

DRUG AND ALCOHOL SCREENING - All adults and heads of household applying for temporary assistance are screened for drug and alcohol abuse. A positive screening results in an assessment of the individual by a certified drug/alcohol counselor. If a treatment program is indicated as a result of the assessment, the individual is referred to the appropriate credentialed substance abuse treatment program. The Drug and Alcohol requirements do not apply to the Medicaid program.

EARNED INCOME DISREGARDS (EID) - Earned income disregards are the allowable deductions and exclusions subtracted from the gross earnings. The resulting amount, or net income, is applied against the household’s need. EIDs vary in amount and type, depending on the category of the applicant and the program applied for.

EARNED INCOME TAX CREDIT (EITC) – The EITC is a special refundable tax benefit offered by the federal government. The credit is for working families and individuals who earn low or moderate incomes. The credit has several important purposes: to reduce the tax burden on these workers, to supplement wages, and to make work more attractive than welfare.

EMERGENCY ASSISTANCE FOR ADULTS (EAA) – EAA is a Temporary Assistance program that provides financial assistance to meet emergency needs of adults who are eligible for SSI.

EMERGENCY ASSISTANCE TO FAMILIES (EAF) – EAF provides assistance for families with children to deal with crisis situations threatening the family and meet emergent needs resulting from a sudden occurrence or set of circumstances demanding immediate attention.

EMERGENCY MEDICAL CONDITION - The term “emergency medical condition” means a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: - placing the person’s health in serious jeopardy; - serious impairment to bodily functions; or

- serious dysfunction of any bodily organ or part. Care and services related to an organ transplant procedure are not included in this definition.

EMERGENCY SAFETY NET ASSISTANCE (ESNA) – ESNA is a Temporary Assistance program that provides financial assistance to meet emergency needs of adults without minor children.

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EMERGENCY SHELTER GRANTS PROGRAM (ESGP) – The purpose of the ESGP is to help improve the quality and quantity of emergency shelters for the homeless, help meet the cost of operating such shelters, provide essential social services to the homeless and avoid an initial occurrence of homelessness through the provision of preventive services.

ENFORCEMENT – Obtaining payment of a child support or medical support obligation through administrative or judicial means.

ESTATE - (1) all of a decedent's real and personal property and other assets passing under the terms of a valid will or by intestacy; and (2) any other real and personal property and other assets in which the decedent had any legal title or interest at the time of death, including such assets conveyed to a survivor, heir, or assign of the decedent through joint tenancy, tenancy in common, survivorship, life estate, living trust or other arrangement, to the extent of the decedent's interest in the property immediately prior to death.

EXCESS (SURPLUS) RESOURCES - Available resources that are in excess of the resource exemption level.

EXPECTED TO REMAIN - Available medical evidence/documentation indicates a reasonable expectation that a person will remain in an institution/facility, receive home and community-based waiver services or a combination of institutional and community-based waiver services for at least 30 consecutive days, even though the person may not actually receive such services for at least 30 days.

FAIR HEARING – Fair Hearing means a formal procedure provided by the Office of Administrative Hearings, upon a request made by an applicant or recipient, to determine whether an action taken or failure to act by a local district was correct.

FAIR MARKET VALUE – “Fair market value” (FMV) means the estimate of the value of an asst if sold at the prevailing price at the time it was actually transferred. Fair market value of real property or other assets may be established by mean of an appraisal by a real estate broker or other qualified dealer or appraiser.

FAMILY HEALTH PLUS (FHPlus or FHP) – FHPlus provides a comprehensive health insurance to low-income adults who have income or assets above the current Medicaid levels, and who do not have other health insurance coverage.

FAMILY HEALTH PLUS PREMIUM ASSISTANCE PROGRAM (FHP-PAP) - This program is available to A/Rs who have access to cost-effective employer sponsored health insurance and who are otherwise eligible for Family Health Plus. Such individual’s have health services available to them including: payment of the recipient’s share of the premium, co-insurance, any deductible amount and the cost- sharing obligations for the A/R’s employer-sponsored health insurance that exceed the amount of the person’s FHPlus co-payment obligations.

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(MRG) FAMILY ASSISTANCE (FA) – FA provides cash assistance to eligible needy families that include a minor child living with a parent(s) or caretaker relative. It is operated under the federal TANF rules. Under FA, eligible adults are limited to receiving benefits for a total of 60 months in their lifetime, including months of TANF- funded assistance granted in other states. Once this limit is reached, the adult and all members of his or her household are ineligible to receive any more FA benefits. FA recipients receive Medicaid under the categorical group Low Income Families (LIF). FA and LIF financial eligibility is generally equivalent. There is no time limit for Medicaid.

FAMILY MEMBER ALLOWANCE (FMA) FOR EACH FAMILY MEMBER - An amount equal to one-third of the amount by which the applicable percent of one- twelfth of the annual federal poverty line for a family of two exceeds the amount of the family member's otherwise available income. (See REFERENCE SPOUSAL IMPOVERISHMENT FAMILY MEMBER ALLOWANCE for the current maximum family allowance per family member.) A family member is a minor child, dependent child, dependent parent or dependent sibling of the institutionalized spouse or community spouse. The family member must be residing with the community spouse and have over 50% of his/her maintenance needs met by the community spouse and/or the institutionalized spouse.

FAMILY PLANNING BENEFIT PROGRAM (FPBP) - The FPBP provides Medicaid reimbursement for family planning services on a fee-for-service basis. Federal financial participation for such services is 90 percent in accordance with Section 1903(a)(5) of the Social Security Act. There is no local cost for services provided under the FPBP.

FAMILY TYPE HOME FOR ADULTS - An adult care facility established and operated for the purpose of providing long-term residential care and personal care, and/or supervision to four or fewer adult persons unrelated to the operator.

FEDERAL PARENT LOCATOR SERVICE (FPLS) – A service operated by the federal Office of Child Support Enforcement to help the States locate parents in order to obtain child support payments; also used in cases of parental kidnapping related to custody and visitation determinations; FPLS obtains address and employer information from federal agencies.

FEDERALLY-ASSISTED FOSTER CARE – A program, funded in part by the federal government, under which a child is raised in a household by someone other than his or her own parent.

FINDING – A formal determination by a court, or administrative process that has legal standing.

FOOD ASSISTANCE PROGRAM (FAP) – A state program that provides food assistance to some individuals who are ineligible for federal food stamps due to their alien status.

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GLOSSARY

(MRG) FOOD STAMPS (FS) – A federally mandated program with the purpose of reducing hunger and malnutrition by supplementing the food purchasing power of eligible low income individuals.

FULL FAITH AND CREDIT – Doctrine under which a State must honor an order or judgment entered in another State.

GARNISHMENT - A notice, issued through legal action, ordering attachment of personal property or income to guarantee payment of a debt.

GOOD CAUSE – An acceptable reason given by a client for refusing to cooperate in establishing paternity or establishing and enforcing child support.

GRANT DIVERSION – The use of funds that would otherwise be used to provide a welfare grant to a household to pay an employer for hiring the public assistance recipient. Grant Diversion is one method of funding a subsidized employment position (See definition of Subsidized Employment).

GUARDIAN – An individual vested with the legal authority, and charged with the duty, of taking care of the person and/or managing the property and financial affairs and rights of another person who is considered incapable of administering his or her own affairs.

HEARING – A court proceeding during which the facts of a case are heard and a decision regarding the case can be made.

HEARING EXAMINER – An attorney employed by the local Family Court who can hear and make decisions in child support cases.

HOME AND COMMUNITY-BASED WAIVER SERVICES - Services provided pursuant to a waiver under Section 1915(c) of the Social Security Act. New York State has obtained several such waivers: • Long Term Home Health Care Program; • Home and Community Based Services (HCBS) Waiver; • Nursing Home Transition and Diversion (NHTD) Waiver; • Office of Mental Health (OMH) Home and Community Based Services Waiver (HCBS) For Children and Adolescents With Serious Emotional Disturbance (SED); and • Traumatic Brain Injury (TBI) Waiver.

Under these waivers, specialized services may be provided, in addition to the regular State Plan services. The general intent is to avoid institutionalization.

HOME ENERGY ASSISTANCE PROGRAM (HEAP) – A DTA federally funded program that provides emergency and non-emergency energy assistance.

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GLOSSARY

(MRG) HOME RELIEF (HR) – Home Relief is the pre-welfare reform state and locally funded cash assistance program. It provided benefits to eligible needy single and childless couples. This program was replaced by the Safety Net Assistance program.

HOMELESS - Any individual or family that is undomiciled, has no permanent address, has no regular nighttime residence, resides in a place not designed for or ordinarily used as a regular sleeping accommodation for human beings, resides in a homeless shelter, resides in a residential program for victims of domestic violence, or resides in a hotel/motel on a temporary basis.

HOMELESS HOUSING AND ASSISTANCE PROGRAM (HHAP) - The HHAP provides capital grants and loans to not-for-profit corporations, charitable and religious organizations, municipalities and public corporations to acquire, construct or rehabilitate housing for persons who are not domiciled and are unable to secure adequate housing without special assistance.

HOMELESSNESS INTERVENTION PROGRAM (HIP) - The intent of the Homeless Intervention Program is to allow more flexibility in the provision of services previously provided through the Homeless Rehousing Assistance Program (HRAP) and the Homelessness Prevention Program (HPP). HIP issues grants to eligible local social services districts and/or not-for-profit corporations that provide services to single individuals and/or families who are homeless or at risk of being homeless.

HOSPICE – A coordinated and supportive program for terminally ill persons and their families. care focuses on easing symptoms rather than treating disease. The patient and his or her family receive physical, psychological, social and spiritual support and care. Hospice may be provided in the community, in a nursing home, in a hospital or in a Hospice Residence Program.

HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA) - The purpose of the HOPWA program is to provide strategies for meeting the housing and support services needs of low-income persons with AIDS and HIV-related diseases.

IMMEDIATE WAGE WITHHOLDING - Automatic deductions from income which start as soon as the agreement or order for support is established (see wage withholding).

IMMIGRANT - The term “immigrant” means any person who is not a citizen or national of the United States.

INCOME – “Income” has the same meaning given to such term in Section 1612 of the Social Security Act, and includes both earned and unearned income, with certain exceptions, as defined in such section.

INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER (ITIN) – The Individual Taxpayer Identification Number (ITIN) is a tax processing number received from the Internal Revenue Service and is not considered an equivalent to an SSN.

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GLOSSARY

(MRG) INSTITUTIONALIZED SPOUSE - is a person who is: (a) in a medical institution or nursing facility and is expected to remain in such a medical institution or nursing facility for at least 30 consecutive days; or (b) in receipt of home and community-based waiver services, and expected to receive such services for at least 30 consecutive days; or (c) receiving institutional or non-institutional services under a Program of All-Inclusive Care for the Elderly (PACE); or (d) in a medical institution/nursing facility or in receipt of home and community-based waiver services, and expected to receive a combination of institutional services and home and community- based waiver services for at least 30 consecutive days; AND (e) is married to a person who is not described in items (a) through (d).

INTERMEDIATE CARE FACILITY FOR THE MENTALLY RETARDED - “Intermediate care facility for the mentally retarded” means a facility certified under Article Sixteen of the Mental Hygiene Law and which has a valid agreement with the Department for providing intermediate care facility services and receiving payment under Title XIX of the Social Security Act.

JURISDICTION - Legal authority which a court has over particular persons, certain types of cases, and in a defined geographical area.

KINGAP - Kinship Guardian Assistance Program – The Kinship Guardian Assistance Program (KinGAP) is designed to provide a monthly payment and other benefits to qualified relative guardians of foster children who have been discharge from foster care. Medicaid coverage is provided to children in receipt of KinGAP payments as long as the child is a citizen or is in satisfactory immigration status. Children receiving KinGAP are eligible for Medicaid regardless of income or resources. The LDSS making the KinGAP payments is the district of fiscal responsibility.

LEGAL FATHER - A man who is recognized by law as the male parent.

LEGALLY RESPONSIBLE RELATIVE (LRR) - A relative who, by law, is responsible for the support and care of another person. In New York State, spouses are responsible for each other and parents are responsible for their children under 21.

LIEN - A claim upon property to prevent sale or transfer until a debt is satisfied.

LIFE ESTATE - A life estate is limited interest in real property

LIFE INSURANCE - A contract between the owner of a policy and an insurance company whereby the company agrees, in return for periodic premium payments, to pay a specified sum of money to the beneficiary upon the death of the insured.

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(MRG) LIMITED LICENSED HOME CARE AGENCY - Provides hourly nursing care and homemaker, housekeeper, personal-care attendant and other health and social services.

LONG-TERM CARE INSURANCE – Insurance available through private companies as a means for individuals to pay for needed care and protect themselves against the high cost of long-term care.

LOOK-BACK PERIOD – For transfers made on or after February 8, 2006, the “look- back period” means the sixty-month period immediately preceding the date that an institutionalized individual is both institutionalized and has applied for Medicaid.

LOW INCOME FAMILIES (LIF) - A category consisting of families with children, children under 21 who are not living with a caretaker relative, applying caretaker relatives (includes adult cases only) and pregnant women. Most Family Assistance recipients will meet the LIF requirements.

LUMP SUM PAYMENTS - Deferred or delayed payments such as benefit awards, bonuses, year end profit sharing, retroactive pay increases and severance pay.

MANAGED LONG TERM CARE PROGRAM (MLTC) - provides health and long- term care services to adults with chronic illness or disabilities to better address their needs and to prevent or delay nursing home placement.

MANAGED LONG TERM CARE IN AN NURSING HOME – Case managed health and long term care to adults with chronic illness or disabilities to better address their needs while in a nursing home.

MEDICAID - A program to assist low-income persons in attaining and paying for medical care. Local Departments of Social Services administer the program, under the oversight of the Department of Health, Office of Health Insurance Programs (OHIP).

MEDICAID BUY-IN FOR WORKING PEOPLE WITH DISABILITIES - Sections 62- 69 of Chapter 1 of the Laws of 2002 established a new Medicaid Buy-In Program to extend Medicaid coverage to working disabled applicants/recipients (A/Rs) who have net incomes at or below 250% of the Federal Poverty Level (FPL) and non-exempt resources. (See REFERENCE INCOME/RESOURCE LEVEL)

MEDICAID CANCER TREATMENT PROGRAM (MCTP) - The Medicaid Cancer Treatment Program for Breast and/or Cervical Cancer provides full Medicaid coverage to individuals who meet the established criteria to qualify for the Centers for Disease Control and Prevention (CDC) screening under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Medicaid Cancer Treatment Program for Colorectal and/or Prostate Cancer provides full Medicaid coverage for individuals who are screened and/or diagnosed by the Cancer Services Program Partnerships (CSPP) or a CSPP provider and meet established criteria.

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(MRG) MEDICAID EXTENDED COVERAGE (MEC) – Medicaid that is available to a qualified Partnership participant who has met the minimum duration requirement under his/her policy. For Total Asset Protection plans, income is considered in determining Medicaid eligibility but resources are exempt. For Dollar-for Dollar Asset Protection plans, income and unprotected resources are considered in determining Medicaid eligibility.

In the case of Total Asset Protection plans, no liens or recoveries will be pursued for correctly paid Medicaid payments made on behalf of qualified Partnership policyholders. In the case of a Dollar-for-Dollar Asset Protection plan participant, the amount of any lien or recovery against the participant’s estate will be reduced by the amount of asset protection provided to the participant as a qualified Partnership policyholder.

MEDICAL INSTITUTIONS - Hospitals, nursing facilities, intermediate care facilities (ICFs), residential treatment facilities (RTFs), small residential units (SRUs), and room and board situations eligible for reimbursement under Title XIX of the Social Security Act.

MEDICAID INCOME STANDARDS - The Medicaid Income Standard is used to determine eligibility for Singles Childless Couples (SCC) and Low Income Family (LIF) categories.

MEDICAL SUPPORT - Any medical, dental, optical, prescription drug, health care services, or other health care benefits made available to a child through a legally responsible relative. Medical support can also be cash payments pursuant to a court order.

MEDICALLY NEEDY - An individual who is not eligible for or in receipt of SSI or LIF, but who has insufficient income and, as appropriate resources to meet the cost of his/her necessary medical and remedial care and services as determined by State standards. Such A/Rs must meet the categorical requirements for SSI or ADC.

MEDICATION GRANT PROGRAM - Section 15 of Kendra's Law authorizes the Commissioner of the Office of Mental Health (OMH) to provide grants to counties and New York City (NYC) for the Medication Grant Program (MGP). The MGP provides for medication and other services necessary to prescribe and administer medication to treat individuals with mental illness while a decision is being made on their application for Medicaid.

MEDICARE SAVINGS PROGRAM (MSP) - Certain A/Rs who receive Medicare may be eligible for Medicaid to pay the Medicare premium, coinsurance and deductible amounts. There are four groups that are eligible for payment or part-payment of Medicare premiums, coinsurance and deductibles: Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Medicare Beneficiaries (SLIMBs), Qualified Disabled and Working Individuals (QDWIs), and Qualifying Individuals – (QI).

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(MRG) MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA) - An amount equal to $1,500 (effective October 1, 1989) as increased annually by the same percentage as the percentage increase in the federal Consumer Price Index. (See REFERENCE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE for the current MMMNA dollar amount.)

MODIFICATION PETITION - A formal written application to a court requesting a change in an existing child support order.

MONEY JUDGMENT - A court order requiring a non-custodial parent to pay a sum of child support to the custodial parent or to the LDSS.

MORTGAGE - A pledge of a particular property for the payment of a debt or the performance of some other obligation within a prescribed time period.

NYS PARTNERSHIP PLAN - New York State has been granted a time-limited waiver pursuant to Section 1115 of the Social Security Act that provides federal matching funds for most eligibles, regardless of the category under which they receive Medicaid.

NATIVE AMERICAN BORN IN CANADA - A Native American born in Canada may freely enter and reside in the United States and is considered to be lawfully admitted for permanent residence if he or she is of at least one-half Native American Indian blood. As such, he or she is a qualified immigrant. This does not include a non- citizen spouse or child of such Native American or a non-citizen whose membership in a Native American Indian tribe or family is created by adoption, unless such person is at least 50 percent Native American Indian blood.

NEW YORK STATE PARTNERSHIP FOR LONG-TERM CARE (NYSPLTC) – Long-term care insurance policies which are approved under the Partnership program by the New York State Insurance Department. The NYSPLTC program combines private long-term care insurance and Medicaid Extended Coverage to assist New Yorkers in covering the cost of long-term care. The Partnership requires that participating insurers provide benefit coverage, operational activities, and oversight that may not be applicable to long-term care insurance products sold outside the Partnership Qualified Partnership policyholders have their Medicaid Extended Coverage eligibility determined based on income while all or a portion of their resources are exempt., depending on the type of plan purchased. Consumers who own long-term care insurance policies that are not Partnership-approved policies do not have their resources exempted in a Medicaid eligibility determination. Partnership policies can be identified by the Partnership logo which appears on all materials related to the Partnership program.

NON-ASSIGNABLE – “Non-assignable” is a term that applies to a plan, annuity, or other arrangement (whether qualified or not qualified under Part I of Subchapter D of Chapter 1 of Subtitle A of the Internal Revenue Code) that qualifies for the marital deduction but for Section 2056 (d) (1) (A), and does not allow the policyholder to assign or transfer the policy to a third party.

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(MRG)

NON CITIZEN U.S. NATIONAL - A “national” is a person, who is not a U.S. citizen, but who owes permanent allegiance to the United States and may enter and work in the U.S. without restriction. A “national” who is otherwise qualified may be naturalized, if he becomes a resident of any state and completes the applicable requirements. Examples of nationals are: (1) persons born in American Samoa and Swain’s Island after December 24, 1952; and (2) residents of the Northern Mariana Islands who did not elect to become U.S. citizens.

NON-CUSTODIAL PARENT - The parent who does not live with or have physical custody of the child but is legally responsible for providing financial and medical support.

NON-IMMIGRANT - A “non-immigrant” is an individual who has been granted a status that allows him or her to remain in the U.S. temporarily for a specific purpose. Most non-immigrant categories require as a condition of the status that the individual have the intent of returning to a residence abroad.

NON-PROBATE – Non-probate assets include jointly owned financial institution accounts, jointly held real property, life estate interests, interest in certain trusts and annuities regardless of whether there is a named beneficiary or right of survivorship.

NURSING FACILITY - A facility that holds a current operating certificate issued by the State Health Department and meets the federal requirements for extended care facilities under Title XVIII of the Social Security Act and those for a nursing home under Title XIX of the Social Security Act.

NURSING FACILTY SERVICES – “Nursing facility services” means nursing care and health related services provided in a nursing facility; a level of care provided in a hospital which is equivalent to the care which is provided in a nursing facility; and care, services or supplies provided pursuant to a waiver under subsection (c) or (d) of Section 1915 of the Social Security Act.

NURSING HOME CARE – Care in a residential health care facility providing 24-hour skilled nursing supervision for patients requiring rehabilitative or custodial care. Nursing home level of care may be provided to a patient in a hospital when a nursing home bed is unavailable (must be eligible for all Medicaid covered services).

ORDER – Legal direction of a court.

ORDER OF FILIATION - A court order stating that a certain man is the father of a certain child.

OTHERWISE AVAILABLE INCOME - Income that is available to a community spouse or family member. In determining otherwise available income the following deductions, if applicable, are made: actual incapacitated adult/child care expenses, court-ordered support payments and health insurance premiums. In addition, German, Austrian and Netherlands reparation payments are disregarded in

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(MRG) determining the otherwise available income of a community spouse or family member.

PACE - Program of All Inclusive Care for the Elderly - Institutional or non- institutional services provided under a PACE demonstration waiver program (as defined in Section 1934 of the Federal Social Security Act) or under a PACE program under section 1934 or 1894 of the Federal Social Security Act.

PARENT - A child’s birth father or birth mother; adoptive father or adoptive mother; or putative father who has acknowledged paternity.

PARENT LOCATOR SERVICE - A computerized information service which the child support enforcement program uses to locate non-custodial parents through State and federal records for the purpose of establishing paternity and establishing and enforcing child support.

PARTICIPATING CONSUMER – An individual who has signed the Partnership Consumer Participation Agreement and has purchased long-term care coverage pursuant to a Partnership approved policy/certificate from a participating insurer.

PARTICIPATING INSURER – An insurance company offering policy/certificate coverage, approved under the New York State Insurance Department Regulation 144 (11 NYCRR 39) that signs the Insurer Participation Agreement. Insurers must submit products proposed for sale as Partnership for Long-Term Care policies for review and approval by the New York State Department of Insurance in order to be approved as a participating insurer.

PATERNITY - Legal determination of fatherhood.

PATERNITY HEARING - A proceeding to examine the facts regarding legal fatherhood for a child.

PATERNITY PETITION - A formal written application to a court requesting judicial action to determine legal fatherhood of a specific man for a specific child.

PERMANENT ABSENCE STATUS - When an individual is not expected to return home, or the individual is an institutionalized spouse. Permanent absence status will be presumed to exist for persons who are not institutionalized spouses if:

(a) a person enters a nursing or intermediate care facility; (b) a person is initially admitted to acute care in a hospital and is then transferred to an alternate level of care, pending placement in a nursing facility; or (c) a person remains in acute care in a hospital for more than six calendar months. Adequate medical evidence may overcome these presumptions.

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(MRG) PERSONAL CARE SERVICES – Provide assistance with personal hygiene, dressing, feeding and incidental household services essential to the provision of home health services when prescribed by the attending physician.

PERSONAL EMERGENCY RESPONSE SERVICES (PERS) – An electronic device which enable high-risk patients to secure help in the event of an emergency.

PERSONAL NEEDS ALLOWANCE (PNA) - PNA is the amount that is set aside to meet the personal needs for persons who: are residing in a medical institution and are in permanent absence status; or have a community spouse and are in receipt of home and community-based waiver services.

PETITION - A formal written application to a court requesting judicial action on a particular matter.

PETITIONER - One who files a petition.

PRE-ADD ALLOWANCE - The monthly Public Assistance allowance that is intended to cover the costs of food, clothing, incidentals and utility bills.

PRESUMPTION OF PATERNITY - A rule of law under which evidence of a man’s paternity (e.g., voluntary acknowledgment, genetic test results) creates a presumption that the husband is the father of his wife’s child. A rebuttable presumption can be overcome by evidence that the man is not the father, but it shifts the burden of proof to the father to disprove paternity.

PRESUMPTIVE ELIGIBILITY - Presumptive eligibility is Medicaid coverage provided to certain applicants who reasonably appear to meet all of the criteria, financial and non-financial, pending the completion of the full eligibility determination.

PRIVATE DUTY NURSING – Nursing services at home from Registered Nurses (RNs) or Licensed Practical Nurses (LPNs), in accordance with physician orders which may be beyond the scope of care, or unavailable, from certified home care agencies.

PRIVATE PROPRIETARY HOME FOR ADULTS - An adult care facility which is operated for compensation and profit, established for the purpose of providing long term residential care, room, board, housekeeping, and supervision to five or more adults unrelated to the operator.

PROBABILITY OF PATERNITY - The probability that the alleged father is the biological father of the child as indicated by genetic test results.

PRUCOL (Permanently Residing Under Color Of Law) - Any immigrant who is permanently residing in the United States with the knowledge and permission or acquiescence of the United States Citizenship and Immigration Services (USCIS) (formerly the Immigration and Naturalization Services [INS]) and whose departure from the United States the USCIS does not contemplate enforcing.

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GLOSSARY

(MRG)

PUBLIC ASSISTANCE STANDARD OF NEED – Prior to April 2008 pursuant to a court order in Atchison v. Berger (76 ADM-17), Medicaid eligibility for Federally- related MA-Only individuals and families (persons under 21, over 65 and adults between 21 and 65 who are ADC or SSI related, and legally responsible relatives of MA-Only A/Rs who are determined able to contribute to the cost of care of their dependent relatives) was computed by comparing net available income to the Medically Needy Income Level or the PA Standard of Need, whichever was greater. The Public Assistance Standard of Need is an amount of money against which the income of an A/R is compared in order to determine eligibility for Public Assistance. The PA Standard is comprised of six separate items including the Pre-Add, the Home Energy Allowance, the Supplemental Home Energy Allowance, the Shelter Allowance, the Fuel for Heating Allowance and other Additional Allowances (including allowances for home delivered meals, a fifty dollar pregnancy allowance, a restaurant allowance, a special restaurant allowance, the cost of water, hotel or motel rates, and room and board where applicable) whose value must be added together to arrive at a needs level. At this time, the Public Assistance Standard of Need is not used when determining eligibility for Medicaid or Family Health Plus. In determining eligibility for LIF and ADC the net income of the A/R, after all appropriate disregards have been deducted, is compared to the Medically Needy Income Level or the Medicaid Standard (and MBL Living Arrangement chart as appropriate) whichever is most beneficial.

PUBLIC HOME - An adult care facility or a residential health care facility operated by a social services district.

PUBLIC INSTITUTION - An institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.

PUTATIVE FATHER - Man alleged to be the biological father of a child.

QUALIFIED ALIEN - An alien who: − has been lawfully admitted for permanent residence under the Immigration and Nationality Act (INA); − has been granted asylum under Section 208 of the INA; − has been admitted to the United States as a refugee under Section 207 of the INA (including Amerasian immigrants admitted under the provisions of Public Law 100-202); − has been paroled into the United States under Section 212(d)(5) of the INA for a period of at least one year; − has had deportation withheld under Section 243(h) or 241(b)(3) of the INA; − is a Cuban and Haitian entrant (as defined in Section 501(e) of the Refugee Education Assistance Act of 1980); − has been granted conditional entry pursuant to Section 203(a)(7) of the INA; or − has been determined by the social services district to be in need of Medicaid as a result of being battered or subject to extreme cruelty in the United

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GLOSSARY

(MRG) States by a spouse or a parent, or by a member of the spouse’s or parent’s family residing in the same household as the alien.

QUALIFIED - For the purposes of the MARG, the term “qualified” has the same meaning as the term “qualified alien”, as used in the federal PRWORA (Welfare Reform). Qualifieds are individuals who usually live and work in the United States with the permission of the USCIS.

QUALIFIED ENTITY - Presumptive eligibility is a means of immediately providing Medicaid covered care and services to children under the age of 19. .A Qualified Entity (QE), under a signed MOU with the State Department of Health, is used to perform a preliminary assessment of the child’s eligibility based upon guidelines established by the Department.

QUALIFIED PARTNERSHIP POLICYHOLDER (QPP) - A participating consumer who has met the minimum benefit duration requirement of his or her New York State Partnership for Long-Term Care insurance policy and qualified to apply for Medicaid Extended Coverage under the Partnership.

REAL PROPERTY - Houses, condominiums, buildings and land including mineral, water and air rights.

RECIPIENT - An individual in receipt of Medicaid benefits.

REFUGEE CASH ASSISTANCE (RCA) - RCA is targeted to newly arriving refugees during their first eight months after entry into the United States and to those who are determined to be eligible for cash assistance but not eligible for Family Assistance.

REFUGEE MEDICAL ASSISTANCE (RMA) - RMA is targeted to newly arriving refugees during their first eight months after entry into the United States and to those who are determined to be ineligible for Medicaid, but meet certain requirements.

REFUGEE SOCIAL SERVICES PROGRAM (RSSP) - The RSSP assists documented refugees and their families in their transition to a new life in this Country. The Refugee Social Services Program provides job preparation training and job placement for refugees, asylees, Cuban and Haitian entrants and certain Amerasian immigrants.

RESIDENCE FOR ADULTS - An adult care facility established and operated for the purpose of providing long term residential care, room, board, housekeeping, case management activities and supervision to 5 or more adults, unrelated to the operator, who are unable or substantially unable to live independently.

RESIDENCES FOR SURVIVORS OF VIOLENCE PROGRAM (RSVP) - This transitional housing program is for victims of domestic violence. The initiative is exclusively targeted to New York City, as the demand for transitional housing for victims of domestic violence far exceeds the available supply there. The program is

(glossary)(page-20)Page 20#

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GLOSSARY

(MRG) administered in accordance with Homeless Housing assistance Program (HHAP) procedures.

RESIDENTIAL HEALTH CARE FACILITY (RHCF) - A nursing home established and operated pursuant to Article 28 of the Public Health Law.

RESIDENTIAL TREATMENT FACILITY (RTF) - A medical facility certified by the State Office of Mental Health (OMH) which provides for long term psychiatric care for persons 21 years of age and younger.

RESOURCE - Property of all kinds including real and personal, tangible and intangible.

RESOURCE LEVEL - Allowable dollar amounts which an SSI-related A/R is permitted to have in reserve and still be eligible for Medicaid.

RESPONDENT - One who answers a petition.

SAFETY NET ASSISTANCE (SNA) - SNA is a State and locally funded program that provides cash assistance to eligible individuals, couples and families that are not eligible for family assistance. Generally, SNA can be provided for a maximum of two years in a lifetime. After that, if eligibility continues, SNA will be provided in non- cash form, such as two-party check or a voucher. In addition, non-cash SNA is provided for families of persons who are unable to work due to the abuse of drugs or alcohol or for refusing drug/alcohol screening, assessment or treatment.

The Medicaid eligibility category which most closely resembles SNA is Singles and Childless Couples (S/CC). It is for individuals ages 21 through 64 who are not certified blind or certified disabled or pregnant and do not have a minor dependent child living with them.

SATISFACTORY IMMIGRATION STATUS - The term “satisfactory immigration status” is defined as an immigration status that does not make the individual ineligible for benefits under the applicable program. All qualified immigrants and PRUCOL immigrants are individuals said to be in satisfactory immigration status, as are citizens, Native Americans and nationals. The only groups excluded are undocumented immigrants and temporary non-immigrants.

SIGNIFICANT FINANCIAL DISTRESS - Exceptional expenses that the community spouse cannot be expected to meet from the monthly maintenance needs allowance amounts or from amounts held in resources. Such expenses may be of a recurring nature or represent major one time costs. They may include, but are not limited to: recurring or extraordinary non-covered medical expenses of the community spouse or family members; amounts to preserve, maintain or make major repairs on the homestead; and amounts necessary to preserve an income-producing asset.

SINGLES/CHILDLESS COUPLES (S/CC) - Single individuals or members of childless married couples who are (1) at least age 21, but not yet 65; (2) not certified

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GLOSSARY

(MRG) blind or certified disabled; (3) not pregnant; and (4) not caretaker relatives of children under age 21.

SPECIAL NON-IMMIGRANT - Some categories of “special” non-immigrant statuses allow the status (visa) holder to work in the United States and eventually adjust to lawful permanent residence status. These categories allow the individual to apply for adjustment to Lawful Permanent Resident (LPR) status after he or she has had the non-immigrant status for a period of time.

SPENDDOWN - The use of medical expenses to reduce available net income and as appropriate, resources in excess of the medically needy income/resource levels. Spenddown is only available to A/Rs whose eligibility is determined under the NYS medically needy income/resources levels. The A/R must submit paid or incurred bills equal to or greater than the amount of any excess. The A/R may also pay the amount of the excess income to the local district (Pay-In).

SPOUSE - A person married to an A/R (not a common law relationship). This includes married persons who are separated, but not divorced. This definition also applies to individuals of the same sex who are married.

SSI-RELATED - A medically needy Medicaid category for the aged, certified blind or certified disabled.

STATE INCOME STANDARDS - The State Income Standards are the standards used in determining the financial eligibility of families for childcare services. The State Income Standards are established each year using the federal poverty level for family size of four as a base, adjusted by family size scale.

STATE PARENT LOCATOR SERVICE (SPLS) - A service operated by the State Child Support Enforcement Agencies to locate non-custodial parents to establish paternity, and establish and enforce child support obligations.

STATUTE OF LIMITATIONS - The period during which someone can be held liable for an action or a debt - statutes of limitations for collecting child support vary from State to State.

STAY - An order by a court that suspends all or some of the proceedings in a case.

STEPPARENT - A person who is not a child’s birth or adoptive parent, but is married to the child’s birth or adoptive parent.

SUBSIDIZED EMPLOYMENT - Subsidized employment occurs when an employer receives a subsidy in exchange for hiring a public assistance recipient. The subsidy payment may offset the employer’s costs of providing wages, fringe benefits or training or for other purposes. Funds used to subsidize a position may include welfare funds, such as those made available through grant diversion, or other funding sources. Subsidized employment is a public assistance work activity. (See definition of Grant Diversion)

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(MRG)

SUMMONS - The notice used to inform all parties of a court proceeding.

SUPPLANT - To replace current spending with another funding source.

SUPPLEMENTAL SECURITY INCOME (SSI) - A federally supported and administered benefit program for eligible individuals or couples who are 65 or over, or who, regardless of age are certified blind or certified disabled.

SUPPORT COLLECTION UNIT – The part of the child support enforcement program responsible for administration, collection, monitoring, and disbursement of support payments.

SUPPORT ENFORCEMENT- The processes by which a court order to provide cash/medical support can be legally enforced using judicial and/or administrative means.

SUPPORT HEARING – A proceeding to examine the facts regarding financial support for a child.

SUPPORT OBLIGATION – The amount a non-custodial parent is ordered to pay for child support.

SUPPORT ORDER – A court order establishing a child support obligation may include cash and/or medical support.

SUPPORT PETITION – A formal written application to a court requesting judicial action on a matter of child support.

TAX-QUALIFIED LONG-TERM CARE INSURANCE CONTRACT- A long-term care insurance policy that provides favorable federal tax treatment for premiums and benefits paid by the policy. These policies must conform to the requirements of the federal Health Insurance Portability and Accountability Act of 1996 in order to have favorable tax status. Long-term care insurance policies that are approved as tax- qualified by the New York State Insurance Department also are provided favorable tax treatment by New York State.

TEMPORARY ABSENCE - A time when a person is absent from his/her permanent residence and is expected to return. Reasons for temporary absence may include employment, hospitalization, military service, vacation, education or visits. A period of temporary absence will be presumed to exist if:

(a) the person is not an institutionalized spouse and returns to his/her permanent residence in the month in which s/he left or the following month;

(b) a person without a community spouse is in an acute care hospital for six calendar months or less;

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GLOSSARY

(MRG) (c) a person with a community spouse is expected to be in an acute care hospital for less than 30 consecutive days; or

(d) a person with a community spouse is expected to receive home and community-based services provided pursuant to a waiver under Section 1915(c) of the Social Security Act for less than 30 consecutive days.

The presumptions set forth in (a) and (b) may be overcome by adequate evidence. Adequate medical evidence is required to overcome the presumptions set forth in (c) and (d).

TEMPORARY ASSISTANCE (TA) – TA is the “cash” assistance component of welfare. In New York State, temporary assistance includes Family Assistance, Safety Net Assistance, Emergency Assistance for Families, Emergency Safety Net Assistance and Emergency Assistance for Adults. TA is often referred to as “public assistance”.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) – Commonly used in reference to the federal assistance program which a state operates. It is the Block Grant that was established under the Personal Responsibility and Work Opportunity Reconciliation Act under which states operate a federally funded program to assist families with children. TANF funds are used for supportive services and federal benefits.

TEMPORARY NON-IMMIGRANT - A temporary non-immigrant is an immigrant who has been allowed to enter the United States for a specific purpose and for a limited period of time. There are more than two dozen non-immigrant categories, each of which has specific requirements concerning the purpose of the individual’s stay in the U.S. Examples include tourists, students, and visitors on business or pleasure.

TEMPORARY PROTECTED STATUS (TPS) - “Temporary Protected Status” is granted to individuals who are physically present in the U.S. and who are from certain countries designated by the U.S. attorney general as unsafe to accept their return. Individuals granted TPS are authorized to remain in the U.S. for a specific, limited period.

TITLE IV-E - Title IV, Part E of the Social Security Act describes federal payments for foster care and adoption assistance. Title IV-E foster care reimbursement is provided for children who would have been categorically and financially eligible for the former ADC program in public assistance. Title IV-E Adoption Assistance reimbursement is provided for special needs children who would have been eligible under either the former ADC program of public assistance or who are eligible for SSI at the time the adoption petition is filed. Children who are Title IV-E eligible are automatically eligible for Medicaid. Children who are not IV-E eligible are categorically and are automatically eligible for Medicaid. Usually eligibility is based on a household of one. If the non-IV-E child is pregnant, the usual Medicaid rules apply.

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GLOSSARY

(MRG) TITLE XIX - That portion of the federal Social Security Act which authorizes a joint federal/state Medicaid program.

TOTAL ASSET PROTECTION (TAP) – Disregard of all qualifying Partnership policyholder’s assets in determining his or her eligibility for Medicaid Extended Coverage, after the policyholder has used the required amount of benefits under a Total Asset 50 or Total Asset 100 insurance policy.

TRANSFER OF ASSETS - A voluntary assignment of property for less than the fair market value of the property.

TRUST FUNDS - Fund held by one party (the trustee) for the benefit of a person (beneficiary) or group of persons. These funds are not owned by the beneficiary but are usually under the control of a trustee who must carry out the stipulated conditions for payments specified in the trust.

UNCOMPENSATED VALUE – “Uncompensated value” means the difference between the fair market value at the time of transfer (less any outstanding loans, mortgages, or other encumbrances on the asset) and the amount received for the asset. If the client’s resources are below the appropriate Medicaid resource level, the amount by which the Medicaid resource level exceeds the client’s resources must be deducted from the uncompensated value of the transfer. Likewise, amounts specified in the Department regulations for burial funds, but not for burial space items, also must be deducted.

UNDERGRADUATE – A student who has not received a bachelor’s degree.

UNDOCUMENTED IMMIGRANT - Undocumented individuals are immigrants who do not have the permission or acquiescence of the United States Citizenship and Immigration Services (USCIS) to remain in the United States. They may have entered the United States legally but have violated the terms of their status, e.g., over-stayed a visa, or they may have entered without documents.

UNITED STATES CITIZEN: For the purposes of qualifying as a United States citizen, the United States includes the 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands and the Northern Mariana Islands. Nationals from American Samoa or Swain’s Island are also regarded as United States citizens for the purpose of Medicaid eligibility. UNITED STATES CITIZENSHIP AND IMMIGRATION SERVICES (USCIS) - On March 1, 2003, service and benefit functions of the U.S. Immigration and Naturalization Service (INS) transitioned into the Department of Homeland Security (DHS) as the U.S. Citizenship and Immigration Services (USCIS). The USCIS is responsible for the administration of immigration and naturalization adjudication functions and establishing immigration services, policies and priorities. These functions include: • adjudication of immigrant visa petitions;

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GLOSSARY

(MRG) • adjudication of naturalization petitions; • adjudication of asylum and refugee applications; • adjudications performed at the service centers, and all other adjudications performed by the INS. VETERAN - The term veteran means a person who served in the active military, naval or air service of the United States who fulfilled the minimum active duty service requirements and was honorably discharged or released, not on account of immigration status.

VICTIMS OF A SEVERE FORM OF TRAFFICKING: A “victim of a severe form of trafficking” is defined as anyone who:

1. has been subjected to a “severe form of trafficking in persons” which is defined as “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery; and

2. has not attained the age of 18 years or who is the subject of a certification issued by the federal government pursuant to Section 107(b)(1)(E) of the Victims of Trafficking and Violence Protection Act of 2000 (P.L. 106-386).

VOLUNTARY ACKNOWLEDGEMENT OF PATERNITY – An acknowledgement by both parents, that the man is the father of a child, provided in writing on a form. This acknowledgement establishes paternity of the child without a court hearing.

WAGE SUBSIDY – A payment made to a public or private employer to subsidize an employee’s wage or fringe benefits. A wage subsidy may be offered as an incentive for an employer to hire a welfare recipient. Funds used to provide wage subsidies may be made available through diversion of the public assistance grant or other funds.

WAGE WITHHOLDING – Procedure by which automatic deductions are made from wage or income to pay some debt such as child support; may be voluntary or involuntary.

WINDFALLS - One-time payments such as inheritances, court ordered settlements, lottery winnings and gifts.

(income)New York Medicaid Reference Guide: Income#

(income)(page-1)Page 1#

UPDATED: NOVEMBER 2007

TABLE OF CONTENTS

INCOME

INCOME………………………………………………………………………….………….103

EARNED…………………………………………………………………………………….104

WAGES, SALARIES AND CONTRACTUAL INCOME...…………….………...106

TIPS……………………………………………………………………………….…108

COMMISSIONS, BONUSES AND SIMILAR PAYMENTS………….…….……110

SELF-EMPLOYMENT OR SMALL BUSINESS INCOME…………….…….….113

INCOME FROM ROOMERS (LODGERS) AND BOARDERS………….……..118

UNEARNED……………………………………………………………………………….…121

UNEMPLOYMENT INSURANCE BENEFITS (UIB)…………………………….122

NEW YORK STATE DISABILITY INSURANCE BENEFITS,

WORKERS’ COMPENSATION AND SICK PAY………………………..124

SOCIAL SECURITY (RETIREMENT, SURVIVORS’ AND DISABILITY INSURANCE), RAILROAD RETIREMENT AND VETERANS’ BENEFITS……………………………………………..126

DIVIDENDS AND INTEREST……………………………………………………...130

RETIREMENT FUNDS……………………………………………………………..135

UNION BENEFITS (OTHER THAN PENSIONS)………………………………..138

SUPPORT PAYMENTS (VOLUNTARY AND COURT ORDERED)…….…….139

CONTRIBUTIONS FROM NON-LEGALLY RESPONSIBLE RELATIVES AND FRIENDS………………………………………….… 142

RENTAL INCOME………………………………………………………………..…144

MILITARY DEPENDENCY ALLOTMENT…………………………………..……147

REVERSE MORTGAGES……………………………………………………..…..149

IN-KIND INCOME…………………………………………………………..………150

LUMP SUM PAYMENTS………………………………………………………..…154

(MRG)

(income)(page-2)Page 2#

UPDATED: JUNE 2010

100

WINDFALLS ................................................................................................. 156

INDIVIDUAL SUPPORT SERVICES……………………………………………..157

INCOME LEVELS .................................................................................................... 158

MEDICALLY NEEDY INCOME LEVEL ........................................................ 160

MEDICAID STANDARD ................................................................................. 162

FEDERAL POVERTY LEVELS

MEDICAID EXPANDED INCOME LEVELS ....................................... 163

MEDICARE SAVINGS PROGRAM .................................................. 166

FAMILY HEALTH PLUS ..................................................................... 169

FAMILY PLANNING BENEFIT PROGRAM ...................................... . 170

BUDGETING ........................................................................................................... 171

LOW INCOME FAMILIES (LIF) DISREGARDS ...................................................... 173

LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY .................. 185

185% MAXIMUM INCOME TEST ..................................................... 187

100% MAXIMUM INCOME TEST ..................................................... 188

MEDICAID INCOME STANDARD .................................................... 189

$90 WORK EXPENSE DISREGARD ............................................... 190

EARNED INCOME DISREGARD ..................................................... 191

CHILD/INCAPACITATED ADULT CARE COST .............................. 193

DETERMINATION OF ELIGIBILITY ................................................. 194

ADC-RELATED DISREGARDS ................................................................................ 196

ADC-RELATED BUDGETING ...................................................................... 207

$90 WORK EXPENSE DISREGARD ........................................................... . 208

(MRG)

(income)(page-3)Page 3#

UPDATED: JULY 2008

101

$30 AND 1/3 EARNED INCOME DISREGARD ........................................... 209

CHILD/INCAPACITATED ADULT CARE COST .......................................... 211

HEALTH INSURANCE PREMIUMS ............................................................ 212

DETERMINATION OF ELIGIBILITY ............................................................ 215

ADOPTED CHILDREN ............................................................................................ 218

SSI-RELATED DISREGARDS ................................................................................ 220

SSI-RELATED BUDGETING METHODOLOGY……………………………………..231

ALLOCATION ............................................................................................... 233

DEEMING ..................................................................................................... 237

HEALTH INSURANCE PREMIUMS ............................................................ 240

IMPAIRMENT-RELATED WORK EXPENSES ............................................ 242

BLIND WORK EXPENSES .......................................................................... 247

PLAN TO ACHIEVE SELF-SUPPORT ........................................................ 248

DETERMINATION OF ELIGIBILITY ............................................................ 250

MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES . ..256

SINGLE/CHILDLESS COUPLES (S/CC) DISREGARDS ....................................... 257

SINGLE/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY………265

185% MAXIMUM INCOME LIMIT ................................................................ 267

100% MAXIMUM INCOME TEST ................................................................ 268

$90 WORK EXPENSE DISREGARD ........................................................... 269

DETERMINATION OF ELIGIBILITY ............................................................ 270

FAMILY HEALTH PLUS .......................................................................................... ...272

(MRG)

(income)(page-4)Page 4#

UPDATED: NOVEMBER 2009

102

PERSONS IN MEDICAL FACILITIES

ASSESSMENT/DETERMINATION OF INCOME AVAILABLE FOR THE COST OF CARE………………………...…………275

CHRONIC CARE BUDGETING METHODOLOGY

FOR INSTITUTIONALIZED SPOUSES…………………………………….278

BUDGETING FOR INSTITUTIONALIZED SPOUSES IN SPECIFIED HOME AND COMMUNITY BASED WAIVERS (HCBS)………………….283

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS………..285

PERSONAL NEEDS ALLOWANCES (PNA) FOR PERSONS TRANSFERRED OR DISCHARGED………………………………………..290

COMMUNITY SPOUSE AND FAMILY MEMBER ALLOWANCES………………291

FAMILY PLANNING BENEFIT PROGRAM (FPBP) BUDGETING

METHODOLOGY ............................................................................................... 292

EXCESS INCOME ....................................................................................................... 293

SIX-MONTH ....................................................................................................... 299

PAY-IN………………………………………………………………………………….303

(MRG)

(income)(page-5)Page 5#

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103

INCOME

Description: Income is any payment received by the A/R from any source. Income may be recurring, a one time payment, earned or unearned.

Policy: All income is reviewed to determine if it is available (See OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILITY) and countable. Certain types of income are disregarded by statute or regulation.

References: SSL Sect. 366.2

Dept. Reg. 360-4.3

360-2.3

ADMs 93 ADM-29

91 ADM-27

Interpretation: Income is considered in the month it is received. Disregards are subtracted from gross countable monthly income. Disregards are established by statute or regulation (see the appropriate category). Any remaining net monthly income is compared to the appropriate income level. (See INCOME INCOME LEVELS) Income in excess of the level is considered available to meet the cost of medical care. (See INCOME EXCESS) Any amounts retained beyond the month of receipt are considered resources. (See RESOURCES RESOURCES)

Lump sum payments (benefit awards, bonuses, year end profit sharing, retroactive pay increases, severance pay, etc.) and windfall payments (inheritances, court settlements, lottery winnings, gifts, etc.) may be considered either income or a resource depending on the category of the A/R and the type of payment. (See INCOME LUMP SUM PAYMENTS)

NOTE: Mandatory deductions/payments (taxes, FICA, New York State Disability, etc.) are generally not disregarded.

Verification/ Documentation: All income and its availability is verified and documented in the case record. When information cannot be verified, the attempts to verify are documented.

(MRG)

(income)(page-6)Page 6#

UPDATED: FEBRUARY 2005

104

INCOME

EARNED

Description: Earned income is income received as a result of work activity. This includes wages, salaries, tips, commissions and income received from self-employment.

Policy: Gross earned income is determined and a decision made as to its availability. All applicable disregards are deducted. The remaining amount of earned income is added to any other income to determine the available net income.

NOTE: Mandatory deductions/payments (taxes, FICA, New York State Disability, etc.) are generally not disregarded.

The earned income of any child under age 21 who is attending school and who is employed may or may not be disregarded depending on his/her status. For further information regarding student disregards see Income Disregards under the specific categorical methodology. References: SSL Sect.

366.2(a)

Dept. Reg.

360-4.3 360-4.6

(MRG)

(income)(page-7)Page 7#

UPDATED: FEBRUARY 2005

105

INCOME

EARNED

Interpretation: Gross earned income is determined based upon wage verification from the employer. In determining the effect of earnings on prospective income, a number of factors are considered in addition to the current wage verification. Some of these factors may include permanence of employment or position, permanent increase or reduction in hours worked, permanent change in rate of pay and seasonal variations or additional seasonal employment. Although income tax records are not required, in many cases where much of the income does not appear on the wage verification, it is valuable to see the income tax records of the A/R. This is also valuable when it is suspected that the A/R might have an additional source of income (a second job, an employed spouse, etc.). In these instances, it is often necessary to request income tax records, in addition to verification of wages, salary, etc. which can be obtained from pay stubs or from the employer.

Irregular earnings or income from casual employment may be extremely difficult to verify when the A/R declares that this is the method by which s/he supports him/herself. It is necessary to obtain as clear a picture of his/her income as possible. Determining the type of work, frequency of employment and prevailing wages is necessary if verification from employers is not available. In this manner, a reasonable figure consistent with the maintenance picture can be obtained from any other available source, including the A/R, to be used in determining eligibility for Medicaid.

Disposition: When the gross earned income is determined, disregards are deducted to result in the available net income. This, in addition to any other income, is then compared to the appropriate income level in determining eligibility for Medicaid.

The following types of earned income are considered in this section:

• Wages and Salaries • Tips • Commissions, Bonuses and Similar Payments • Self-Employment or Small Business Income • Income from Roomers (Lodgers) and Boarders

(MRG)

(income)(page-8)Page 8#

UPDATED: FEBRUARY 2005

106

INCOME EARNED

WAGES, SALARIES AND CONTRACTUAL INCOME

Description: Wages are cash payments, for labor or services. Wages are paid on an hourly, daily, or piecework basis. For example: a factory worker may be paid $5.00 an hour; a different factory worker may be paid $.03 for every bolt s/he tightens; a farmer may pay a worker by the day during harvest; or an A/R may clean a house for an agreed upon wage, regardless of how long it takes. Salaries are fixed cash compensation, paid regularly, for labor or services. Salaries are generally paid weekly, biweekly, or monthly. Salaries do not vary with the amount of labor or services produced. However, a salaried employee's income may vary occasionally due to overtime pay, bonuses, commissions, etc. (See INCOME LUMP SUM)

Contractual income is income paid on a contractual basis. The income is intended to cover a specific period of time. This includes, but is not limited to school employees. For all categories, except SSI- related, the income is averaged over the months covered by the contract, regardless of whether the employee chooses to receive/be paid the income in fewer or more months than the contract covers. For example: a school aide is employed under a yearly contract, but only receives a paycheck for the months of September through June. The pay for September through June should be added and divided by 12 to determine the A/R's monthly income.

For SSI-related A/Rs contractual income is budgeted as received.

Policy: All income is reviewed to determine if it is available (See OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILITY) and countable. Income is generally considered in the month it is received. See above for a description of when to consider contractual income.

References: Dept Reg.

360-2.3

ADM

93 ADM-29

Interpretation: Wages and salaries are verified. State computer matches are reviewed to determine the source of income. When determining eligibility for a retroactive period, the actual income received by the A/R is budgeted.

(MRG)

(income)(page-9)Page 9#

UPDATED: JUNE 2010

107

INCOME EARNED

WAGES, SALARIES AND CONTRACTUAL INCOME

When determining eligibility for a prospective period, the local district estimates the A/R's future income. When the A/R's income is constant or salaried, one (1) pay stub within the past four (4) weeks is acceptable as an overall representation of income. If the A/R's income varies, the A/R's wages for the four (4) weeks immediately preceding the application are averaged. If the A/R received an exceptionally high or low payment during this period, that payment may be disregarded. When the A/R cannot supply documentation, the social services district can accept other forms of information, which it determines will verify the wages earned.

When the A/R is paid a salary for labor or services provided over a period greater than one month, the salary is broken down to determine monthly income.

When to Verify: When the A/R indicates that s/he is employed.

When the A/R indicates that s/he was employed in the recent past.

When the Resource File Integration (RFI) reports indicate that the A/R has income.

If the A/R indicates that he/she lost or changed jobs in the last three months and provides his/her former employer’s name, even if this information still appears on the RFI system, the LDSS must accept the information on the application and not require additional documentation (e.g. Employment Verification form, LDSS-3707) from the former employer to prove loss of employment.

Documentation: Sufficient to establish an audit trail:

• The pay stubs; pay checks; or a written statement from the employer; • In the event the A/R does not have pay stubs or receive pay checks, Attachment IV to 10 OHIP/ADM-05 is used, “Verification of Employment” and is sent to the A/R for him/her to give to his/her employer to complete; • The A/R's income tax return, W-2 form, or records of bank deposits may be used; or • When an A/R indicates that he/she is paid in cash because he/she is paid “off the books” and his/her employer refuses to provide a statement of wages, the Self-Declaration of Income form (10 OHIP/ADM-05 Attachment V) must be filled out by the A/R.

(MRG)

(income)(page-10)Page 10#

UPDATED: AUGUST 1999

108

INCOME EARNED

TIPS

Description: Tips are a gratuity paid to persons engaged in personal service, based upon a percentage of the price of goods or services, exceptional service or preferred attention. Policy: Tips received by the A/R and members of his/her household are considered in determining eligibility for Medicaid. References: SSL Sect.

366.2(a)

Dept. Reg. 360-4.3

Interpretation: Tips given to people working in personal service occupations are often a significant part of their income. Wages and salaries paid to such persons are often quite low because tips are expected to provide a large portion of their income. Tips may vary seasonally or by the quality and type of service rendered. Some occupations for which tips may constitute a substantial portion of earnings are:

Waiters and waitresses Taxi drivers Bellhops Bus persons Bartenders Porters Shoe shiners Delivery persons Barbers and beauticians Chambermaids Checkroom, locker room and washroom attendants Masseurs and masseuses Caddies Vending stand operators Entertainers who play in restaurants, bars or nightclubs Parking attendants

Since the list is not all inclusive, income from tips is considered for any A/R who is engaged in a personal service occupation.

(MRG)

(income)(page-11)Page 11#

UPDATED: AUGUST 1999

109

INCOME EARNED

TIPS

In determining the amount of gross earned income an A/R receives from tips, a reasonable estimate of tips may be obtained if such factors as the number of persons served and the kind of establishment are kept in mind. For example, a person working in the dining room of a major hotel would generally receive larger tips than a person working in a small coffee shop.

When to Verify Status: (a) When the A/R declares income from tips on the application;

(b) When the A/R is employed in one of the occupations listed above or another personal service occupation,

Verification: While there is no standardized method for verifying tips, the following techniques have proven useful:

(a) Seeing the A/R's income tax return;

(b) Obtaining a statement from the employer with an estimate of the A/R's tips earned.

(MRG)

(income)(page-12)Page 12#

UPDATED: NOVEMBER 2007 110

INCOME EARNED

COMMISSIONS, BONUSES AND SIMILAR PAYMENTS

Policy: Commissions, bonuses or other amounts paid on the basis of superior performances, sales made or goals accomplished are considered earned income and the amount paid is verified.

References: SSL Sect. 366.2(a)

Dept. Reg. 360-4.3

ADM

92 ADM-32

Interpretation: The situations in which commissions, bonuses, royalties and other similar payments are made vary considerably. The A/R may be paid under a commission only, salary plus commission, guaranteed minimum commission or draw against future commissions. The commissions may be a percentage of sales price or a flat amount per unit sold.

Royalties are payments such as remuneration to the holder of a patent or copyright for the use of an invention or the duplication of a writing, or to the owner of a mine for the extraction of a product such as oil, gas or minerals. In the event that the A/R has incurred expenses in generating the commissions or royalties such as promotional literature, samples or costs for transporting customers, the expenses are verified and deducted from the amount of the commissions to obtain the gross earned income. Some employed persons are paid bonuses based upon individual or group achievement, production, sales goals, or employer profits. These may be paid annually or more frequently. When commissions, bonuses, royalties or similar payments are paid less frequently than monthly, a decision as to how to treat such payments is based on the category of the A/R.

(MRG)

(income)(page-13)Page 13#

UPDATED: NOVEMBER 2007 111

INCOME EARNED

COMMISSIONS, BONUSES AND SIMILAR PAYMENTS

For all categories, royalty payments are treated as earned income in the month received and as a resource thereafter. For SSI related A/Rs, the district must determine whether the royalty will be considered infrequent or irregular income and apply the appropriate policy. (See INCOME SSI-RELATED DISREGARDS)

When to Verify Status: (a) When the A/R declares in the application that s/he is a salesperson, route person, or employed in another occupation related to selling goods and services;

(b) When the A/R indicates in the application that s/he has recently been employed as a salesperson (s/he may have residual commissions which are due to be paid to him/her, especially in the field of contract sales);

(c) When the A/R indicates that s/he receives commissions or bonuses as part of the conditions of employment or is employed by a business which is known to pay bonuses.

(d) When the A/R indicates that s/he is a writer or has produced another product from which a royalty may be provided as payment.

(MRG)

(income)(page-14)Page 14#

UPDATED: NOVEMBER 2007 112

INCOME EARNED

COMMISSIONS, BONUSES AND SIMILAR PAYMENTS

Verification: (a) Seeing a statement from the employer stating the criteria for payment of commissions bonuses or royalties and the anticipated earnings;

(b) Seeing the income tax return for the previous year;

(d) If applicable, seeing statements of expenses. Documentation: Sufficient to establish an audit trail:

(a) Employer's statement verifying the amount and pay period of salary, if any, and the amount of past commissions , royalties or bonuses; and

(b) Name of the supplier, date, amount and item of business expenses; or.

(MRG)

(income)(page-15)Page 15#

UPDATED: JUNE 2010

113

INCOME EARNED

SELF-EMPLOYMENT OR SMALL BUSINESS INCOME

Description: Self-employment, small business or farm income is income that results from work activity on the part of the A/R, in which s/he is self-directing and receives compensation directly from the customer.

Policy: After allowable business expenses have been deducted, the remaining income is considered available earned income of the A/R and is subject to the appropriate budgeting methodology based on the category of the A/R.

References: SSL Sect. 366.2(b)

Dept. Reg. 360-4.3(c)

GIS

09 MA/025

01 MA/024

Interpretation: When an individual is self-employed or owns or operates a small business in which s/he is employed, certain costs related to the business or self-employment (e.g. the cost of materials, supplies, and labor) are deducted from the gross income for the purpose of determining eligibility for Medicaid.

Following are some of the items of business expenditures which are generally deductible from gross business income:

• Rental of quarters, equipment, or furniture; • Salaries and fringe benefits of employees; • Cost of goods for re-sale; • Business taxes, licenses and permits; • Cost of tools, supplies and raw materials; • Insurance for the business; • Lights, heat, water, sewage and telephone charges; • Advertising and travel; • Taxes and carrying charges on any property used in the business.

NOTE: For SSI-related A/Rs, depreciation costs for buildings, equipment and materials necessary for and directly related to the operation of the business are also deducted from gross income. Depletion, amortization and 179 expenses, which are types of depreciation, may also be deducted for the SSI-related.

(MRG)

(income)(page-16)Page 16#

UPDATED: JANUARY 2012

114

INCOME EARNED

SELF-EMPLOYMENT OR SMALL BUSINESS INCOME

Following are some of the items of business expenditures, which are not deductible from gross business income:

• Payments on the principal for real property used wholly or partially in the business;

• Any expenses which are not directly related to the operation of the business, (for example, personal expenses such as lunch or transportation for work).

Income and expenses are generally considered on an annual basis. The difference between income and expenses is then divided by 12 to establish the A/R’s monthly earned income. The primary source for verifying the A/R's income and expenses is his/her income tax records.

How to Estimate Net Earnings from Self-Employment:

If the A/R has been conducting the same trade or business/farm for several years; has had net earnings which have been fairly constant from year to year; and anticipates no change or gives no satisfactory explanation why net earnings would be substantially lower than in the past, take the net profit from the past year as an estimate for the current year. Divide yearly net profit by 12 to determine monthly income.

If an A/R is engaged in a new trade or business/farm, give the A/R the Financial Status (Farm or Business) Form (DOH-4469) to complete. Divide net profit by 3 to project monthly income for the next year.

NOTE: When using the three-month business record, a loss in one month may be used to offset a profit in another month. If an A/R owns more than one business, and tax returns are not available, a DOH- 4469 must be completed for each business. A loss in one business does not offset a gain in another.

(MRG)

(income)(page-17)Page 17#

(MRG)

UPDATED: JANUARY 2012

115

INCOME EARNED

SELF-EMPLOYMENT OR SMALL BUSINESS INCOME

Procedure to Determine Net Profit

Income Tax Return

Business Organization Documentation

Single Owner Business/Farm

tax return including Schedule C or C-EZ or Schedule F (farm) or Financial Status Form (farm or business) DOH- 4469

Partnership tax return including Schedule E or F (farm) or Form 1065 and Schedule K-1 and W-2 if applicable or partnership agreement or Form 1065, Partnership Return or Schedule K-1 (1065) or Financial Status Form (farm or business) DOH- 4469

S-corporation Tax return (Form 1120S) and Schedule K-1 and W-2 if applicable, or Financial Status Form (farm or business) DOH- 4469

Take net profit from appropriate lines of schedules, and:

For LIF, Medically Needy (ADC-Related) and S/CC A/Rs, add back any depreciation, depletion, amortization or 179 expenses, deducted; or

For SSI-related A/Rs, because depreciation, depletion, amortization, 179 expenses are allowed, use net profit as gross income.

NOTE: One-half of self-employment tax as listed under Adjustments to Income on Form 1040, is an allowable deduction for all categories.

(income)(page-18)Page 18#

UPDATED: JANUARY 2012

116

INCOME EARNED

SELF-EMPLOYMENT OR SMALL BUSINESS INCOME

Do not allow personal expenses and entertainment, personal transportation, purchase of capital equipment to expand a business*,or payment on the principal of loans or mortgages. Depreciation, depletion, amortization and 179 expenses may be allowed for SSI- related A/Rs.

*NOTE: The repair or replacement of existing capital equipment is allowed.

Assume that all deductions taken on tax returns or business records are allowed by the IRS, unless there is conclusive evidence to the contrary.

If the annualized self-employment income indicates a loss (negative dollar amount), use zero income.

EXCEPTION: Within a single type of business, use zero income only when the tax return or business record indicates a cumulative loss, for example: an A/R has three rental properties; two show a net profit and one shows a net loss; use the loss to off-set the profits, and do not reduce the loss to zero unless the cumulative bottom line for the three properties is a negative dollar amount.

If tax returns are not available because the A/R indicates:

• that the business is new, and no federal tax return has yet been filed; or, • that last year’s tax return is not representative of the current year’s earnings; or, • that s/he does not file a tax return for the business,

then the Financial Status Form (DOH-4469) can be used to document the self-employment income.

(MRG)

(income)(page-19)Page 19#

UPDATED: JANUARY 2012

117

INCOME EARNED

SELF-EMPLOYMENT OR SMALL BUSINESS INCOME

Inasmuch as, the DOH-4469 reflects a three-month financial snapshot of a business, it is appropriate to allow a loss in one month to offset a profit in another month. When using an annualized business record such as a tax return a business loss is brought to zero, and cannot be used to reduce income from another source.

A/Rs are not required to supply actual bills and receipts to substantiate the income and expenses recorded on the Financial Status form (DOH-4469). The applicant’s certification on the bottom of the form, that the information is true and correct, is sufficient.

Documentation: Sufficient to establish an audit trail.

Disposition: When the gross business income is determined and the business expenses are determined and deducted, the resulting amount is earned income.

NOTE: The A/R’s income is evaluated against the maintenance picture of the A/R. (See OTHER ELIGIBILITY REQUIREMENTS FINANCIAL MAINTENANCE)

(MRG)

(income)(page-20)Page 20#

UPDATED: AUGUST 1999

118

INCOME EARNED

INCOME FROM ROOMERS (LODGERS) AND BOARDERS

Description: Income from roomers (lodgers) and boarders is payment received by the A/R for meals and/or lodging from other individuals residing in the home who are not members of the A/R’s Medicaid household.

Roomers (lodgers) rent a room or rooms and receive no meals as part of the rent. Boarders rent a room or rooms and receive meals as part of the rent.

Policy: The treatment of income from roomers and boarders varies depending on the category of the A/R. For all categories of assistance, if the A/R can document that actual expenses incurred in providing the room or board exceed the specified roomer/boarder deduction, the actual expenses are disregarded and any money received in excess of this documented amount is considered available income.

When an SSI-related A/R provides room and/or board as a business rather than as a convenience for relatives or friends, the income is considered to be earned income. Motels, hotels, rooming houses and boarding houses are considered businesses. If the SSI-related A/R does not provide room or board as a business, the income is treated as unearned income. For LIF, S/CC and ADC-related categories of assistance, roomer/boarder income is always treated as earned income.

References: SSL Sect.

366

Dept. Reg.

352.31(a)(3) 360-4.3 360-4.6(a)(1)(xviii)

Interpretation: To determine countable roomer/boarder income, the following roomer/boarder disregard is to be applied based on the category of the A/R.

$15 for S/CC and LIF - roomers (meals not included)

$60 for S/CC and LIF - boarders (meals included)

$90 for ADC-related and SSI-related roomers or boarders (meals may or may not be included)

(MRG)

(income)(page-21)Page 21#

UPDATED: AUGUST 1999

119

INCOME EARNED

INCOME FROM ROOMERS (LODGERS) AND BOARDERS

For all categories of assistance, if the individual can document that the actual expenses paid in providing room or board are greater then the allowable roomer/boarder disregard, the actual expenses are deducted.

In determining if the actual expenses paid in providing room and/or board exceed the monthly roomer/boarder deduction, the following expenses are deductible:

• property, school, water and sewer taxes; • utilities; • interest payments on mortgages; • cost of essential repairs; • food (if included in rent)

A person providing room/board as part of a business, may deduct allowable business expenses paid the same taxable year to the extent the expenses are attributable to the rented portion of the property.

The allowable expenses incurred in providing room and board are prorated based on the number of rooms designated for rent compared to the number of rooms (other than bathrooms) in the house.

If income received for room or board is less than the allowable expenses of providing room or board, the excess expenses are deducted from the next month’s roomer/boarder income.

When to Verify: (a) When the A/R declares in the application that s/he has income from roomers or boarders;

(b) When the A/R declares in the application that persons live with him/her who are not applying for assistance and who contribute to the support of the household;

(c) When the case record indicates that the A/R received income from roomers and/or boarders, but does not currently declare that s/he is receiving it.

(MRG)

(income)(page-22)Page 22#

UPDATED: AUGUST 1999

120

INCOME EARNED

INCOME FROM ROOMERS (LODGERS) AND BOARDERS

Verification: (a) Seeing a statement from the roomer and/or boarder as to the amount and frequency of his/her payment;

(b) Seeing any business records that the A/R may have maintained; and/or

Documentation: Sufficient to establish an audit trail:

(a) Name of the roomer or boarder, plus the amount and frequency of payment; and/or

(b) Copies of actual expense listing, if the costs are greater than categorical disregard.

(MRG)

(income)(page-23)Page 23#

UPDATED: AUGUST 1999

121

INCOME

UNEARNED

Description: Unearned income is income which is paid because of a legal or moral obligation rather than for current services performed. It includes pensions, government benefits, dividends, interest, insurance compensation and other types of payments.

Policy: The available net amount of unearned income, in addition to any other countable income, is compared to the appropriate income level.

References: SSL Sect. 366.2

Dept. Reg. 360-4.3 Interpretation: The following types of unearned income are described in detail in this section: Unemployment Insurance Benefits; NYS Disability Benefits and Workers' Compensation Social Security, Railroad Retirement, Veterans' Benefits; Dividends and interest; Private pensions/Retirement Funds; Union benefits; Support payments (voluntary and court-ordered); Contributions from relatives and friends; Income from rental of property; Military Dependency allotments; and Reverse Mortgages.

Unearned income is verified as to the amount, type and frequency, and the information is documented in the case record. Disposition: When the gross unearned income has been determined, disregards are deducted to result in available net unearned income. This, in addition to any other countable income, is then compared to the appropriate income level in determining eligibility for Medicaid.

(MRG)

(income)(page-24)Page 24#

UPDATED: JANUARY 2012

122

INCOME UNEARNED

UNEMPLOYMENT INSURANCE BENEFITS (UIB)

Description: Unemployment Insurance Benefits (UIB) are benefits to offset the loss of earned income for certain workers who have lost their jobs through no fault of their own. The program is administered by the New York State Department of Labor. The claimant applies by making a toll-free phone call or through an on-line process at the NYSDOL website. Benefits are paid by check. The amount of benefits is based upon income earned while employed.

Policy: UIB is countable unearned income.

NOTE: The American Recovery and Reinvestment Act (ARRA) of 2009 “Stimulus Bill”, Public Law 111-5 Section 2002 authorized additional unemployment insurance benefits (UIB) of $25 per week effective the period March 1, 2009 through the week ending December 12, 2010. The additional payment of $25 per week must be disregarded when determining retroactive, initial, and on-going eligibility for all Medicaid A/Rs receiving UIB.

Reference: INFs

88 INF-84

GISs

10 MA/024

09 MA/018

09 MA/012

When to Verify: (a) When the A/R indicates in the application that s/he has applied for, or is receiving UIB;

(b) When the A/R indicates in the application that s/he has recently been employed, but is now unemployed; (c) When the case record indicates that the A/R has been in receipt of UIB, but does not declare in the application that s/he is currently in receipt of UIB.

Verification: Benefits may be verified by:

(a) The Resource File Integration (RFI) WMS subsystem; (b) Seeing the benefit check; (c) Seeing the UIB claim award letter sent to the A/R detailing the status and amount of the claim; (d) Seeing a current on-line printout of UIB that the A/R can access with their unique password; or

(MRG)

(income)(page-25)Page 25#

UPDATED: JANUARY 2012

123

INCOME UNEARNED

UNEMPLOYMENT INSURANCE BENEFITS (U.I.B.)

(e) If none of the above is available and cannot readily be obtained by the A/R or additional information is needed, clear through the NYS Department of Labor (DOL) Unemployment Insurance On-line System. This system can be accessed through the county’s TTSS coordinator.

Documentation: Sufficient to establish an audit trail: (a) Screen print of the RFI WMS subsystem, filed in the case record;

(b) Date, number and amount of check;

(d) Returned clearance from the NYS UIB-MIS filed in the case record. Related Form: LDSS-3861 (UIB Current Inquiry) and LDSS-3936 (UIB Investigative Inquiry).

(MRG)

(income)(page-26)Page 26#

UPDATED: FEBRUARY 2005

124

INCOME UNEARNED

NEW YORK STATE DISABILITY INSURANCE BENEFITS, WORKERS' COMPENSATION AND SICK PAY

Description: (1) New York State Disability Insurance Benefits (DIB) are cash benefits to offset the loss of earned income for certain workers who are unable to work because of a non-job-related injury, disease, or condition. There are also cash benefits to offset the loss of Unemployment Insurance Benefit (UIB) for persons who are unemployed and are unable to accept employment because of illness or injury.

For employed persons and those unemployed less than four weeks, application is made to the employer. Medical verification is required. When the person is eligible, the employer's insurance carrier pays benefits bi-weekly by check.

For persons unemployed more than four weeks, application is made to the local office of the State Department of Labor. Medical verification is required. If eligible, benefits are paid bi-weekly by state check. (2) Workers' Compensation can be a cash benefit to offset the loss of earned income for certain workers who are unable to work because of a job-related injury or disease. It can also be a payment made directly to a medical provider for the cost of care required to treat a work related injury. Payments made directly to medical providers are not considered unearned income. Rather they are similar to third party health insurance payments. If the injury or disease results in death, the benefits may be paid to the surviving dependents of the worker. Benefits include all necessary medical care arising from the job-related injury or illness. A claim for Workers' Compensation is made with the employer. Medical verification is required.

Benefits are paid by either the employer or in most cases his/her insurance carrier on a bi-weekly basis or as a lump sum. Benefits may be either temporary or permanent, and either partial or total, dependent on the severity and prognosis of the injury or disease. Only the cash benefit to offset loss of earned income is considered unearned income.

(MRG)

(income)(page-27)Page 27#

UPDATED: FEBRUARY 2005

125

INCOME UNEARNED

NEW YORK STATE DISABILITY INSURANCE BENEFITS, WORKERS' COMPENSATION AND SICK PAY

(3) Sick Pay as Unearned Income are any payments made due to sickness and/or accident disability more than six months after the A/R stopped working because of that sickness or disability, is unearned income. Sick pay received during the first six months is earned income (See INCOME EARNED).

Policy: NYS DIB, Workers’ Compensation and sick pay are countable income.

When to Verify: When the A/R indicates in the application that s/he has applied for or is receiving DIB and/or Workers' Compensation Benefits;

When the A/R indicates in the application that s/he has recently been employed or has recently received UIB and indicates in the application that s/he is ill or injured;

When the case record indicates that the A/R was in receipt of DIB, Workers' Compensation and/or sick pay, but the A/R does not declare that s/he is currently receiving DIB, Workers’ Compensation and/or sick pay.

Verification: Benefits may be verified by:

Seeing the benefit check; Seeing a letter from the insurance carrier or the Workers' Compensation Board denying or terminating benefits; Clearing in writing through the usual local district procedure.

Documentation: Sufficient to establish an audit trail:

Date, number and amount of check, and name and address of payer (insurance or state fund);

Date and sender of letter, and disposition;

Returned clearance filed in case record.

NOTE: Workers' Compensation and New York State DIB and sick pay do not establish incapacity or SSI-related disability status for Medicaid purposes. A separate determination of incapacity or disability is done for A/Rs. (See CATEGORICAL FACTORS INCAPACITY)

(MRG)

(income)(page-28)Page 28#

(MRG)

UPDATED: AUGUST 1999

126

INCOME UNEARNED

SOCIAL SECURITY (RETIREMENT, SURVIVORS’ AND DISABILITY INSURANCE), RAILROAD RETIREMENT AND VETERANS’ BENEFITS

Description: 1) Retirement, Survivors’ and Disability Insurance (RSDI), commonly referred to as Social Security, is a federally administered program which provides cash benefits to offset the loss of earned income for retired, certified disabled workers and/or the dependents of the retired, disabled or deceased income earner.

2) Railroad Retirement cash benefits are paid to retired or certified disabled railroad workers and/or to the surviving dependents of retired, disabled or deceased railroad workers.

3) Veterans’ benefits are cash benefits paid to retired or disabled veterans and their dependents, or to surviving dependents of veterans.

References: ADM 93 ADM-31

Interpretation: 1) RSDI - Application for these benefits is made at a Social Security Administration district office. Verification of age, medical disability if under age 65, relationship and/or earnings may be required. Recipients may be eligible for Medicare Parts A and B.

When an individual is in RSDI claim status, s/he is identified by a Social Security Number with a benefit identification code suffix which describes his/her status. The following is a list of commonly used suffixes and the status which they describe:

Suffix Code Status A Primary Claimant B(1-9), (A-Y) Husband or wife of Primary Claimant C(1-9), (A-K) Child, includes minor child, disabled child, and student child D(1-9), (A-Z) Widow, widower, or surviving divorced spouse E(1-9), (A-M) Widowed parent or surviving divorced parent F(1-8) Parent, stepparent, adopting parents, second alleged parent J(1-4) Primary Prouty Benefit (Special over age 72)

(income)(page-29)Page 29#

(MRG)

UPDATED: AUGUST 1999

127

INCOME UNEARNED

SOCIAL SECURITY (RETIREMENT, SURVIVORS' AND DISABILITY INSURANCE), RAILROAD RETIREMENT AND VETERANS' BENEFITS

Suffix Code Status K(1-9) or KA-M Wife’s Prouty Benefit (Special over age 72) W(1-9) Disabled widow, disabled widower or surviving disabled divorced spouse

(2) Railroad Retirement Benefits - When the eligible employee is alive, all benefits, including dependents' benefits, are paid to him/her. Survivors' benefits are paid directly to the surviving dependents. Benefits are paid monthly. Beneficiaries are also potentially eligible for Medicare Parts A and B.

(3) Veterans' Benefits - The veteran may be retired, or partially or totally disabled by either a service connected or non-service connected disability.

Dependents or surviving dependents of veterans may also be entitled to benefits. In addition to cash benefits, eligible veterans and their dependents may receive educational benefits, medical and/or dental care. When a veterans' benefit paid to the A/R includes a dependent's benefit, only the portion of the benefit designated by the Veterans' Administration to the A/R is considered in determining the A/R's eligibility. If the dependent is not applying, his/her portion is disregarded.

NOTE: Even if a veteran is not eligible for cash VA payment, s/he may be eligible for medical care through the VA. (See OTHER ELIGIBILITY REQUIREMENTS VETERANS’ AFFAIRS REFERRAL) Availability of these medical benefits does not affect eligibility for Medicaid.

When to Verify: (a) When there is an indication either in the application or by a benefit suffix as listed above, that an A/R, a member of the applying household or a legally responsible relative is in benefit status for RSDI;

(b) When the A/R indicates in the application that s/he is 62 years of age or older;

(c) When the A/R declares on the application that s/he is widowed and 60 years of age or older and/or is caring for minor children;

(income)(page-30)Page 30#

UPDATED: AUGUST 1999

128

INCOME UNEARNED

SOCIAL SECURITY (RETIREMENT, SURVIVORS' AND DISABILITY INSURANCE), RAILROAD RETIREMENT AND VETERANS' BENEFITS

(d) When the A/R declares on the application that s/he is blind or disabled and the disability is permanent or is expected to last a year;

(e) When the A/R declares on the application that a spouse or the parent of a minor child under age 18 (or under age 19 if the child is still a student in secondary school) is deceased, retired or disabled;

(f) When the case record indicates that the A/R received RSDI, but the A/R does not indicate that s/he is currently in benefit status;

(g) When the A/R declares on the application that s/he or other family members are receiving Medicare;

(h) When the A/R declares on the application that s/he is receiving Railroad Retirement benefits;

(i) When the A/R declares on the application that s/he has been an employee of the railroad or is the dependent or surviving dependent of someone who has;

(j) When the case record shows that the A/R received Railroad Retirement benefits, but the A/R does not declare that s/he is currently receiving such benefits;

(k) When the A/R declares on the application that s/he is a veteran, the spouse of a veteran or the spouse of a deceased veteran or the child of a veteran;

(l) When the case record indicates that the A/R received veterans' benefits, but the A/R does not currently declare that s/he is receiving them.

Verification: Benefits from RSDI, Railroad Retirement, or the Veterans' Administration may be verified by:

(a) Seeing the Notice of Award or award letter;

(b) Seeing the current benefit check;

(MRG)

(income)(page-31)Page 31#

UPDATED: AUGUST 1999

129

INCOME UNEARNED

SOCIAL SECURITY (RETIREMENT, SURVIVORS' AND DISABILITY INSURANCE), RAILROAD RETIREMENT AND VETERANS' BENEFITS

(d) Obtaining necessary information on RSDI benefits from the Beneficiary Data Exchange (Bendex) which is available in each local district.

Documentation: Sufficient to establish an audit trail

(a) Date of award letter, amount of award and to whom paid;

(b) Date, amount and number of current benefit check;

NOTE: When an A/R is receiving a benefit, it is determined if a portion of the benefit or the entire benefit is intended for the support of a dependent.

(MRG)

(income)(page-32)Page 32#

UPDATED: JUNE 2011

130

INCOME UNEARNED

DIVIDENDS AND INTEREST

Description: Dividends and interest are returns on capital investments such as stocks, bonds, or savings accounts.

Policy: Dividends and interest are considered unearned income. Interest or dividend income from certain resources is exempt for SSI-related A/Rs under community budgeting, NOTE: Certain trust funds, which are unavailable as a resource may pay interest or dividends and, therefore, are carefully reviewed. Trust instruments are often very complicated documents. They may need to be reviewed by an attorney to determine the availability of the trust principal and any dividends or interest they may pay. (See RESOURCES TRUST FUNDS for treatment of trusts as resources.)

References: ADMs 11 OHIP/ADM-1

GISs

05 MA/01

04 MA/027

Interpretation: Except for interest or dividend income derived from certain resources for SSI-related A/Rs under community budgeting, income from dividends and interest is included with all other sources of income in the eligibility determination process. Dividends and interest often vary from month to month depending on deposits, withdrawals, or company profits. Since dividends and interest credited to an individual account are generally not reflected until the end of the quarter, local districts project the amount of monthly dividends or interest based on the most current information available. If dividends or interest are credited/paid quarterly, one third of the quarterly interest or dividend is counted as income each month. Interest or dividends credited on other than a monthly or quarterly basis generally are annualized and divided by twelve to determine a monthly amount.

NOTE: Account service fees or penalties for early withdrawal do not reduce the amount of dividend or interest income.

The following describes when dividends or interest are considered countable unearned income for categories other than SSI-related:

(MRG)

(income)(page-33)Page 33#

UPDATED: FEBRUARY 2005

131

INCOME UNEARNED

DIVIDENDS AND INTEREST

Series H/HH U.S. Savings Bonds - Series H/HH bonds pay interest semi-annually by check or electronic funds transfer. Count interest on these bonds as unearned income in the month available to the individual, either when the check is received or when the interest is electronically transferred to the individual’s account.

NOTE: Series E/EE U.S. Savings Bonds - Interest on series E/EE U.S. Savings Bonds is only available to the individual upon expiration of the minimum retention period. When series E/EE bonds are redeemed, the interest is to be counted as an increase in the value of the resource (it is not income).

Zero Coupon Bonds - Owners of zero coupon bonds do not receive interest payments, even though the accruing interest may be taxed by the Internal Revenue Service (IRS). Interest accrues on zero coupon bonds and is paid when the bond matures. The accrued interest is to be considered countable unearned income in the month the bond matures. It is not prorated. The equity value of the zero coupon bond is a countable resource.

Dividend Reinvestment - When an individual chooses to reinvest rather than receive interest or dividends on stocks, bonds or mutual funds, the reinvested interest or dividends is counted as unearned income in the month credited to the A/R’s account and available for use, and is an available resource the following month.

Capital Gains - Capital gains on property (e.g., stocks or real estate) are an increase in the value of the resource. A capital gain distribution outside of a trust is considered unearned income in the month received. A capital gain distribution within a trust is considered a part of the trust principal, unless specified otherwise in the trust. (See RESOURCES TRUST FUNDS) Capital gains distributions are generally made at the end of the year. Taxes or transaction fees are not deducted in determining the value of capital gains.

Life Insurance Policy - The dividends paid on a life insurance policy are not income. If the life insurance policy pays interest on dividends, the interest is income. (See RESOURCES LIFE INSURANCE)

(MRG)

(income)(page-34)Page 34#

UPDATED: FEBRUARY 2005

132

INCOME UNEARNED

DIVIDENDS AND INTEREST

Promissory Note or Other Loan Agreement - A promissory note held by the A/R pays interest or pays principal and interest in the same payment. The interest is unearned income.

Interest or dividend income derived from most resources is disregarded for SSI-related A/Rs.

Although most interest/dividends are treated as excludable income, there are some exceptions when interest and dividends are counted. Interest/dividend income is still countable for SSI-related A/Rs if generated by the following resources:

Retroactive SSI and Retirement, Survivors and Disability (RSDI) payments for nine months following the month of receipt;

Unspent State or local government relocation payments (but not federal or federally assisted funds) for nine months following the month of receipt;

Unspent tax refunds related to an earned income tax credit (EITC), paid either as a refund from the Internal Revenue Service or as an advance from an employer, or child tax credit (CTC) for the period beginning with the second calendar month following the month of receipt through the ninth month.

Excluded funds (i.e., from an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986 which is exempt from taxation under Section 501(a)) from gifts to children under 18 years of age with life threatening conditions, if the funds are an in-kind gift of any amount that is not converted to cash, or if cash gifts, up to $2,000 in any year; and

Unspent State victims’ crime compensation payments for nine months following the month of receipt.

(MRG)

(income)(page-35)Page 35#

UPDATED: NOVEMBER 2007

133

INCOME UNEARNED

DIVIDENDS AND INTEREST

NOTE: The SSI-related interest/dividend income exclusion only applies to community budgeting, not to chronic care budgeting, regardless of whether the resources are above or below the appropriate resource level.

Although some life insurance policies pay dividends, these dividends are generally treated as a resource.

Periodic payments received by an SSI-related A/R from an annuity and/or IRA continue to be treated as countable unearned income. Capital gain distributions (e.g. from mutual funds) noted on Internal Revenue Form 1099-DIV, Dividends and Distributions, whether paid as cash or reinvested, are to be treated as unearned income. (See GIS 04MA/027, page 2)

When to Verify: (a) When the A/R declares in the application that s/he receives dividends or interest.

(b) When the A/R declares in the application that s/he has bank accounts, stocks/bonds, trust funds, or life insurance.

(c) When the case record indicates that the A/R received income from dividends or interest, but the A/R does not now declare that it is being received.

(d) When the A/R declares membership in a credit union.

(e) When the Resource File Integration (RFI) report indicates that the A/R has income.

(f) If the A/R voluntarily reports a change in interest income. Verification: Income from dividends and interest can frequently be verified by seeing bankbooks, benefit check stubs, correspondence, etc. If the A/R is not able to obtain these records, they are cleared through the usual local district procedure with stockbrokers, life insurance companies, banks, mutual fund companies, etc. The local district obtains the consent of the A/R before it can obtain such information.

(MRG)

(income)(page-36)Page 36#

UPDATED: JUNE 2011

134

INCOME UNEARNED

DIVIDENDS AND INTEREST

Documentation: All Medicaid recipients who do not have a resource test may, at renewal attest to the amount of interest income generated by resources.

Districts must continue to review RFI reports to identify resources belonging to individuals who do not have a resource test to determine when a resource identified by RFI is significant enough to generate interest that would/could affect the individual’s eligibility. In such instances, the district must request documentation of the interest income and re-calculate eligibility as appropriate.

Districts are encouraged to minimize the scope of the investigation into resources.

Documentation must be sufficient to establish an audit trail:

• Include such facts as type of resource from which income is obtained, amount and frequency of payment and the name and address of person(s) or institution(s) making the payment and the type of documentation seen;

• In all cases, a returned clearance filed in the case record is adequate documentation if it includes the appropriate facts.

(MRG)

(income)(page-37)Page 37#

UPDATED: NOVEMBER 2007

135

INCOME UNEARNED

RETIREMENT FUNDS

Description: Retirement funds are annuities or work-related plans for providing income when employment ends (e.g., pension, disability, or other retirement plans administered by an employer or union). Other examples are funds held in an individual retirement account (IRA) and plans for self-employed individuals (e.g., Keogh plans). Also, depending on the requirements established by the employer, some profit sharing plans may qualify as retirement funds.

Medicaid A/Rs who are eligible for periodic retirement benefits must apply for those benefits to be eligible for Medicaid. Periodic retirement benefits are payments made to an individual at some regular interval (e.g., monthly, quarterly, annually), which result from entitlement under a retirement fund. An individual commonly selects a payment plan, and, generally, only an initial filing for benefits is needed.

An individual is eligible for periodic payments if he/she is authorized to receive distributions on a regularly scheduled basis without having a penalty assessed. An individual is not entitled to periodic payments if he/she is not permitted to take regularly scheduled withdrawals penalty free. Ordinary taxes are not considered a penalty. Once periodic payments are received, the periodic payments are unearned income, and the fund is not a countable resource.

An A/R, who ordinarily might not be eligible for benefits, may be able to access his/her retirement fund sooner, without incurring a penalty under certain circumstances. The circumstances can vary, depending on the type of account and rules for the specific retirement fund. Examples of possible situations: when an A/R may be able to receive periodic benefits without incurring a penalty, when the A/R is found to be disabled (a finding of disability), or when the withdrawal of distributions are considered as part of a series of substantially equal periodic payments. If an A/R can receive distributions from a retirement fund on a regularly scheduled basis without having a penalty assessed, the individual would be considered to be eligible for periodic payments. The A/R would be required to file for maximized periodic payments as a condition of Medicaid eligibility.

(MRG)

(income)(page-38)Page 38#

UPDATED: NOVEMBER 2007

136

INCOME UNEARNED

RETIREMENT FUNDS

If the individual has a choice between periodic payments and a lump sum, the individual must choose the periodic payments. The individual must apply for the maximum payment amount that could be made available over the individual’s lifetime. By federal law, if the Medicaid A/R has a living spouse, the maximum income payment option that is available will usually be less than the maximum income payment option available to a single individual. This provision applies to all Medicaid A/Rs.

NOTE: An individual who has met the minimum benefit duration requirement of a New York State Partnership for Long-Term Care (NYSPLTC) policy is not required to maximize income from a retirement fund. If, however, the amount of any interest earned since the purchase of the policy, which would have been added to the value of the retirement fund, is available to be withdrawn, a qualified NYSPLTC participant is required to pursue or cooperate in the pursuit of the amount of the income payments. This requirement applies to a qualified NYSPLTC participant who is subject to chronic care budgeting. It does not apply under community budgeting. Non- applying spouses/parents are not required to apply for periodic payments or to maximize income from a retirement fund.

References: GIS

98 MA/024

When to Verify: When the A/R indicates s/he receives a pension or retirement benefit.

When the A/R has left his/her employment and is retired or disabled.

When the record indicates that the A/R received a pension or retirement benefit in the past. When the Resource File Integration (RFI) report indicates that the A/R has income.

When the A/R indicates that s/he has group health insurance.

When the A/R's bank records indicate recurring electronic deposits.

(MRG)

(income)(page-39)Page 39#

UPDATED: AUGUST 1999

137

INCOME UNEARNED

RETIREMENT FUNDS

Verification: Benefits from pensions may be verified by:

(a) Seeing the benefit check;

(b) Seeing a benefit award letter;

(c) If neither of the above are available or cannot readily be obtained, clear through the usual local district procedure.

Documentation: Sufficient to establish an audit trail:

(a) Date, amount and number of benefit check and name of payor;

(b) Date, amount of benefit and name of organization paying pension.

NOTE: An A/R with low income and large recurring medical bills may not be required to pay income tax or may pay income tax at a reduced rate. A/Rs may elect to change or revoke the amount of federal income tax withheld from their pensions. The A/R may complete the appropriate IRS form and file it with the IRS.

(MRG)

(income)(page-40)Page 40#

UPDATED: AUGUST 1999

138

INCOME UNEARNED

UNION BENEFITS (OTHER THAN PENSIONS)

Description: Union benefits are payments received by the A/R from labor organizations during strikes, lockouts, periods of unemployment or periods of disability. Many unions have strike funds, layoff funds or health and welfare funds that pay benefits to members when they are not working. These vary considerably in amount and availability by such factors as the type of union, the number of members out of work and the reason for the unemployment.

Policy: Union benefits are countable unearned income.

When to Verify: (a) When the A/R declares in the application that s/he is in receipt of union benefits;

(b) When the A/R declares in the application that s/he was recently employed and declares in the application that s/he is a past or present union member;

(c) When the case record indicates that the A/R received union benefits, but the A/R does not now declare that s/he is receiving them.

(d) When the Resource File Integration (RFI) report indicates that the A/R has income.

Verification: Union benefits may be verified by: (a) Seeing the benefit check;

(b) Seeing a statement of benefits or correspondence from the union relating to benefits;

(c) If neither of the above are available or cannot readily be obtained, clear through the usual local district procedure.

Documentation: Sufficient to establish an audit trail: (a) Date and amount of check, name and address of union;

(b) Date and type of correspondence, amount of benefit;

(MRG)

(income)(page-41)Page 41#

UPDATED: JUNE 2010

139

INCOME UNEARNED

SUPPORT PAYMENTS (VOLUNTARY AND COURT-ORDERED)

Description: Support payments are payments made to the A/R by a legally responsible relative or a divorced spouse. (See OTHER ELIGIBILITY REQUIRMENTS LEGALLY RESPONSIBLE RELATIVES (LRRS)) Support payments may be either court-ordered or voluntary. Voluntary payments of support in some cases are formalized by agreements in writing, but in other cases are highly informal and may vary in amount. Court-ordered support payments are an amount specified by a court order.

Policy: Support payments (voluntary and court-ordered) are countable unearned income. If an applicant is receiving voluntary support payments, s/he is referred to the Child Support Enforcement Unit (CSEU), unless the applicant is otherwise exempt.

The first $100 of court-ordered support received is disregarded from the A/R’s income.

References: SSL Sect.

366.3

Dept. Reg.

360-3.2 360-4.3 360-4.6 360-7.4

ADMs

93 ADM-21 92 ADM-40 91 ADM-40 84 ADM-43 79 ADM-82

Interpretation: To what extent support payments are considered in determining eligibility for Medicaid depends on the category of the A/R (see categorical disregards). If the amount being received in support is less than the court-ordered amount, a referral is made to the Child Support Enforcement Unit (CSEU), unless the applicant is pregnant or one of the other exceptions exists. When determining eligibility for a retrospective period, budget the actual support payments received. When determining eligibility for a prospective period, an average anticipated weekly support amount is established. Generally, the A/R's support for the four weeks preceding the determination is averaged. If the A/R received exceptionally high or low support payments for any of the four weeks, those weeks are not used in calculating the average.

(MRG)

(income)(page-42)Page 42#

UPDATED: AUGUST 1999

140

INCOME UNEARNED

SUPPORT PAYMENTS (VOLUNTARY AND COURT-ORDERED

When to Verify: (a) When the A/R declares in the application that s/he is receiving support payments;

(b) When the A/R declares in the application that s/he has a spouse living elsewhere;

(d) When the case record indicates that the A/R received support payments, but the A/R does not now declare that s/he is receiving them;

(e) When the Resource File Integration (RFI) report indicates that the A/R has income.

Verification: If a support agreement is in existence, the terms of the agreement are verified as well as the effective date. If drawn up by an attorney, the name of the attorney is included. If the support is court-ordered, the amount ordered is verified as well as the amount actually being paid. The amount received or ordered may be verified by: (a) Seeing the court order for either paternity, support or alimony; or if this is not readily available or cannot easily be obtained, communicating in writing with the appropriate court or probation office to obtain the necessary information;

(b) Seeing a support payment check;

(d) Seeing the attorney’s records;

(MRG)

(income)(page-43)Page 43#

UPDATED: AUGUST 1999

141

INCOME UNEARNED

SUPPORT PAYMENTS (VOLUNTARY AND COURT-ORDERED)

Documentation: Sufficient to establish an audit trail:

(a) Copy of court order, if available;

(b) Name of court ordering the support, name of the person who is ordered to pay, date and amount of the order, docket number, name of person for whom the support is intended;

(d) Amounts and dates of payment and the source of the information, such as payment checks, statement of the person making the payment, etc.;

(e) Returned clearance filed in the case record;

(f) Written or phone verification from Support/Collection unit.

(MRG)

(income)(page-44)Page 44#

UPDATED: AUGUST 1999

142

INCOME UNEARNED

CONTRIBUTIONS FROM NON-LEGALLY RESPONSIBLE RELATIVES AND FRIENDS

Description: Cash contributions from relatives and friends who are not legally responsible, when such contributions are not in return for work performed, are considered unearned income. (See INCOME INKIND INCOME for a discussion of in-kind income and INCOME EARNED for a discussion of earned income.)

Policy: Cash contributions may be countable unearned income when such contributions are not in return for work performed. (See INCOME SSI- RELATED DISREGARDS for SSI-related income disregards)

References: Dept. Reg.

352.16(a)

Interpretation: Since payments of this type are based only on the relative or friend’s willingness or ability to pay, they frequently are irregular. A local district decision is required as to whether and in what amount they are to be considered. While benefits are verified and documented, this should not be pursued to the point where it jeopardizes continued receipt of the contribution. The obligation is not a legal one and the person who is paying may not be willing to put the information in writing. In these instances, the circumstances and the basis for making the decision, as well as any statement are recorded in the case record.

When to Verify: (a) When the A/R declares in the application that s/he receives income from friends or non-legally responsible relatives;

(b) When the case record indicates that the A/R received contributions from friends or non-legally responsible relatives, but the A/R does not declare that it is now being received;

(c) When the maintenance picture is unclear, that is, when expenses seem to exceed the income that the A/R claims to be available.

Verification: (a) Seeing the payment check;

(b) Seeing a signed statement from the person providing the income;

(MRG)

(income)(page-45)Page 45#

UPDATED: AUGUST 1999

143 INCOME UNEARNED

CONTRIBUTIONS FROM NON-LEGALLY RESPONSIBLE RELATIVES AND FRIENDS

Documentation: Sufficient to establish an audit trail:

(a) Amount, date of check, frequency and regularity and person paying (name and address);

(b) Date of statement, amount, frequency and regularity, name, address and relationship of person paying;

(MRG)

(income)(page-46)Page 46#

UPDATED: AUGUST 1999

144

INCOME UNEARNED

RENTAL INCOME

Description: Rent is a payment that an individual receives for the use of real or personal property, such as land, housing or machinery. Net rental income is gross rent less the ordinary and necessary expenses paid in the same taxable year.

Policy: For SSI-related A/Rs, net rental income is unearned income unless it is earned income from self-employment (e.g., someone who is in the business of renting properties).

For S/CC, LIF and ADC-related A/Rs, net rental income is earned income.

References: SSL Sect.

366

Dept. Reg.

360-4.3 (d)

Interpretation: For SSI-related A/Rs: income received from non-business rental property is considered unearned income after allowable expenses have been deducted. For LIF, S/CC and ADC-related A/Rs: income received from non- business rental property is considered earned income after allowable expenses have been deducted. (See RESOURCES REAL PROPERTY and REAL PROPERTY INCOME-PRODUCING)

Ordinary and necessary expenses are those necessary for the production or collection of rental income. Examples of deductible expenses are:

(1) Property, school, water and sewer taxes;

(2) The cost of utilities if they are included in the rent;

(3) The cost of fire, windstorm, flood, theft and liability insurance; (4) Interest payments on mortgages for such property;

(5) The cost of essential repairs on such property (i.e., minor correction to an existing structure);

(6) Wages paid to employees for maintaining the property;

(MRG)

(income)(page-47)Page 47#

UPDATED: NOVEMBER 2007 145

INCOME UNEARNED

RENTAL INCOME

(7) Advertising for tenants;

(8) Any other expenses essential to maintaining the property (lawn care/snow removal).

Examples of non-deductible expenses:

(1) Payments on the principal of mortgages;

(2) Improvements to the property (i.e., an expense for an addition or increase in the value of the property);

(3) Any other expenses which are not directly related to maintaining the property.

NOTE: Depreciation or depletion of property is not a deductible expense from rental income.

Expenses are deducted when paid, not when incurred.

When the rental property is also the A/R’s homestead (i.e., two-family residence), the allowable expenses is prorated based on the number of units designated for rent compared to the total number of units.

Rental deposits are not income to the landlord while subject to return to the tenant. Rental deposits used to pay rental expenses become income to the landlord at the point of use.

When to Verify: (a) When the A/R declares in the application that part of his/her own home is rented out;

(b) When the A/R declares in the application that s/he receives income from rent;

(MRG)

(income)(page-48)Page 48#

UPDATED: AUGUST 1999

146

INCOME UNEARNED

RENTAL INCOME

(d) When the case record indicates that the A/R received income from rent, but s/he does not now declare that s/he is receiving it. Verification: Income from rental property may be verified in a number of ways: (a) seeing a lease or other rental agreement;

(b) Seeing documents in the A/R’s possession, including copies of bills, receipts for payments received, ledgers and income tax records may be seen;

Expenses for rental property may be verified by seeing bills or receipts for interest, taxes, insurance, utilities or repairs or by statements from the individuals or organization which received those payments. Any of the above may be cleared in writing through the usual local district procedure if the A/R is unable to provide verification. Documentation: Sufficient to establish an audit trail: (a) Name of tenants, amount and frequency of payment and document seen;

(b) Type, amount and frequency of expense and document seen;

Disposition: Rental income is determined. Business expenses are deducted to determine net rental income. This net amount is then budgeted according to the category of the A/R.

(MRG)

(income)(page-49)Page 49#

UPDATED: AUGUST 1999

147

INCOME UNEARNED

MILITARY DEPENDENCY ALLOTMENT

Description: Military dependency allotments are payments received by the A/R for support while a legally responsible relative (or sometimes another relative) is on active service with the armed forces. Military dependency allotments are received monthly as a government check.

Policy: Military dependency allotments are countable unearned income.

References: Dept. Reg.

360-4.3

Interpretation: Persons in active military service can make allotments of military pay and allowances to spouses, former spouses, other dependents, and relatives who are not designated legally as dependents. When these allotments are received by an A/R, they are counted as unearned income.

NOTE: Third party insurance benefits are available to dependents of active military personnel (CHAMPUS) and are used for medical expenses before Medicaid is used. (See RESOURCES THIRD PARTY RESOURCES)

When to Verify: (a) When the A/R declares in the application that a military dependency allotment is being received;

(b) When the A/R declares in the application that a spouse and/or parent who is living elsewhere is in the military service;

(c) When the case record indicates that the A/R received military payments, but does s/he not currently declare that s/he is receiving them.

Verification: (a) Seeing the benefit check;

(b) Seeing correspondence about the allotment;

(MRG)

(income)(page-50)Page 50#

UPDATED: AUGUST 1999

148

INCOME UNEARNED

MILITARY DEPENDENCY ALLOTMENT

Documentation: Sufficient to establish an audit trail:

(a) Date and amount of check;

(b) Date and type of correspondence, amount of allotment, armed forces serial number, any other file or reference numbers;

(MRG)

(income)(page-51)Page 51#

UPDATED: AUGUST 1999

149

INCOME UNEARNED

REVERSE MORTGAGES

Description: A homeowner can convert home equity into cash without moving out of the home through a variety of home equity conversion plans. The home is either sold or mortgaged, but remains occupied by the homeowner until a future date or the death of the homeowner.

Under a reverse mortgage (RM), the homeowner borrows up to a fixed percentage of the appraised value of the home, for a set period of time, usually five to ten years. The funds borrowed are generally paid to the homeowner monthly. Repayment of the loan and any accrued interest is not due until the end of the loan term, the death of the borrower, or the sale of the property. A reverse annuity mortgage (RAM) is an RM in which the funds borrowed are paid to the homeowner through the purchase of an annuity.

Policy: For LIF, S/CC and ADC-related A/Rs, both RMs and RAMs are disregarded as income and resources.

For SSI-related A/Rs, an RM is generally disregarded as income and countable as a resource if retained beyond the month received. However, if the RM is a RAM, the annuity payments are unearned income in the month received and a resource thereafter.

References: SSL Sect.

366.1 366.2

Documentation: Sufficient to establish an audit trail:

(a) Reverse Mortgage Agreement - date, amount, terms, name of lender;

(b) Reverse Mortgage Annuity - date, amount, terms, name of lender.

(MRG)

(income)(page-52)Page 52#

UPDATED: NOVEMBER 2007 150

INCOME UNEARNED

IN-KIND INCOME

Description: In-kind income is received in goods or services rather than in cash. It can either be earned or unearned.

Policy: The value of goods and services is considered in determining eligibility for Medicaid only when they are provided by a legally responsible relative living outside the household or in return for services rendered.

NOTE: Clothing received by an SSI-related A/R from a legally responsible relative is not countable as in-kind income. If the clothing is received from an employer instead of cash, the value of the clothing is counted as in-kind earned income.

When persons other than legally responsible relatives provide goods or services to the A/R and the A/R has not provided any services in return for these goods or services, the in-kind income is not considered in determining eligibility for Medicaid.

References: SSL Sect.

366.2

Dept. Reg.

352.17 360-4.3 (e)

ADMs

84 ADM-21

GIS

05 MA/029

Interpretation: To evaluate if in-kind income is countable, local districts determine the relationship of the A/R to the person providing the goods or services and whether or not the A/R performs any services to earn the in-kind income.

In-kind income might include free lodging, meals, groceries or farm produce. In-kind income may be received by itself or together with income in cash as in the case of certain employed persons (e.g., dishwasher who receives wages and meals in compensation for his/her services).

The value of in-kind income is based upon the fair market value of the goods or maintenance received by the A/R. The fair market value is the dollar amount that an individual would receive if the goods or maintenance were sold on the open market in the A/R's local area.

(MRG)

(income)(page-53)Page 53#

UPDATED: NOVEMBER 2007

151

INCOME UNEARNED

IN-KIND INCOME

The fair market value of in-kind income, other than shelter, may also be determined by obtaining a statement from the person providing the in-kind income. The statement should specify the dollar value of the goods or maintenance provided.

In-kind income that is provided by persons other than legally responsible relatives for whom the A/R has not rendered a service is not considered in determining eligibility for Medicaid. This type of in- kind income includes donations from relatives (who are not legally responsible, as well as from friends or charitable and civic organizations. See INCOME UNEARNED CONTRIBUTIONS FROM NON-LEGALLY RESPONSIBLE RELATIVES AND FRIENDS for monetary donations.)

In instances where the A/R is a member of a communal organization or religious order which provides in-kind goods and services (e.g., meals, housing, personal items, clothing, etc.), the value of such in- kind goods and services is counted in the determination of eligibility.

In the absence of a clearly established fair market value for the goods and services provided (e.g., goods are purchased in bulk, members live in dormitory settings, etc.), the value of the goods and services provided is determined by reference to the local district-specific schedule for shelter, utilities, day care, food stamps, etc. This comparison provides a reasonable basis for evaluating the value of the goods and services without the necessity of determining the fair market value of such goods and services in each instance. The value of in-kind income for shelter cannot exceed the maximum Public Assistance allowance for shelter, based on the living arrangements of the A/R.

When to Verify: (a) When the A/R declares in the application that food, shelter, or other needs are provided by another person or organization;

(b) When the A/R declares in the application that s/he shares housing arrangements or lives with another person;

(MRG)

(income)(page-54)Page 54#

UPDATED: NOVEMBER 2007

152

INCOME UNEARNED

IN-KIND INCOME

(c) When the A/R declares in the application that s/he lives in the employer's house or the employer pays rent for the A/R's living accommodations;

(d) When the A/R declares that his/her landlord and employer are the same;

(e) When the A/R is employed where meals are prepared and served; or

(f) When the A/R declares his/her occupation to be any occupation in which accommodations and/or meals are likely to be provided (building superintendent, tenant farmer, farm laborer, live-in domestic worker).

Verification: (a) Seeing pay envelopes, check stubs, or wage statements;

(b) Obtaining employer's statement as to what is provided as part of the compensation for the job and the dollar value of such compensation;

(c) Obtaining a dated statement from the person or group providing in-kind income specifying his/her relationship, if any, to the A/R, what compensation is provided and whether or not the A/R performs any services in return for the compensation;

(d) Seeing a copy of a court order that included in-kind support; or

(e) Seeing a statement from the legally responsible relative specifying what goods or services are provided and the frequency with which they are provided.

Documentation: Sufficient to establish an audit trail:

(a) Name and address of employer, person, or organization providing the in-kind income, and a statement as to what is provided, the relationship, if any, to the A/R and the terms and frequency of the arrangement;

(MRG)

(income)(page-55)Page 55#

UPDATED: NOVEMBER 2007

153

INCOME UNEARNED

IN-KIND INCOME

(b) The basis of the local district’s decision as to the amount to be budgeted as income to the A/R for the goods and services provided by the employer or the legally responsible relative ; or

(c) Name of court, docket number, date of order, terms, and name of the legally responsible relative when such in-kind income is ordered by the court.

(MRG)

(income)(page-56)Page 56#

UPDATED: JUNE 2010

154

INCOME UNEARNED

LUMP SUM PAYMENTS

Description: Lump sum payments are deferred or delayed payments. They include, but are not limited to benefit awards, bonuses, year-end profit sharing, severance pay, and retroactive pay increases.

Policy: All lump sum payments are reviewed to determine if they are available and countable. (See OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILTY) Lump sum payments as a result of employment, such as bonuses, retroactive pay increases and severance pay are considered earned income. Lump sum payments such as benefit awards from railroad retirement or Social Security are unearned income.

Essential expenses incurred when attaining a payment are deducted from that payment. Essential expenses are deducted from the first and any subsequent payments until the expenses are met. When an A/R receives a retroactive payment from a benefit program, other than SSI, legal fees connected with the claim are deducted.

Countable lump sum payments are considered income in the month received. To determine if a lump sum payment is disregarded as income consult the disregards section. (See INCOME LIF DISREGARDS, INCOME ADC-RELATED DISREGARDS, and INCOME S/CC DISREGARDS)

Certain lump sum payments are exempt or excluded as a resource in the month received. To determine if a lump sum is disregarded or excluded as a resource in the month of receipt, consult the resource disregards section. (See RESOURCES SSI-RELATED RESOURCE DISREGARDS)

References: SSL Sect. 366.2

ADMs OMM/ADM 97-2

92 ADM-11

(MRG)

(income)(page-57)Page 57#

UPDATED: JULY 2008

155

INCOME UNEARNED

LUMP SUM PAYMENTS

Interpretation: After allowable deductions, countable lump sum payments are considered income in the month received. The lump sum is combined with any other countable income. Allowable disregards are subtracted. The remaining income is compared to the appropriate income level. (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS) Any excess income is considered available to meet the cost of medical care and services.

When to Verify: When the A/R indicates that s/he recently received a benefit award, bonus, year-end profit share, retroactive pay increase, or other lump sum.

When the A/R indicates that s/he is anticipating a lump sum payment.

When the record indicates that the A/R has applied for a benefit and may be eligible for a retroactive payment.

When the Resource File Integration (RFI) report indicates that the A/R has income.

Verification/ Documentation: Sufficient to establish an audit trail:

• Lump sum payments are verified. State computer matches are reviewed to determine the source of income.

• The amount, date and source of all lump sums are documented. The preferred forms of verification/documenta- tion are checks, check stubs, award letters, or other written statements from the payer of the lump sum.

(MRG)

(income)(page-58)Page 58#

UPDATED: JUNE 2010

156

INCOME UNEARNED

WINDFALLS

Description: Windfall payments are one-time only payments. They include, but are not limited to, lottery winnings, gifts and court settlements. Policy: Treatment of windfall payments, in the month of receipt, varies depending on the category of the A/R. When determining eligibility for LIF and ADC-related A/Rs, windfall payments are generally considered countable resources in the month received. When determining eligibility for SSI-related and S/CC A/Rs, windfall payments are considered countable income in the month received.

Essential expenses incurred when attaining a payment are deducted from that payment. Essential expenses are deducted from the first and any subsequent payments until the expenses are met. From a payment received for damages in connection with an accident: legal, medical, and other expenses connected with the accident are allowable deductions.

When any or all of a windfall payment is retained beyond the month of receipt, it is considered a resource, regardless of the A/R's category.

References: SSL Sect. 366.2.

ADMs OMM/ADM 97-2

92 ADM-11

Disposition: For LIF and ADC-related A/Rs, in the month of receipt and thereafter (if the windfall or part of it is retained), the amount of the windfall payment is a resource. (See RESOURCES EXCESS RESOURCES for rules regarding the treatment of excess resources.)

For SSI-related and S/CC A/Rs, windfall payments are considered income in the month of receipt. The windfall is combined with any other countable income. Allowable disregards are subtracted. The remaining income is compared to the appropriate income level.

When an SSI-related or S/CC A/R retains any or all of a windfall payment beyond the month of receipt, it is considered a resource. For SSI-related A/Rs, the windfall together with other countable resources is compared to the appropriate resource level.

(MRG)

(income)(page-59)Page 59#

UPDATED: JANUARY 2011

157

INCOME UNEARNED

INDIVIDUAL SUPPORT SERVICES DISREGARD

Description: The Individual Support Services (ISS) program under the Office for People with Developmental Disabilities (OPWDD) assists people remaining in or being placed into the community to help meet their needs. ISS provides assistance to help individuals achieve or maintain self-sufficiency, including reduction or prevention of dependency, and to prevent or reduce inappropriate institutional care.

Policy: ISS payments are disregarded in determining eligibility for Medicaid for all categories.

References: INF

95 INF-23

(MRG)

(income)(page-60)Page 60#

UPDATED: JULY 2008

158

INCOME

INCOME LEVELS

Description: Income levels are the amount of income a person or household can retain and still be eligible for Medicaid.

Policy: In determining eligibility for Medicaid, an A/R’s net available income is compared to the appropriate Medicaid level or standard. An A/R’s income may be compared to more than one income level or standard.

References: SSL Sect.

366

369-ee

Dept. Reg.

352 360-4.3 360-4.6 360-4.7(b)

GISs

08 MA/022

05 MA/013

04 MA/031

Interpretation: Generally, the amount of the income level or standard increases as the size of the household increases. Persons who are ADC-related, SSI-related, under age 21, pregnant, stepparents, and/or fathers of unborns with no children of their own in the household are allowed the Medically Needy income level, or the Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial. In some instances (pregnant women and some children), the federal poverty levels are used.

Persons who are SCC-related and LIF are allowed the Medicaid Standard.

Pregnant women and children under age 19 are allowed the Medicaid expanded levels (federal poverty levels). Family Health Plus, Medicaid Buy-In Program for Working People with Disabilities, Medicare Savings Program and Family Planning Benefit Program A/Rs are allowed the applicable percentage of the federal poverty level.

Disposition: Net available income is compared to the appropriate income level to determine eligibility for Medicaid. For some persons, income in excess of the level is available to meet the cost of medical care and services as determined according to Department regulations. (See INCOME EXCESS)

(MRG)

(income)(page-61)Page 61#

UPDATED: JULY 2008

159

INCOME

INCOME LEVELS

The following subjects are covered in this section:

o Medically Needy Income Level o Medicaid Standard o Federal Poverty Levels (FPL) Medicaid Expanded Levels Medicare Savings Program Family Health Plus (FHPlus) Family Planning Benefit Program (FPBP) Medicaid Buy-In for Working People with Disabilities (MBI-WPD).

(See CATEGORICAL FACTORS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES (MBI-WPD) for the federal poverty level allowed for MBI-WPD A/Rs)

(MRG)

(income)(page-62)Page 62#

UPDATED: JULY 2008

160

INCOME

MEDICALLY NEEDY INCOME LEVEL

Policy: The medically needy income level is used to determine eligibility for all categories except S/CC and LIF.

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels.

References: SSL Sect.

101

101-a

365 366

Public Law

94-48

94-603

92-603

Dept. Reg.

360-1.4 (r)

360.7 (d)

360.4.1 (b)

360-4.3 360.4.3 (f) 360-4.6 360-4.7(b) 360-4.8 (a) (c)

ADMs

06 OMM/ADM-4

05 OMM/ADM-4

05 OMM/ADM-2

04 OMM ADM-5

04 OMM/ADM-2

03 OMM/ADM-4

02 OMM/ADM-7

02 OMM/ADM-1

01 OMM/ADM-1

99 OMM/ADM-3

98 OMM/ADM-28

98 OMM/ADM-6

(MRG)

(income)(page-63)Page 63#

UPDATED: JULY 2008

161

INCOME

MEDICALLY NEEDY INCOME LEVEL

GISs

08 MA/022

07 MA/005

06 MA/029

06 MA/006

05 MA/047

05 MA/045

05 MA/027

05 MA/013

05 MA/011

04 MA/030

04 MA/031

03 MA/006

03 MA/005

02 MA/029

02 MA/018

02 MA/010

02 MA/008

Interpretation: Determine the A/R's household size and net available monthly income in accordance with the A/R's category. For A/Rs who are ADC- related, SSI-related, under age 21, pregnant, stepparents, and/or fathers of unborns with no children of their own in the household the net available income is compared to the Medically Needy Income level or the Medicaid Standard, (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial.

(MRG)

(income)(page-64)Page 64#

UPDATED: JUNE 2010

162

INCOME

MEDICAID STANDARD

Policy: The Medicaid Standard is used to determine eligibility for Singles Childless Couples (S/CC) and Low Income Family (LIF) categories.

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Standards and Federal Poverty Levels.

References: GIS 08 MA/022

Interpretation: Determine the A/R's household size and net available monthly income in accordance with the A/R's category. For A/Rs who are LIF or S/CC, the net available income is compared to the Medicaid Standard (and MBL Living Arrangement Chart as appropriate).

Medically Needy A/Rs will have their net available monthly income compared to the Medically Needy Income level or the Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial.

Effective April 1, 2008, the Medicaid Standard is used to determine Medicaid eligibility for single individuals and childless couples, regardless of their living arrangement, since medical care is now considered an unmet need. Therefore, it is not necessary to determine if there is an unmet need.

When the A/R resides in specified living arrangements, a water allowance and/or a special shelter amount is added to the Medicaid Standard. (See REFERENCE MBL LIVING ARRANGEMENT CHART to determine when such items should be added to the Medicaid Standard)

NOTE: A request for documentation of a water bill shall be made when the additional allowance affects eligibility under the LIF and S/CC categories. If documentation of a water bill is not provided, the A/R must be budgeted without the additional allowance.

(MRG)

(income)(page-65)Page 65#

UPDATED: JANUARY 2012

163

INCOME FEDERAL POVERTY LEVELS

MEDICAID EXPANDED INCOME LEVELS

Policy: The expanded income levels represent 100%, 133% and 200% of the federal poverty level (FPL). They are used to determine eligibility as follows:

• pregnant women - 100% or 200% (See CATEGORICAL FACTORS PREGNANCY and OTHER ELIGIBLITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY PREGNANT WOMEN); • infants under the age of one (1) - 200% • children between the age of one (1) and eighteen (18) - 133%

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels.

References: SSL Sect.

366.4 (m), (n) and (o)

Dept. Reg.

360-4.1(b) 360-4.7(b) 360-4.8(a)

ADMs

06 OMM/ADM-4

05 OMM/ADM-2

98 OMM/ADM–6

90 ADM-42

90 ADM-9

GISs

11 MA/021

07 MA/005

06 MA/029

06 MA/006

05 MA/045

05 MA/013

05 MA/011

02 MA/008

Interpretation: When determining eligibility under the Medicaid expanded income levels, household size is determined by counting those applying, their legally responsible relatives and any siblings under age 21 residing with them, whether or not the siblings are applying (See OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION, HOUSEHOLD SIZE FOR POVERTY LEVEL PROGRAMS (PREGNANT WOMEN AND CHILDREN).

(MRG)

(income)(page-66)Page 66#

UPDATED: JULY 2008

164

INCOME FEDERAL POVERTY LEVELS

MEDICAID EXPANDED INCOME LEVELS

When the A/R is pregnant and the pregnancy is medically verified, the household size is increased by one, effective the month of conception or three months prior to the month of application, whichever is later.

When determining eligibility for a pregnant woman, appropriate income disregards (See INCOME ADC-RELATED DISREGARDS) are subtracted before comparing the remaining income to the Medically Needy Income level, the Medicaid Standard, or 100% of the federal poverty level, whichever is higher/most beneficial. When the A/R's household income is equal to or less than the appropriate level, the pregnant woman and any children under age 19 are fully eligible for Medicaid. If the pregnant woman’s income exceeds 100% FPL, compare to 200% FPL. When the A/R's family income is equal to or less than 200% FPL, the pregnant woman is eligible for Medicaid coverage of perinatal services. Perinatal care includes all Medicaid services necessary to promote a healthy birth outcome from the determination of pregnancy through the postpartum period. A pregnant woman whose income exceeds 200% FPL must spend down to the medically needy level to be eligible.

When determining eligibility for an infant under age one, subtract the appropriate income disregards. The household income of the infant is compared to the Medically Needy Income level or the Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial. If ineligible under that level, household income is then compared to 200% of the poverty level. The infant under one is fully eligible for Medicaid if household income is equal to or less than 200% of the poverty level.

When determining Medicaid eligibility for a child from the age of one (1) through 18, the household income of the child, after appropriate disregards, is compared to the Medically Needy Income level or the Medicaid Standard, (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial. If income exceeds the appropriate level, compare to 133% of the poverty level. A child under the age of 19, with household income

(MRG)

(income)(page-67)Page 67#

UPDATED: JANUARY 2012

165

INCOME FEDERAL POVERTY LEVELS

MEDICAID EXPANDED INCOME LEVELS

above 133% of the federal poverty level must spend down to the medically needy income levels to be eligible for Medicaid coverage.

It may be necessary to compare the household income to several levels to determine Medicaid eligibility.

For example: Household Composition - Pregnant Mother Child A age 10 months Child B age 16 years

All members of the household are applying. The mother is employed. After applicable deductions, her income is at 200% of the poverty level for a household of four. The mother is eligible for Medicaid coverage of perinatal services. Child A is eligible for full Medicaid coverage. Child B is not eligible.

NOTE: Pregnant women, infants and children under age 19 cannot spend down to their applicable percentage of the poverty level to achieve eligibility. A pregnant woman with income between 100% and 200% of the federal poverty level is eligible for Medicaid covered ambulatory prenatal services. Ambulatory Prenatal Care includes all outpatient Medicaid services necessary to promote a healthy birth outcome. She must spend down to the medically needy income level to be eligible for full Medicaid coverage. An infant, under one (1) year of age, with household income above 200% of the federal poverty level and children under age 19 with household income above the applicable percentage of the federal poverty level must spend down to the Medically Needy Income level to be eligible for full Medicaid coverage.

(MRG)

(income)(page-68)Page 68#

UPDATED: JUNE 2010

166

INCOME FEDERAL POVERTY LEVELS

MEDICARE SAVINGS PROGRAM

Policy: Certain A/Rs who receive Medicare may be eligible for Medicaid to pay the Medicare premium, coinsurance and deductible amounts.

References: SSL Sect.

367-a (3)a

GISs

10 MA/10

08 MA/016

05 MA/013

Interpretation: The A/R may spend down income to become eligible for Medicaid and also eligible for Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLIMB) however, the Medicare premium cannot be applied in whole or in part to reduce excess income. At the time of application, the applicant is encouraged to make a choice to apply the Medicare Premium to their spenddown to attain Medicaid eligibility OR to forego Medicaid eligibility for eligibility in the Medicare Savings Program. The advantages and disadvantages of both programs are fully explained. An A/R may switch between spenddown and Medicare Savings Program; however, in the interest of accuracy and administrative efficiency, the A/R is encouraged to select one of the two programs.

Eligibility for the MSPs must be determined even if an applicant does not indicate that he or she is applying for the MSP on the LDSS-2919 or the DOH-4220. If applying for MSP only the DOH-4328 is used.

NOTE: When two spouses reside together in a household, eligibility for MSP will be determined by comparing income to a household of two, regardless of the income or category of the spouses.

There are four groups that are eligible for payment or part-payment of Medicare premiums, coinsurance and deductibles.

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels.

Qualified Medicare Beneficiaries (QMBs)

The A/R must:

1. be entitled to benefits under Part A of Medicare; and

2. have income equal to or less than 100% of the federal poverty level.

(MRG)

(income)(page-69)Page 69#

UPDATED: NOVEMBER 2009 167

INCOME FEDERAL POVERTY LEVELS

MEDICARE SAVINGS PROGRAM

Qualified Medicare Beneficiaries (QMBs)

The A/R must:

1. be entitled to benefits under Part A of Medicare; and

2. have income equal to or less than 100% of the federal poverty level.

If the A/R meets the above criteria, s/he is eligible for Medicaid payment of the Medicare Part A and B premiums, coinsurance and deductible amounts.

Specified Low-Income Medicare Beneficiaries (SLIMBs)

The A/R must:

1. have Part A of Medicare; and

2. have income greater than 100% but less than 120% of the federal poverty level.

If the A/R meets the above criteria s/he is eligible for Medicaid payment of the Medicare Part B premiums.

Qualified Disabled and Working Individuals (QDWIs)

The A/R must:

1. have lost Part A benefits because of return to work;

2. be a disabled worker less than 65 years of age;

3. have income equal to or less than 200% of the federal poverty level;

4. have resources not in excess of twice the SSI limit; therefore, resources cannot exceed $4,000 for a household of one or $6,000 for a household of two; and

5. not be otherwise eligible for Medicaid.

(MRG)

(income)(page-70)Page 70#

UPDATED: JUNE 2011

168

INCOME FEDERAL POVERTY LEVELS

MEDICARE SAVINGS PROGRAM

If the A/R meets the above five criteria s/he is eligible for Medicaid payment of the Medicare Part A premium, not the Medicare Part B premium.

Qualifying Individuals (QI)

The A/R must:

1. have Part A of Medicare;

2. have income greater than or equal to 120% but less than 135% of the federal poverty level.

If the A/R meets the above criteria s/he is eligible for Medicaid payment of the Medicare Part B premiums. The monthly amounts are identified in REFERENCE MEDICARE PART A and PART B PREMIUMS. Each state has been given a capped allocation to fund these premium payments.

NOTE: See REFERENCE section for a chart displaying the Medicaid Levels and Federal Poverty Levels. The A/R can either be eligible for the Medicare Savings Program or apply his/her income/resources, in excess of the appropriate Medically Needy level (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS and MEDICAID RESOURCE LEVELS) to the cost of medical care and services, spending down to become eligible for Medicaid coverage. At the time of application, the applicant is encouraged to make a choice. The advantages and disadvantages of both programs are fully explained. An A/R may switch between spenddown and Medicare Savings Program; however, in the interest of accuracy and administrative efficiency, the A/R is encouraged to select one of the two programs.

(MRG)

(income)(page-71)Page 71#

UPDATED: NOVEMBER 2007

169

INCOME FEDERAL POVERTY LEVELS

FAMILY HEALTH PLUS (FHPlus)

Policy: The federal poverty level is used to determine eligibility for FHPlus. The gross countable income of parents or persons age 19 and 20 who live with their parents is compared to 150% of the federal poverty level for the appropriate family size. For single individuals and childless couples, both disabled and non-disabled, and for 19 and 20 year-olds not residing with their parents, gross countable income is compared to 100% of the federal poverty level for the family size.

Reference: SSL

369-ee

ADMs 06 OMM/ADM-4

01 OMM/ADM-6

GISs 07 MA/005

06 MA/029 06 MA/006

05 MA/047

05 MA/045

05 MA/013

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels and CATEGORICAL FACTORS FAMILY HEALTH PLUS (FHPLUS) for discussion of other eligibility criteria for FHPlus.

(MRG)

(income)(page-72)Page 72#

UPDATED: NOVEMBER 2007

170

INCOME FEDERAL POVERTY LEVELS

FAMILY PLANNING BENEFIT PROGRAM (FPBP)

Policy: The federal poverty level is used to determine eligibility for FPBP. The net countable income of applicants who meet the appropriate criteria (See CATEGORICAL FACTORS FAMILY PLANNING BENEFIT PROGRAM (FPBP) for a discussion of the categorical requirements) is compared to 200% of the federal poverty level for the appropriate family size.

Reference: SSL Sect. 366(1)(a)(11)

ADM 02 OMM/ADM-7

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels.

(MRG)

(income)(page-73)Page 73#

UPDATED: NOVEMBER 2009

171

INCOME

BUDGETING

Description: Budgeting is the process that is used to determine the value of an A/R’s income. The budgeting of income to determine eligibility for Medicaid varies according to category.

Policy: The budgeting process involves several steps, some of which are common to all budgeting methodologies and some of which include elements that are specific to a particular category.

References: SSL Sect.

366

Dept. Reg.

360-4

ADM

OMM/ADM 97-2

Interpretation: To determine eligibility for Medicaid, five budgeting methodologies are used:

(1) Low Income Families (LIF) budgeting methodology is used for the following: • Parents living with their dependent children under age 21; • Persons under age 21; • Pregnant women; and • FNP parents.

(2) When ineligible under LIF criteria, the ADC-related budgeting methodology is used for the following: • Parents living with their dependent children under age 21; • Persons under age 21; • Pregnant women; and • FNP parents.

NOTE: This budgeting methodology is used for pregnant women and children under age 19 in determining their eligibility under the poverty levels.

(3) The SSI-related budgeting methodology is used for the following: aged (65 or over), certified blind, or certified disabled A/ Rs and for all of the Medicaid A/Rs who are applying for and determined eligible for payment or part payment of the Medicare premiums, coinsurance and deductibles. (See INCOME MEDICAID EXPANDED INCOME LEVELS)

(MRG)

(income)(page-74)Page 74#

UPDATED: NOVEMBER 2009

172

INCOME

BUDGETING

(4) The Singles/Childless Couples (S/CC) budgeting methodology is used for A/Rs age 21 and over, but under age 65, who are not living with dependent children under age 21, not pregnant and who are not certified blind or certified disabled.

(5) The chronic care budgeting methodology is used for all individuals in permanent absence status (See GLOSSARY).

NOTE: FNP parents can NOT spenddown to obtain full Medicaid coverage.

Frequently, more than one budgeting methodology is used to determine eligibility. For example, a certified disabled person may be given the choice between LIF, ADC-related budgeting and SSI-related budgeting. The remaining family members are only eligible for either LIF or ADC-related budgeting, as appropriate.

(See INCOME MEDICARE SAVINGS PROGRAM for the treatment of Medicare beneficiaries (QMBs, SLMBs, etc.))

Disposition: After applying the appropriate methodology to arrive at the net available income, the net available income is compared to the appropriate income/resource level. All other eligibility requirements must be met.

(MRG)

(income)(page-75)Page 75#

UPDATED: NOVEMBER 2009

173

INCOME

LIF DISREGARDS

Description: Disregards of income are not considered in whole or in part in determining eligibility for Medicaid.

Policy: The following types of income are disregarded in the determination of gross monthly income for Medicaid: (See REFERENCE INCOME DISREGARDS for chart)

AMERICORPS - Child care allowances and other benefits and services including payments for living expenses provided by Americorps VISTA;

Child care allowances and all other benefits and services except payments for living expenses, provided by Americorps USA and Americorps NCCC;

ASSISTANCE BASED ON NEED - Any regular cash assistance payments based on need received by the A/R and furnished as supplemental income by the federal government, a State or political subdivision;

Support and maintenance assistance based on need and furnished either in-kind by a private non-profit agency or in cash or in-kind by one of the following: a supplier of home heating oil or gas, an entity whose revenues are primarily derived on a rate- of-return basis regulated by a State or Federal governmental entity or a municipal utility providing home energy;

BLOOD PLASMA SETTLEMENTS - Payments received as a result of a federal class action settlement with four manufacturers of blood plasma products on behalf of hemophilia patients who are infected with human immunodeficiency virus (HIV);

BONA FIDE LOAN - A bona fide loan received by the A/R from an institution or person not legally liable for the support of the A/R. The loan must be a written agreement, signed by the A/R and the lender. The written agreement must indicate: the A/R's intent to repay the loan within a specific time; and how the loan is to be repaid, by specific real or personal property, held as collateral, or from future income. The loan remains an exempt resource as long as it retains the characteristics of a bona fide loan. Any interest accrued is considered unearned income in the month received.

(MRG)

(income)(page-76)Page 76#

UPDATED: JUNE 2010

174

INCOME

LIF DISREGARDS

CASH ASSISTANCE INCOME - Any income of a cash assistance recipient in the A/R’s household. However, any room/board such cash assistance recipient may pay to a LIF A/R is countable;

CHILD CARE INCOME - Five dollars a day per child for a homemaker providing family day care for children other than his/her own is disregarded from the total amount of childcare payments received;

CHILDCARE SERVICES PAYMENTS - Payments made to the A/R for childcare services or the value of any childcare services provided by the A/R to a recipient of employment-related and JOBS-related childcare services. Transitional child care services, at-risk low income child care services or child care and development block grant services;

CHILDCARE/INCAPACITATED ADULT CARE COSTS- paid by the A/R subject to dollar limitations (See INCOME LIF BUDGETING METHODOLOGY CHILD/INCAPACITATED ADULT CARE COST);

Payments received from Child and Adult Care Food Program (CACFP);

CHILD SUPPORT ARREARAGE PAYMENTS- all arrearage payments must be budgeted as income in the month following the month the payment is issued and as a resource thereafter.

DISASTER RELIEF AND EMERGENCY ASSISTANCE - Any federal major disaster and emergency assistance provided under the Disaster Relief Act of 1974 (P.L. 93-288), as amended by the Disaster Relief and Emergency Assistance Amendments of 1988 (P.L. 100-107), and any comparable disaster assistance provided by states, local governments, and disaster assistance organization;

DONATED FOODS - The value of federally donated foods;

EARNED INCOME, PERCENTAGE OF, (See INCOME LIF BUDGETING METHODOLOGY EARNED INCOME DISREGARD).

(MRG)

(income)(page-77)Page 77#

UPDATED: JUNE 2011

175

INCOME

LIF DISREGARDS

EARNED INCOME TAX CREDIT PAYMENTS;

FEDERAL ECONOMIC OPPORTUNITY ACT, TITLE III - Any loan made to a family under Title III of the Federal Economic Opportunity Act;

FEDERAL ENERGY ASSISTANCE PAYMENTS

FEDERAL OLDER AMERICANS ACT OF 1965 - Any assistance (other than wages or salaries) to an individual under the Federal Older American Act of 1965. Green Thumb assistance is countable if wages or salaries; other Green Thumb assistance is disregarded.

FEDERAL RELOCATION ASSISTANCE - Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

FOSTER PARENT PAYMENTS - Payments received for a child boarded out in the home of a recipient by an agency or a relative of the child.

FOOD STAMPS - The value of food stamps.

FREE MEALS - The value of free meals, other than school meals, except when more than one meal a day is furnished or when the A/R receives an allowance for meals away from home.

GARDEN PRODUCE OR LIVESTOCK - The value of produce from a garden or livestock when used exclusively by the A/R and members of his/her household.

GI BILL DEDUCTION - That portion of a military person's pay that is deducted by mandate to help fund the GI Bill.

HOUSING AND URBAN DEVELOPMENT (HUD) COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS.

INCOME TAX REFUNDS - Any income tax refund or federal advance payment received by an A/R is disregarded in the month received and considered an exempt resource in the following month.

(MRG)

(income)(page-78)Page 78#

UPDATED: FEBRUARY 2005

176

INCOME

LIF DISREGARDS

INDIVIDUAL DEVELOPMENT ACCOUNTS - These accounts are trusts which allow recipients to set aside funds, outside of the resource limits, for the purposes of post-secondary education at an eligible educational institution, first home purchases and business capitalization.

Eligible educational institution means:

(a) an institution described in section 481(a)(1) or 1201(a) of the Higher Education Act of 1965 as such sections were in effect on August 26, 1996; or

(b) an area vocational education school as defined in subparagraph (C) or (D) section 521(4) of the Carl D. Perkins Vocational and Applied Technology Education Act as such sections were in effect on August 26,1996.

Post-secondary educational expenses means:

(a) tuition and fees required for the enrollment or attendance of a student of an eligible education institution; or

(b) fees, books, supplies, and equipment required for courses of instruction at an eligible education institution.

Qualified acquisition costs means the cost of acquiring, constructing, or reconstructing a residence. The term includes any usual or reasonable settlement, financing or other closing cost.

Qualified business means any business that does not contravene any law or public policy.

Qualified business capitalization expenses are qualified expenditures for the capitalization of a qualified business pursuant to a qualified plan.

Qualified expenditures are expenditures included in a qualified plan, including capital, plant, equipment, working capital, and inventory expenses.

(MRG)

(income)(page-79)Page 79#

UPDATED: JUNE 2011

177

THIS PAGE IS INTENTIONALLY LEFT BLANK

(MRG)

(income)(page-80)Page 80#

UPDATED: JUNE 2010

178

INCOME

LIF DISREGARDS

Qualified first-time homebuyer is a taxpayer (and, if married, the taxpayer’s spouse) who has no present ownership interest in a principal residence during the 3-year period ending on the date of acquisition of the principal residence.

Date of acquisition means the date of entry into a binding contract to acquire, construct, or reconstruct the principal residence.

Qualified plan means a business plan which:

(a) is approved by a financial institution, or by a nonprofit loan fund having demonstrated fiduciary integrity; and

(b) includes a description of services or goods to be sold, a marketing plan, and projected financial statements; and

Qualified principal residence is a principal residence (within the meaning of Section 1034 of the Internal Revenue Code of 1986), the qualified acquisition costs of which do not exceed 100% of the area purchase price applicable to such residence (determined in accordance with paragraphs (2) and (3) of section 143 (e) of the Internal Revenue Code).

INSURANCE PAYMENTS - Moneys from insurance payments for the purpose of repairing or replacing a disregarded resource, which was lost, damaged or stolen, are disregarded. Any interest received from such payments is also disregarded.

JOB CORPS - Money received by a family based on the enrollment of a child in the Job Corps.

NATIVE AMERICAN PAYMENTS -Seneca Nation Settlement Act payments made by the State and Federal governments, under P.L. 101-503, to the Seneca Nation.

Distribution to Native Americans of funds appropriated in satisfaction of judgments of the Indian Claims Commission or the United States Court of Federal Claims. This includes up to $2,000 per year of income for interests of individual Native Americans in trust or restricted lands, from funds appropriated in satisfaction of the Indian Claims Commission or the United States Court of Federal Claims.

(MRG)

(income)(page-81)Page 81#

UPDATED: JUNE 2010

179

INCOME

LIF DISREGARDS

Alaskan Native Claims Settlement Act (ANCSA) distributions. The following distributions from a native corporation formed pursuant to ANCSA are disregarded as income or resources:

a. cash, to the extent that it does not, in the aggregate, exceed $2,000 per individual per year;

b. stock;

c. a partnership interest;

d. land or an interest in land; and

e. an interest in a settlement trust.

NYS DEPARTMENT OF LABOR PAYMENTS - Payments from Youth Education, Employment and Training Programs (Department of Labor programs).

OVERPAYMENTS - The amount of income that is withheld to recover a previous overpayment is not income if the individual received Medicaid at the time of the overpayment and the overpayment amount was included in determining the individual’s Medicaid eligibility.

PERSECUTION PAYMENTS - Benefits received by eligible Japanese-Americans, Aleuts, or Pribilof Islanders under the Civil Liberties Act of 1988, the Wartime Relocation of Civilians Law, and the Aleutian and Pribilof Islands Restitution Act.

Payments made to individuals because of their status as victims of Nazi persecution, including: German Reparation Payments; Austrian Reparation Payments made pursuant to sections 500- 506 of the Austrian General Social Insurance Act; and Netherlands Reparation Payments based on Nazi, but not Japanese, persecution.

(MRG)

(income)(page-82)Page 82#

UPDATED: JUNE 2010

180

INCOME

LIF DISREGARDS

PREVENTATIVE HOUSING SERVICE - Payments provided as a preventive housing service under 18 NYCRR 423.4(l).

RADIATION EXPOSURE COMPENSATION TRUST FUND PAYMENTS - Payments for injuries or deaths resulting from exposure to radiation from nuclear testing and uranium mining.

ROOM AND/OR BOARD - The first $60 per month of any income from each boarder and the first $15 per month from each roomer (lodger). If the A/R can document that the actual expenses incurred in providing the room for the roomer, exceeds $15 per month, or that the actual expenses incurred in providing room and board for a boarder exceeds $60 per month, then the actual documented expenses are disregarded.

SSI, SUPPLEMENTAL SECURITY INCOME- Any SSI payments received by the A/R.

STUDENTS - Earned Income - Student earned income as described below:

If the under age 21 A/R is not employed full-time, all earned income is disregarded whether the A/R is a full or part-time student. It is not necessary to verify school attendance, unless there is an indication that the A/R is not attending. The A/R's statement on the application that s/he is a high school student is sufficient.

If the under age 21 A/R is employed full-time, the treatment of earned income depends on whether the A/R is a full or part- time student.

If the under age 21 A/R is a full-time student all earned income is disregarded for a six-month period per calendar year. Thereafter, such income becomes countable.

(MRG)

(income)(page-83)Page 83#

UPDATED: JANUARY 2009

181

INCOME

LIF DISREGARDS

If the under age 21 A/R is a part-time student all earned income is countable.

School and Employment Status Income Disregarded Full-time student employed full-time Yes (Income disregarded for up to six months per calendar year) Full-time student employed part-time Yes Part-time student employed full-time No Part-time student employed part-time Yes

NOTE: Summer employment is seasonal and not considered full-time employment.

Graduate Educational Grants or Scholarships - Educational grants, fellowships or scholarships for a graduate student, obtained and used for educational purposes only. This precludes their use for meeting current living expenses. The student must attest to this in writing. The language of the attestation attached to 83 ADM-67 must be used without change.

When an A/R is in receipt of a graduate assistantship, the local district receives verification from the financial aid office involved to determine if the assistantship is considered employment or an educational grant. If the assistantship is a grant, it is treated as outlined in the previous paragraph. When the assistantship is considered employment, the A/R receives any appropriate earned income disregards (See INCOME EARNED INCOME DISREGARD), but additional deductions for educational expenses are not allowed.

School Meals - The value of free school meals.

Student Loans - Student loans received by a graduate or undergraduate student.

Undergraduate Educational Grants, Scholarships or Work-Study - Educational grants, scholarships, fellowships or work-study for undergraduate students.

(MRG)

(income)(page-84)Page 84#

UPDATED: JANUARY 2009

182

INCOME

LIF DISREGARDS

NOTE: This does not apply to V.A. Educational Grants which are part of the G.I. Bill and which provide a monthly allowance for support while veterans are enrolled in school. Only specific education-related expenses such as tuition, books, school fees, transportation, etc., are exempt for recipients of G.I. Bill educational money. The remainder is considered available unearned income in determining eligibility for Medicaid.

SUPPORT PAYMENTS - The first $100 of current total household support payments, including child support and alimony in any month including support payments collected and paid to the family by the local district.

TRADE READJUSTMENT ALLOWANCE (TRA) - TRA benefits are paid as part of Unemployment Benefits (UIB). When an A/R loses his/her job as the result of import competition, s/he may qualify for a TRA allowance. When an A/R is receiving a TRA allowance, as part of his/her UIB, for transportation and/or books for the purpose of attending training, the TRA benefit is exempt.

U.S. CENSUS - Earnings from census employment.

VIETNAM VETERANS - Agent Orange Settlement Fund – Payments from the Agent Orange Settlement Fund or any other fund established pursuant to the Agent Orange product liability litigation, and payments from court proceedings brought for personal injuries sustained by veterans resulting from exposure to dioxin or phenoxy herbicide in connection with the war in Indochina in the period of January 1, 1962 through May 7, 1975.

Children - Monthly allowances paid to certain Vietnam Veterans’ children with Spina Bifida.

VISTA - Payments received by VISTA volunteers under Part A of Title I of Public Law 93-113 (VISTA) are disregarded as income and resources in determining eligibility and degree of need, provided that all of the VISTA payment is to be counted as income when the Director of the ACTION agency determines that the value of all such payments, adjusted to reflect the number of hours such volunteers are serving, is equivalent to or greater than the minimum wage. (See REFERENCE NEW YORK STATE MINIMUM WAGE)

(MRG)

(income)(page-85)Page 85#

UPDATED: JUNE 2010

183

INCOME

LIF DISREGARDS

VOLUNTEER PROGRAM PAYMENTS - Payments received by participants in volunteer programs under Title II of P.L. 93-113 (Domestic Volunteer Services Act of 1973). These include: retired senior volunteer, foster grandparent, senior companion and senior health aid programs. Payments made in the form of stipends, allowances and/or reimbursements for incurred expenses are disregarded when determining Medicaid eligibility.

Payments received by participants in volunteer programs established under Title III of P.L. 93-133. These include the Service Corps of Retired Executives (SCORE) and the Active Corps of Executives (ACE) programs.

WOMEN, INFANTS AND CHILDREN (WIC) - The value of benefits under the WIC program.

WORK EXPENSE - $90 work expense from earned income. (See INCOME $90 WORK EXPENSE DISREGARD)

WORKFORCE INVESTMENT ACT (WIA)—formerly known as JOB TRAINING PARTNERSHIP ACT (JTPA) - Income (earned or unearned) derived through participation in a program carried out under the JTPA and paid to a dependent minor. Earned income is disregarded for only one six-month period per calendar year. Further discussion of JTPA payments can be found in the Public Assistance Source Book.

Payments for supportive services paid under JTPA to any A/R to defray costs attributable to training such as transportation, meals, childcare, etc.

References: SSL Sect. 366.2

366.3

Dept. Reg. 352.22

360-4.6(a)(1)

360-4.6(a)(3)

ADMs OMM/ADM 97-2

97 ADM-23

94 ADM-10

92 ADM-43

92 ADM-42

92 ADM-32

(MRG)

(income)(page-86)Page 86#

UPDATED: JUNE 2011

184

INCOME

LIF DISREGARDS

92 ADM-11

90 ADM-3

84 ADM-21

84 ADM-1

83 ADM-67

81 ADM-38

INFs

95 INF-30

94 INF-7

90 INF-33

LCMs

95 LCM-53

92 LCM-120

GISs

11 MA/004

01 MA/024

98 MA/017

98 MA/016

97 MA/022

95 ES/DC006

Interpretation: The source and amount of income disregards are documented in the case record and a notation is made that this income is not to be considered in determining eligibility for Medicaid.

(MRG)

(income)(page-87)Page 87#

UPDATED: NOVEMBER 2009 185

INCOME

LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY

Policy: The following persons who apply for Medicaid are entitled to LIF budgeting:

• Families with a dependent child under age 21; • Persons under age 21; • Pregnant women • FNP parents.

References: SSL Sect.

366

ADMs

OMM/ADM 97-2 97 ADM-23

GIS

08 MA/022

Interpretation: The financial criteria for LIF generally parallel the criteria of the Family Assistance cash program. However, the LIF methodology may not be more restrictive than the methodology used in the Aid to Dependent Children cash program on July 16, 1996.

Financial eligibility for LIF requires that the A/R’s countable income meet certain tests. Three income tests are applied in determining whether an A/R may be eligible for LIF. These tests are:

1. comparison of gross income to 185% of the Medicaid Standard. If an A/R’s gross income, after certain disregards, exceeds 185% of the Medicaid Standard, the A/R will not be eligible for LIF. (See INCOME LIF DISREGARDS)

2. comparison of gross income to the poverty level. If the A/R’s gross income exceeds 100% of the federal poverty level, the A/R will not be eligible under LIF. For certain special housing situations (See 97 ADM-23), the income comparison will parallel calculations used in Public Assistance.

3. comparison to the Medicaid Standard. If an A/R’s net income after allowable deductions exceeds the Medicaid Standard (and the MBL Living Arrangement Chart, as appropriate), the A/R will not be eligible under LIF.

NOTE: If a family’s countable income exceeds the Medicaid Standard the family may not spend down to the Medicaid Standard. However, eligibility may exist under one of the medically needy or expanded eligibility (poverty level) programs.

(MRG)

(income)(page-88)Page 88#

UPDATED: JULY 2008

186

INCOME

LOW INCOME FAMILIES (LIF) BUDETING METHODOLGY

This section is comprised of:

• 185% Gross Income Test

• 100% of the Poverty Level Test

• Comparison of net income to the Medicaid Standard

(MRG)

(income)(page-89)Page 89#

UPDATED: NOVEMBER 2009 187

INCOME LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY

185% MAXIMUM INCOME TEST

Description: The maximum income limit allowed for a LIF A/R is 185% of the applicable Medicaid Standard (including additional allowances).

Policy: When using LIF budgeting, an A/R's total income, after subtracting any disregards, must be less than or equal to 185% of the applicable Medicaid Standard.

References: Dept. Reg.

352.18 360-3.3(a)(1)

ADMs

OMM/ADM 97-2 97 ADM-21 85 ADM-33 83 ADM-38 82 ADM-49 81 ADM-55

GIS

08 MA/022

Interpretation: Families with dependent children under age 21, individuals under age 21, pregnant women and FNP parents cannot have gross income exceeding 185% of the Medicaid Standard. All income disregards (See INCOME LOW INCOME FAMILY DISREGARDS) except the $90 work expense, child/incapacitated adult care and the earned income disregard are deducted before determining if the A/R meets the 185% maximum income test. The Public Assistance Source Book for Regulations contains a more detailed description of income excluded from the 185% income limit.

NOTE: Persons in Congregate Care (Levels I, II, and III) are not required to pass the 185% income test.

This income test is performed by multiplying the Medicaid Standard, for the appropriate size household, by 185%. The income of the A/R as described above is then compared to this figure. If the income is less than or equal to 185% of the Standard of Need then the household must pass the next test. If the income exceeds this figure, the household is not eligible for Medicaid under LIF and is further evaluated under medically needy or poverty level budgeting.

(MRG)

(income)(page-90)Page 90#

UPDATED: AUGUST 1999

188

INCOME LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY

100% MAXIMUM INCOME TEST

Description: The 100% maximum income test is a test performed after the LIF household passes the 185% income test. Earned and unearned income is compared to 100% of the federal poverty level for a household of the appropriate size.

Policy: The income of the LIF applicant household, after disregards, must be less than or equal to 100% of the federal poverty level.

References: ADMs

OMM/ADM 97-2 97 ADM-23

Interpretation: LIF A/Rs cannot have income exceeding 100% of the federal poverty level. All disregards noted under INCOME LIF DISREGARDS except the $90 work expense, child/incapacitated adult care and the earned income disregard are deducted before determining if the client meets the 100% test.

NOTE: Persons in Congregate Care (Levels I, II, and III) are not required to pass the 100% income test.

This income test is performed by comparing the income of the LIF household with the federal poverty level for the appropriate household size. (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for the federal poverty levels) If the income exceeds this figure, the household is not eligible for Medicaid under LIF and is further evaluated using medically needy or expanded poverty level budgeting. If the gross income is less than or equal to 100% of the federal poverty level then the budgeting procedures described are followed. (See INCOME LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY)

(MRG)

(income)(page-91)Page 91#

UPDATED: JULY 2008

189

INCOME LIF BUDGETING METHODOLOGY

MEDICAID STANDARD

Policy The A/R cannot have net income equal to or in excess of the Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) to be eligible under LIF. (See INCOME LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY)

References: ADMs OMM/ADM 97-2 97 ADM-23

GIS

08 MA/022

Interpretation: Net income is calculated after disregards have been applied. A/Rs of LIF receive certain deductions from income. (See INCOME LIF DISREGARDS)

Disposition: The A/Rs net income is compared to the Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) based on the A/R’s household size. If the household’s income equals or exceeds the Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) the household is ineligible for LIF and eligibility is determined using Medically Needy or poverty level budgeting.

(MRG)

(income)(page-92)Page 92#

UPDATED: AUGUST 1999

190

INCOME LIF BUDGETING METHODOLOGY

$90 WORK EXPENSE DISREGARD

Policy: In determining eligibility for Medicaid, the first item deducted from the gross monthly earnings is $90 of earned income for those individuals engaged in full-time or part-time employment (including those not employed throughout the month).

NOTE: Whenever an A/R has earned income, the first $90 per month is disregarded even though the A/R may not currently be employed or working.

References: SSL Sect.

366

Dept. Reg. 3 52.19 360-4.6(a)(3)

ADMs

OMM/ADM 97-2 90 ADM-3 87 ADM-32

GISs

89 MA028 87 MA0028

Interpretation: When determining net earned income using LIF budgeting (See INCOME LIF BUDGETING METHODOLOGY DETERMINATION OF ELIGIBILITY) subtract $90 for each person working full-time or part- time. The $90 work expense is given regardless of the amount of the work expenses incurred.

When the A/R earns less than $90 per month, disregard the entire amount.

Although the A/R may have more than one job, only one $90 disregard for work-related expenses is allowed.

(MRG)

(income)(page-93)Page 93#

UPDATED: JULY 2008

191

INCOME LIF BUDGETING METHODOLOGY

EARNED INCOME DISREGARD

Description: An earned income disregard will be applied to the earnings of each income earner in families who have earned income. A percentage of earned income will be disregarded from the earnings of each income earner for families who:

1. pass the three tests

• 185% of Medicaid Standard,

• 100% of poverty level test (See INCOME LOW INCOME FAMILY (LIF) BUDGETING METHOD- OLOGY: 185% MAXIMUM INCOME TEST and 100% MAXIMUM INCOME TEST),

• 100% of Medicaid Standard, or

2. pass the 185% Medicaid Standard, the 100% poverty level test and received LIF in one out of the four previous months.

No time limit is applied to the earned income disregard.

The earned income disregard will be adjusted annually to reflect changes in the poverty level guidelines. The annual earned income disregard percentages can be found in REFERENCE EARNED INCOME DISREGARD.

Policy: After the $90 work expense is deducted from gross income, the current earned income disregard percentage is applied to the remaining income to determine the amount of the earned income disregard. The earned income disregard is then deducted from gross income.

References: SSL Sect.

366

ADMs

05 ADM-09

OMM/ADM 97-2

(MRG)

(income)(page-94)Page 94#

UPDATED: JULY 2008

192

INCOME LIF BUDGETING METHODOLOGY

EARNED INCOME DISREGARD

GISs

08 MA/022

07 MA/012

06 MA/007

05 MA/021

00 MA/008

Interpretation: The earned income disregard is computed as follows:

(a) Subtract the $90 work expense disregard from the gross earned income;

(b) Multiply the remainder by the appropriate percentage; and

When to Verify: (a) When the A/R or the case record indicates that the A/R is employed and has received Medicaid under LIF budgeting in one of the four previous months;

(b) When the A/R’s earned income is equal to or less than the Medicaid Standard, (and MBL Living Arrangement Chart, as appropriate).

(MRG)

(income)(page-95)Page 95#

UPDATED: JUNE 2010

193

INCOME LIF BUDGETING METHODOLOGY

CHILD /INCAPACITATED ADULT CARE COST

Policy: The actual cost of care up to $175 a month for each dependent child age two or over, or incapacitated adult that the A/R pays for may be deducted from the earned income of the A/R. The actual cost of care, up to $200 a month, may be deducted for each dependent child under age two. The children or adult must reside in the same home as the A/R who is making the payments.

NOTE: Although the adult care deduction was eliminated in statute, Medicaid retains the deduction for the LIF category because it was part of the ADC program on July 16, 1996. LIF budgeting may not be more restrictive than the ADC cash program in effect on July 16, 1996.

References: SSL Sect. 366

Dept. Reg. 360-4.6(a)(3)(iv)

ADMs 91 ADM-8

90 ADM-3

81 ADM-55

Verify Status: When the A/R indicates that s/he is employed full or part-time and that there are dependent children or an incapacitated adult in the household for whom care is being provided and paid for by the A/R while s/he works. Only one parent is required to be employed to be eligible for this deduction from earned income even if there are two parents in the home.

Verification: Seeing a statement from the caretaker or day care center including the hours of care and the amount charged for such care.

Documentation: Sufficient to establish an audit trail:

Name of caretaker or day care center, children names and ages, amount paid, hours of care and receipts for payment.

(MRG)

(income)(page-96)Page 96#

UPDATED: NOVEMBER 2009 194

INCOME LIF BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

Policy: LIF budgeting is used to determine eligibility for persons who meet the following categorical requirements:

• Families with a dependent child under age 21; • Persons under age 21; • Pregnant women, or • FNP parents.

Eligibility is determined by comparing the net available income of the A/R to the Medicaid Standard (and MBL Living Arrangement chart, as appropriate). (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS)

References: SSL Sect.

366

Dept. Reg.

360-4.2 360-4.6(a)(3)

ADMs

OMM/ADM 97-2

INFs

98 OMM/INF-02

GIS

08 MA/022

Interpretation: Eligibility using LIF budgeting is determined as follows:

(1) Determine the gross monthly income of the person or household. (See OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION for an explanation of household composition) Certain kinds of income are disregarded in whole or in part. (See INCOME LOW INCOME FAMILY DISREGARDS)

(2) Compare the gross monthly income to 185% of the Medicaid Standard. (See INCOME LOW INCOME FAMILIES (LIF) BUDGETING METHODOLOGY 185% MAXIMUM INCOME TEST) If gross income exceeds 185% of the Medicaid Standard, the A/R is not eligible for Medicaid using LIF budgeting. If the gross monthly income is equal to or less than 185% of the Medicaid Standard, then

(MRG)

(income)(page-97)Page 97#

UPDATED: JUNE 2010

195

INCOME LIF BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

(3) Compare the gross monthly income to 100% of the federal poverty level. If gross income exceeds 100% of the federal poverty level, the A/R is not eligible for Medicaid using LIF budgeting. If the gross monthly income is equal to or less than 100% of the federal poverty level, then

(4) Deduct the $90 work expense disregard;

(5) Deduct child/incapacitated adult care costs paid by the A/R up to the cap;

(6) Determine if the household received Medicaid under LIF budgeting in one of the previous four months. If so, subtract the earned income disregard from the A/R’s earned income. (See INCOME LIF BUDGETING METHODOLOGY EARNED INCOME DISREGARD)

(7) Compare the resulting net income to the Medicaid Standard.

If the A/R did not receive Medicaid under LIF budgeting in one of the previous four months and the A/R’s income is equal to or less than the Medicaid Standard, the earned income disregard is then applied.

If the A/R did not receive Medicaid under LIF budgeting in one of the previous four months and the A/R’s income is more than the Medicaid Standard, no earned income disregard is applied. If a family’s countable income exceeds the Medicaid Standard, the family may not spend down to the Medicaid Standard. However, eligibility may exist and should be evaluated under one of the Medically Needy or Expanded Eligibility (poverty level) programs, Family Health Plus., or Family Planning Benefit Program.

(MRG)

(income)(page-98)Page 98#

UPDATED: NOVEMBER 2009 196

INCOME

ADC-RELATED DISREGARDS

Description: Disregards of income are not considered in whole or in part in determining eligibility for Medicaid.

Policy: The following types of income are disregarded in the determination of gross monthly income for Medicaid: (See REFERENCE INCOME DISREGARDS for chart)

AMERICORPS - Child care allowances and other benefits and services including payments for living expenses provided by Americorps VISTA;

Child care allowances and all other benefits and services except payments for living expenses, provided by Americorps USA and Americorps NCCC;

ASSISTANCE BASED ON NEED - Any regular cash assistance payments based on need received by the A/R and furnished as supplemental income by the federal government, a State or political subdivision;

(MRG)

(income)(page-99)Page 99#

UPDATED: JUNE 2010

197

INCOME

ADC-RELATED DISREGARDS

CASH ASSISTANCE INCOME - Any income of a cash assistance recipient in the A/R’s household. However, any room/board such cash assistance recipient may pay to an ADC-related A/R is countable, after the $90 room and board (See INCOME INCOME FROM ROOMERS (LODGERS) AND BOARDERS) and $90 earned income (See INCOME ADC-RELATED BUDGETING METHODOLOGY $90 WORK EXPENSE DISREGARD) disregards.

CHILDCARE INCOME- Five dollars a day per child for an A/R who provides family day care for children other than his/her own is disregarded from the total amount of childcare payments received.

CHILDCARE/INCAPACITATED ADULT CARE COSTS- paid by the A/R subject to dollar limitations (See INCOME ADC-RELATED BUDGETING METHODOLOGY CHILD/INCAPA-CITATED ADULT CARE COST).

Payments received from Child and Adult Care Food Program (CACFP).

CHILD SUPPORT ARREARAGE PAYMENTS- all arrearage payments must be budgeted as income in the month following the month the payment is issued.

DONATED FOODS - The value of federally donated foods.

EARNED INCOME TAX CREDIT PAYMENTS.

(MRG)

(income)(page-100)Page 100#

UPDATED: JUNE 2011

198

INCOME

ADC-RELATED DISREGARDS

FEDERAL ECONOMIC OPPORTUNITY ACT, TITLE III - Any loan made to a family under Title III of the Federal Economic Opportunity Act.

FEDERAL ENERGY ASSISTANCE PAYMENT.

FEDERAL OLDER AMERICANS ACT OF 1965 - Any assistance (other than wages or salaries) to an individual under the Federal Older Americans Act of 1965. Green Thumb is countable if wages or salaries; other Green Thumb assistance is disregarded.

FEDERAL RELOCATION ASSISTANCE - Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

FOOD STAMPS - The value of food stamps.

FOSTER PARENT PAYMENTS - Payments received for a child boarded out in the home of a recipient by an agency or a relative of the child.

FREE MEALS - The value of free meals, other than school meals, except when more than one meal a day is furnished or when the A/R receives an allowance for meals away from home.

GARDEN PRODUCE OR LIVESTOCK - The value of produce from a garden or livestock when used exclusively by the A/R and members of his/her household.

GI BILL DEDUCTION - That portion of a military person's pay, which is deducted by mandate to help fund the GI Bill.

HOUSING AND URBAN DEVELOPMENT (HUD) COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS.

HEALTH INSURANCE PREMIUMS.

INCOME TAX REFUNDS - Any income tax refund or federal advance payment received by an A/R is disregarded in the month received and considered an exempt resource in the following month.

INSURANCE PAYMENTS - Moneys from insurance payments for the purpose of repairing or purchasing disregarded resource,

(MRG)

(income)(page-101)Page 101#

UPDATED: JUNE 2011

199

INCOME

ADC-RELATED DISREGARDS

which was lost, damaged or stolen, are disregarded. Any interest received from such payments is also disregarded.

JOB CORPS - Money received by a family based on the enrollment of a child in the Job Corps.

NATIVE AMERICAN PAYMENTS - Seneca Nation Settlement Act payments made by the State and Federal governments, under P.L. 101-503, to the Seneca Nation.

Alaskan Native Claims Settlement Act (ANCSA) distributions - The following distributions from a native corporation formed pursuant to ANCSA are exempt as income or resources:

• cash, to the extent that it does not, in the aggregate, exceed $2,000 per individual per year;

• stock;

• a partnership interest;

• land or an interest in land; and

• an interest in a settlement trust.

NYS DEPARTMENT OF LABOR PAYMENTS - Payments from Youth Education, Employment and Training Programs (Department of Labor programs).

(MRG)

(income)(page-102)Page 102#

UPDATED: JUNE 2010

200

INCOME

ADC-RELATED DISREGARDS

PERCENTAGE OF EARNED INCOME, (See INCOME ADC- RELATED DISREGARDS $30 and 1/3 EARNED INCOME DISREGARD).

PREVENTATIVE HOUSING SERVICE - Payments provided as a preventive housing service under 18 NYCRR 423.4(l).

RADIATION EXPOSURE COMPENSATION TRUST FUND PAYMENTS - Payments for injuries or deaths resulting from exposure to radiation from nuclear testing and uranium mining.

ROOM AND/OR BOARD - The first $90 per month of any income from each boarder or roomer (lodger). If the A/R can document that the actual expenses incurred in providing the room or room and board exceeds the $90 per month, then actual documented expenses are disregarded.

SUPPLEMENTAL SECURITY INCOME (SSI) - Any SSI payments received by the A/R.

(MRG)

(income)(page-103)Page 103#

UPDATED: APRIL 2008

201

INCOME

ADC-RELATED DISREGARDS

STUDENTS - Earned Income - Student earned income as described below:

If the under the age 21 A/R is not employed full-time, all earned income is disregarded whether the A/R is a full or part-time student. It is not necessary to verify high school attendance, unless there is an indication that the A/R is not attending. The A/R's statement on the application that s/he is a high school student is sufficient. Attendance in other educational programs must be verified.

If the under age 21 A/R is employed full-time, the treatment of earned income depends on whether the A/R is a full or part- time student.

If the under age 21 A/R is a full-time student, all earned income is disregarded for a six-month period per calendar year. Thereafter, such income becomes countable.

If the under age 21 A/R is a part-time student, all earned income is countable.

School and Employment Status Income Disregarded Full-time student employed full time Yes (Income disregarded for up to six months per calendar year) Full time student employed part-time Yes Part-time student employed full-time No Part-time student employed part-time Yes

NOTE: Summer employment is seasonal and not considered full-time employment.

(MRG)

(income)(page-104)Page 104#

UPDATED: JUNE 2010

202

INCOME

ADC-RELATED DISREGARDS

Graduate Educational Grants or Scholarships- Educational grants, fellowships or scholarships for a graduate student, obtained and used for educational purposes only. This precludes their use for meeting current living expenses. The student must attest to this in writing. The language of the attestation attached to 83-ADM-67 must be used without change.

When an A/R is in receipt of a graduate assistantship, the local district receives verification from the financial aid office involved to determine if the assistantship is considered employment or an educational grant. If the assistantship is a grant, it is treated as outlined in the previous paragraph. When the assistantship is considered employment, the A/R receives any appropriate earned income disregards (See INCOME ADC-RELATED DISREGARDS), but additional deductions for educational expenses are not allowed.

School Meals - The value of free school meals.

Student Loans - Student loans received by a graduate or undergraduate student.

Undergraduate Educational Grants, Scholarships or Work- Study - Educational grants, scholarships, fellowships or work- study for undergraduate students.

(MRG)

(income)(page-105)Page 105#

UPDATED: JUNE 2010

203

INCOME

ADC-RELATED DISREGARDS

SUPPORT PAYMENTS - The first $100 of current total household support payments, including child support and alimony, in any month including support payments collected and paid to the family by the local district.

U.S. CENSUS - Earnings from census employment.

VIETNAM VETERANS - Agent Orange Settlement Fund - Payments from the Agent Orange Settlement Fund or any other fund established pursuant to the Agent Orange product liability litigation, and payments from court proceedings brought for personal injuries sustained by veterans resulting from exposure to dioxin or phenoxy herbicide in connection with the war in Indochina in the period of March 1, 1962 through May 7, 1975.

Children - Monthly allowances paid to certain Vietnam Veterans’ Children with Spina Bifida.

(MRG)

(income)(page-106)Page 106#

UPDATED: JUNE 2010

204

INCOME

ADC-RELATED DISREGARDS

WOMEN, INFANTS AND CHILDREN (WIC) - The value of benefits under the WIC program.

WORK EXPENSE - $90 work expense from earned income. (See INCOME ADC-RELATED BUDGETING METHODOLOGY $90 WORK EXPENSE DISREGARD)

Payments for supportive services paid under JTPA to any A/R to defray costs attributable to training such as transportation, meals, childcare, etc.

(MRG)

(income)(page-107)Page 107#

UPDATED: JUNE 2011

205

INCOME

ADC-RELATED DISREGARDS

References: SSL Sect.

366.2 366.3

Dept. Reg.

352.22 360-4.6(a)(1) 360-4.6(a)(3)

ADMs

01 OMM/ADM-6

OMM/ADM 97-2 97 ADM-23 94 ADM-10 92 ADM-43 92 ADM-42 92 ADM-32 92 ADM-11 91 ADM-8 90 ADM-3 84 ADM-21 84 ADM-1 83 ADM-67 81 ADM-38

INFs

95 INF-30 94 INF-7 90 INF-33

LCMs

95 LCM-53 92 LCM-120

GISs

11 MA/004

01 MA/024

98 MA/017 98 MA/016 97 MA/022 95 ES/DC006

Interpretation: The kinds of income listed previously are not considered in determining eligibility for Medicaid for the ADC-related category. Only available income is counted in the determination of eligibility. (See OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILITY for a more detailed discussion of availability of income.)

(MRG)

(income)(page-108)Page 108#

UPDATED: NOVEMBER 2007

206

INCOME

ADC-RELATED DISREGARDS

NOTE: Most ADC-related categorical disregards are used when determining gross countable income for parents or persons age 19 and 20 who are applying for Family Health Plus.

Documentation: The source and amount of income disregards are documented in the case record and a notation is made that this income is not to be considered in determining eligibility for Medicaid.

(MRG)

(income)(page-109)Page 109#

UPDATED: NOVEMBER 2009

207

INCOME

ADC-RELATED BUDGETING

Policy: The following persons who apply for Medicaid are entitled to ADC- related budgeting, if they are ineligible under LIF budgeting:

• Families with a dependent child under age 21; • Persons under age 21; • Pregnant women, and • FNP parents.

References: SSL Sect.

366

Dept. Reg.

360-4.6

ADMs

OMM/ADM 97-2 91 ADM-8 90 ADM-3 87 ADM-32 84 ADM-39 82 ADM-6 81 ADM-55

GIS

90MA063

Interpretation: There are certain forms of income that are not considered in the calculation of gross monthly income for budgeting purposes.

The following topics are discussed in detail for ADC-related budgeting:

• $90 work expense disregard; • $30 and 1/3; • Child care/incapacitated adult care cost; and • Health insurance premiums.

These disregards are discussed in the order that they are subtracted from the A/R's income. In addition, INCOME ADC-RELATED DISREGARDS describes the $100 support payment disregard that is deducted from support income (child support and alimony) only before determining the countable gross income of the A/R.

(MRG)

(income)(page-110)Page 110#

UPDATED: AUGUST 1999

208

INCOME ADC-RELATED BUDGETING METHODOLOGY

$90 WORK EXPENSE DISREGARD

NOTE: Whenever an A/R has earned income, the first $90 per month is disregarded even though the A/R may not currently be employed or working.

References: SSL Sect.

366

Dept. Reg.

352.19 360-4.6(a)(3)

ADMs

OMM/ADM 97-2 90 ADM-3 87 ADM-32

GISs

89 MA028 87 MA0028

Interpretation: When determining net earned income using ADC-related budgeting (See INCOME ADC-RELATED BUDGETING) subtract $90 for each person working full-time or part-time. The $90 work expense is given regardless of the amount of the work expenses incurred.

When the A/R earns less than $90 per month, disregard the entire amount.

Although the A/R may have more than one job, only one $90 disregard for work-related expenses is allowed.

(MRG)

(income)(page-111)Page 111#

UPDATED: FEBRUARY 2005

209

INCOME ADC-RELATED BUDGETING METHODOLOGY

$30 AND 1/3 EARNED INCOME DISREGARD

Policy: The $30 and 1/3 Earned Income Disregard (EID) applies when using ADC-related budgeting for employed persons who have received Medicaid under a LIF budget in one out of the four preceding months. The $30 and 1/3 disregard applies when a family with earned income loses LIF eligibility and is not eligible for Transitional Medicaid (TMA).

After the $90 work expense is disregarded, the first $30 plus 1/3 of income remaining is subtracted. Eligible persons are entitled to receive this disregard for four consecutive months. In addition, these persons may receive a $30 disregard per month for a period of eight months following this four month period provided the A/R continues to be employed.

Description: The $30 and 1/3 Earned Income Disregard (EID) is calculated by subtracting the first $30 of earned income and then subtracting 1/3 of the remaining earned income.

References: SSL Sect.

366

Dept. Reg.

352.2 360-4.6(a)(3)

ADMs

90 ADM-3 85 ADM-33 82 ADM-21 81 ADM-55

INF

98 OMM/INF-02

Interpretation: The $30 and 1/3 or $30 disregard is applicable only to earned income. The income earner(s) in the applying household is entitled to receive the $30 and 1/3 portion of this disregard if they have received Medicaid under a LIF budget in one of the four preceding months. The $30 and 1/3 or $30 disregard is applicable regardless of the reason for the loss of eligibility under the LIF program. Eligible individuals may receive the $30 and 1/3 disregard for four consecutive months.

(MRG)

(income)(page-112)Page 112#

UPDATED: FEBRUARY 2005

210

INCOME ADC-RELATED BUDGETING METHODOLOGY

$30 AND 1/3 EARNED INCOME DISREGARD

In addition, these persons are entitled to the $30 disregard for eight additional months as long as they continue to be employed. The eight-month period continues to run even if the recipient goes off assistance. If the individual reapplies for Medicaid at any time during the eight-month period, the $30 disregard is deducted from earned income in determining eligibility.

Once the eight-month maximum has been reached, the individual may not receive the $30 and 1/3 or $30 disregard again until s/he has been off Medicaid under LIF budgeting for 12 consecutive months.

See CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS for information about certain groups of people that are eligible for Medicaid as a result of their eligibility remaining in effect from a previous period of time. Because of this automatic eligibility, these persons are not entitled to the $30 and 1/3 disregard.

When to Verify: (a) When the recipient or the case record indicates that the recipient is employed and has received Medicaid under LIF budgeting in one of the four previous months;

(b) When the A/R indicates that his/her Medicaid case, under LIF budgeting, was closed for a reason other than an increase in income.

(MRG)

(income)(page-113)Page 113#

UPDATED: JUNE 2010

211

INCOME ADC-RELATED BUDGETING METHODOLOGY

CHILD /INCAPACITATED ADULT CARE COST

Policy: The actual cost of care up to $175 a month for each dependent child age two or over, or incapacitated adult that the A/R pays for may be deducted from the earned income of the A/R. The actual cost of care, up to $200 a month, may be deducted for each dependent child under age two. The child(ren) or adult must reside in the same home as the A/R who is making the payments.

References: SSL Sect. 366

Dept. Reg. 360-4.6(a)(3)(iv)

ADMs 91 ADM-8

90 ADM-3

81 ADM-55

Verify: When the A/R indicates that s/he is employed full or part-time and that there are dependent children or an incapacitated adult in the household for whom care is being provided and paid for by the A/R while s/he works. Only one parent is required to be employed to be eligible for this deduction from earned income even if there are two parents in the home.

Verification: Seeing a statement from the caretaker or day care center including the hours of care and the amount charged for such care.

Documentation: Sufficient to establish an audit trail:

Name of caretaker or day care center, children’s names and ages, amount paid, hours of care and receipts for payment.

(MRG)

(income)(page-114)Page 114#

UPDATED: JUNE 2010

212

INCOME ADC-RELATED BUDGETING METHODOLOGY

HEALTH INSURANCE PREMIUMS

Description: Health insurance premiums are premiums paid for insurance which covers hospital, medical, dental, drug and/or other charges for medical care and services.

Policy: Health insurance premiums are deducted from income in determining eligibility for Medicaid.

References: SSL Sect. 366.2(a)(6)

Dept. Reg. 360-4.6(a)(3)(vii)

ADMs 93 ADM-28

91 ADM 53

91 ADM-27

87 ADM-40

83 ADM-44

Interpretation: When using ADC-related budgeting (See INCOME ADC-RELATED BUDGETING), the amount of the work expense disregard, the $30 and 1/3 or $30 disregard, the child or incapacitated adult care and the premium paid for health insurance are disregarded from earned income. When the A/R has no earned income or his/her entire earned income has been disregarded, the amount of the health insurance premium paid is deducted from unearned income.

Health insurance policies, which indemnify the A/R against charges for medical care and services, are considered for this disregard. These include: Medicare Parts A & B, Blue Cross, Blue Shield, Major Medical insurance, dental insurance, prescription drug insurance, long term care insurance, union health fund premiums, and other hospital and medical insurance.

Policies, which indemnify the A/R against loss of income due to illness or disability, may be considered for this disregard. These include: income protection insurance, medical liability insurance and any other insurance which offsets the loss of wages due to illness or hospitalization. A policy, which pays the A/R a certain amount of money for each day s/he is hospitalized, but does not cover specific hospital services, may be eligible for this disregard. The policy must be assignable (See OTHER ELIGIBILITY REQUIREMENTS THIRD PARTY RESOURCES ASSIGNMENT AND SUBROGATION) a hospital and be cost effective for its premiums to be considered as a deduction. A policy belonging to a non-applying spouse does not have to be assignable in order to receive the premium disregard.

(MRG)

(income)(page-115)Page 115#

UPDATED: JUNE 2010

213

INCOME ADC-RELATED BUDGETING METHODOLOGY

HEALTH INSURANCE PREMIUMS

RESOURCES ENROLLMENT IN GROUP HEALTH INSURANCE contains information on the eligibility requirement that A/Rs obtain any health insurance available through their employer. When the health insurance is cost-effective and the A/R is below the income level and SSI-related A/R is below the resource level, the local districts may pay the recipient's premium, unless it is an income protection policy.

When a child is covered under a non-applying or ineligible parent’s health insurance policy, the health insurance premium may be paid in full by the local district if the child is otherwise eligible and the premium payment is cost effective. This reimbursement policy does not apply to a non-applying or ineligible parent if the health insurance premium is court-ordered.

When to Verify: (a) When the A/R declares in the application that s/he or other family members are covered by health insurance;

(b) When the A/R declares in the application that s/he or other family members are covered by Medicare, Part A or B;

(d) When the A/R or absent parent is employed;

(e) When the A/R is receiving RSDI; and

(f) When the A/R is receiving a pension.

Verification: Health insurance premiums may be verified by:

(a) The health insurance policy;

(b) The health insurance card; or

Documentation: Sufficient to establish an audit trail:

(a) Amount of premium, frequency, date of pay stub or envelope, policy number and employer's name; or

(MRG)

(income)(page-116)Page 116#

UPDATED: NOVEMBER 2007 214

INCOME ADC-RELATED BUDGETING METHODOLOGY

HEALTH INSURANCE PREMIUMS

(b) For privately paid policies, amount, date and frequency of payment, insurance company name and policy number; and

Disposition: When the amount of health insurance premiums paid is indicated, that amount is disregarded to determine net available income. (See RESOURCES THIRD PARTY RESOURCES for when the local district may pay the health insurance premium.)

(MRG)

(income)(page-117)Page 117#

UPDATED: NOVEMBER 2009 215

INCOME ADC-RELATED BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

Policy: ADC-related budgeting is used to determine eligibility for persons who meet the following categorical requirements and who are ineligible under LIF budgeting:

• Families with dependent children under age 21; • Persons under age 21; • Pregnant women; and • FNP parents.

Eligibility is determined by comparing the net available income of the A/R to the Medically Needy Income level, or the Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial. (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS), whichever is higher. For pregnant women and children under specified ages, income may be compared to the federal poverty level. (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS)

References: SSL Sect.

366

Dept. Reg.

360-4.2 360-4.6(a)(3)

ADMS

OMM/ADM 97-2 91 ADM-8 90 ADM-9

INFs

98 OMM/INF-02

GISs

08 MA/022

91MA041 90MA063

Interpretation: ADC-related eligibility is determined as follows:

(1) Determine the A/R's household size by counting those persons who are applying and their legally responsible relatives (See OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION ADC-RELATED HOUSE- HOLD).

(MRG)

(income)(page-118)Page 118#

UPDATED: NOVEMBER 2009 216

INCOME ADC-RELATED BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

(2) Determine the monthly income of the person or household. All income from all sources is reviewed to determine if it is to be included in the eligibility determination. Certain kinds of income are disregarded in whole or in part. Determine the monthly income of the person or household. All income from all sources is reviewed to determine if it is to be included in the eligibility determination. Certain kinds of income are disregarded in whole or in part (See INCOME ADC-RELATED DISREGARDS) and not counted as part of the monthly income. The income is converted to a monthly figure.

(3) Deduct the applicable disregards from the A/R's income in the following order to determine the net income:

(a) $90 for work related expenses

(b) The first $30 and 1/3 of the remainder or the first $30 in those cases where it is applicable;

(c) The actual cost of child or dependent care up to $175 a month for each child, age 2 or over, or incapacitated adult, the actual cost of child care, up to $200 a month for each child under age 2;

(d) Health insurance premiums and

(See INCOME ADC-RELATED BUDGETING METHODOLOGY: $90 WORK EXPENSE DISREGARD, $30 and 1/3 EARNED INCOME DISREGARD, CHILD/INCAPACITATED ADULT CARE COST, and INCOME HEALTH INSURANCE PREMIUMS)

(e) $100 Support Payment Disregard (child support and alimony. (See INCOME ADC_RELATED DISREGARDS)

(MRG)

(income)(page-119)Page 119#

UPDATED: JUNE 2010

217

INCOME ADC-RELATED BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

(4) The resulting net income is compared to the appropriate income level. If the income is less than or equal to the applicable income level, the person or household is eligible for Medicaid. If the income exceeds the level for pregnant women and children under age 19, household income is compared to the applicable percentage of the federal poverty level (See INCOME MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS to determine if a pregnant woman is fully eligible or eligible for prenatal services only). For pregnant women and children under the age of 19 whose income exceeds the appropriate federal poverty level, income in excess of the Medicaid level or Medicaid Standard is considered available. The resulting net income is compared to the appropriate income level. If the income is less than or equal to the applicable income level, the person or household is eligible for Medicaid. If the income exceeds the level for pregnant women and children under age 19, household income is compared to the applicable percentage of the federal poverty level (See INCOME MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS to determine if a pregnant woman is fully eligible or eligible for prenatal services only). For pregnant women and children under the age of 19 whose income exceeds the appropriate federal poverty level, income in excess of the Medicaid level is considered available to meet the cost of medical care and services. Parents in a household with a deprivation, pregnant women and persons under age 21 may become eligible for Medicaid if the household incurs medical bills which equal or exceed the amount of excess income. Persons who spend down must spend down to the Medicaid level not the Medicaid Standard or poverty level. For a more detailed discussion of excess income see INCOME EXCESS SIX-MONTH.

(MRG)

(income)(page-120)Page 120#

UPDATED: JANUARY 2011

218

INCOME

ADOPTED CHILDREN

Policy: Children eligible for Title IV-E adoption assistance are automatically eligible for Medicaid. In addition, a child with a non-IV-E adoption assistance agreement in effect is eligible for Medicaid when a special medical or rehabilitative need makes his/her placement for adoption difficult without Medicaid coverage and s/he was in receipt of, or eligible, for Medicaid during the three months prior to the adoption agreement.

Adopted children not meeting the above criteria must have their eligibility for Medicaid determined.

References: SSL Sect.

453 (1)(b)

Dept. Reg.

421.24(c) 360-3.3(a)(6)

ADMs

92-ADM-42

92 ADM-23

87 ADM-22 86 ADM-36 85 ADM-33 81 ADM-10

Interpretation: Children eligible for Title IV-E adoption assistance payments are eligible for Medicaid as soon as the adoption assistance agreement is signed by the respective parties and approved by New York State. The district that entered in to the Title IV-E adoption agreement remains responsible for the child’s Medicaid as long as the adoption agreement remains in effect and the child remains a resident of New York State. When a voluntary authorized agency places a child for adoption and the State is paying the subsidy for IV-E and non IV-E special needs eligible children, then the district where the child resides with his/her adoptive parents authorizes the adopted child’s Medicaid. If a child enters certain facilities certified by the Office of Mental Health (OMH) or the Office for People with Developmental Disabilities (OPWDD), the State may be responsible for the child's Medicaid coverage while s/he remains in the facility (See OTHER ELIGIBILITY REQUIREMENTS STATE AND FEDERAL CHARGES)

(MRG)

(income)(page-121)Page 121#

UPDATED: JANUARY 2011

219

INCOME

ADOPTED CHILDREN

When the child moves out of New York State, the state where the child resides is responsible for providing his/her Medicaid. When a child residing in New York State has a Title IV-E adoption agreement in effect, which was initiated by another state, the adoptive parent(s) must complete a Medicaid application, on behalf of the child, in the district where the child resides. The parent(s) documents the child’s name, date of birth, Social Security number, Title IV-E eligibility, and any information concerning any available third party health insurance coverage. No further documentation is required because the Title IV-E child is otherwise automatically eligible for Medicaid.

A child with a non-IV-E adoption agreement in effect is eligible for Medicaid when a special medical or rehabilitative need makes his/her placement for adoption difficult without Medicaid coverage and s/he was in receipt of or eligible for Medicaid during the three months prior to the adoption agreement (COBRA).

The cases of all children eligible for Medicaid under Title IV-E are reviewed annually by services. The adoption agreement must continue in effect. The adoptive parent(s) must continue to be legally responsible for the child and continue to support the child.

Prior to the adoption finalization, the child is considered a household of one. Once the adoption is finalized, Medicaid eligibility is determined using the household size of the child, adoptive parent(s) and any other applying siblings. The child’s adoption subsidy is counted in the eligibility determination unless the child has been deleted from the household based on Mehler/Vailes. The child’s adoption subsidy is counted in the eligibility determination unless the child is not counted in the household. Adoption subsidy children remain Medicaid eligible, regardless of their treatment under Mehler/Vailes.

Adopted children not meeting the IV-E or COBRA criteria are not automatically eligible for Medicaid and must have their eligibility determined.

When a child, with a non-IV-E adoption agreement which provides for Medicaid, moves out of state to a non-reciprocal COBRA state, the New York State Medicaid case remains open. The adoptive parents must seek out providers who are enrolled or willing to enroll in the New York State Medicaid program in the new state of residence.

(MRG)

(income)(page-122)Page 122#

UPDATED: JUNE 2010

220

INCOME

SSI-RELATED DISREGARDS

Description: Disregards of income are not considered in whole or in part in determining eligibility for Medicaid.

Policy: The following types of income are disregarded in the determination of income for Medicaid: (See REFERENCE INCOME DISREGARDS for chart)

AMERICORPS - Child care allowances and other benefits and services including payments for living expenses provided by Americorps VISTA.

Child care allowances and all other benefits and services except payments for living expenses, provided by Americorps USA and Americorps NCCC.

ASSISTANCE BASED ON NEED - Any regular cash assistance payments based on need received by the A/R and furnished as supplemental income by the federal government, a State or political subdivision.

Money paid by a third party directly to a vendor except for food, clothing and shelter.

(MRG)

(income)(page-123)Page 123#

UPDATED: JUNE 2010

221

INCOME

SSI-RELATED DISREGARDS

BONA FIDE LOAN - A bona fide loan received by the A/R from an institution or person not legally liable for the support of the A/R. The loan may be an oral or written agreement, signed by the A/R and the lender. The written agreement must indicate: the A/R's intent to repay the loan within a specific time; and how the loan is to be repaid, by specific real or personal property, held as collateral, or from future income.

BURIAL FUNDS/BURIAL ARRANGEMENT (EXCLUDED) - Interest earned on excluded burial funds and appreciation in the value of an excluded burial arrangement.

CASH ASSISTANCE INCOME - Any income of a cash assistance recipient in the A/R’s Medicaid household. However, any room/board received by an SSI-related A/R from a cash assistance recipient, who is living in the A/R’s home but is not in the A/R’s Medicaid household, is countable room/board income to the SSI-related A/R. Appropriate room/board deductions are allowed to determine countable roomer/boarder income.

CERTIFIED BLIND OR CERTIFIED DISABLED CHILD SUPPORT PAYMENTS - One third of any support payments received by a certified blind or certified disabled child from an absent parent.

CERTIFIED BLIND REASONABLE WORK-RELATED EXPENSES - For persons who are certified blind all remaining reasonable work-related expenses including mandatory retirement deductions after the other disregards. (See INCOME SSI- RELATED BUDGETING METHODOLGY BLIND WORK EXPENSES)

CHILD CARE SERVICES PAYMENTS- Payments made by the A/R for child care services or the value of any child care services provided by the A/R to a recipient of employment-related and JOBS-related child care services. Transitional child care services, at-risk low income child care services or child care and development block grant services.

(MRG)

(income)(page-124)Page 124#

UPDATED: JUNE 2011

222

INCOME

SSI-RELATED DISREGARDS

CHILD SUPPORT (including CHILD SUPPORT ARREARAGE) PAYMENTS - For SSI-related children, child support arrearage payments are unearned income to the child in the month the payment is received. One-third of the amount of the child support payment is excluded. If payment is made for several children, a per capita portion of the payment is calculated as unearned income to the SSI-related child.

CRIME VICTIMS’ FUND PAYMENTS - Payments received from a fund established by a state to aid victims of crime.

(MRG)

(income)(page-125)Page 125#

UPDATED: JUNE 2010

223

INCOME

SSI-RELATED DISREGARDS

DIVIDEND/INTEREST INCOME – (See INCOME INTEREST/DIVIDEND)

DONATED FOODS - The value of federally donated foods.

EARNED INCOME - The first $65 of earned income or the first $65 of a couple’s combined earned income and ½ of the remainder after any impairment related work expenses.

EARNED INCOME TAX CREDIT PAYMENTS - Including any federal child tax credit payments and any advance payment of earned income tax credit made by an employer.

EXPENSES OF OBTAINING INCOME - Income does not include that part of a payment that is an essential expense incurred in receiving the payments (legal fees, and other expenses connected with a claim).

FEDERAL ENERGY ASSISTANCE PAYMENTS.

FEDERAL OLDER AMERICANS ACT OF 1965 - Any assistance (other than wages or salaries) provided to an individual under the federal Older Americans Act of 1965. Green Thumb assistance is countable if wages or salaries; other Green Thumb assistance is disregarded.

FEDERAL RELOCATION ASSISTANCE - Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

FOOD STAMPS - The value of food stamps.

FOSTER CARE - Payments received by foster parents for foster care children.

(MRG)

(income)(page-126)Page 126#

UPDATED: JUNE 2011

224

INCOME

SSI-RELATED DISREGARDS

FREE MEALS - The value of free meals, other than school meals, except when more than one meal a day is furnished or when the A/R receives an allowance for meals away from home.

GI BILL DEDUCTION - That portion of a military person's pay which is deducted by mandate to help fund the GI Bill.

GARDEN PRODUCE OR LIVESTOCK - The value of produce from a garden or livestock when used exclusively by the A/R and members of his/her household.

HEALTH INSURANCE PREMIUMS.

HOSTILE FIRE PAY - Income from hostile fire pay (pursuant to Section 310 of Title 37 US Code) received while in active military service.

HUD COMMUNITY BLOCK GRANTS - Any funds received by an A/R under the Department of Housing and Urban Development community block grants.

INCOME TAX REFUNDS –Any income tax refund or federal advance payment received by an A/R is disregarded as income in the month received.

INFREQUENT OR IRREGULAR INCOME – The first $30 of earned income and the first $60 of unearned income in a calendar quarter if it is received infrequently or irregularly. Income is infrequent if it is received only once in a calendar quarter from a single source. It is irregular if the A/R could not reasonably expect to receive it or budget for it due to its unpredictability. If the amount of infrequent or irregular income in a month exceeds $30 or $60, as applicable, the exclusion still applies. The dollar amount of the exclusion does not increase even if both an individual and spouse have infrequent or irregular income.

(MRG)

(income)(page-127)Page 127#

UPDATED: JUNE 2011

224.1

INCOME

SSI-RELATED DISREGARDS

IMPAIRMENT-RELATED WORK EXPENSES - For certified disabled Medicaid A/Rs, non-medical, impairment-related work expenses (See INCOME SSI-RELATED BUDGETING METHODOLOGY IMPAIRMENT-RELATED WORK EXPENSES) INTEREST/DIVIDEND INCOME - From most resources is disregarded. (See INCOME DIVIDENDS AND INTEREST for a list of resources which generate interest/dividend income that is countable for SSI-related A/Rs.)

(MRG)

(income)(page-128)Page 128#

UPDATED: FEBRUARY 2005

225

INCOME

SSI-RELATED DISREGARDS

NATIVE AMERICAN PAYMENTS - Seneca Nation Settlement Act payments made by the State and Federal governments, under P.L. 101-503, to the Seneca Nation.

Alaskan Native Claims Settlement Act (ANCSA) distributions - The following distributions from a native corporation formed pursuant to ANCSA are exempt as income or resources:

a. cash, to the extent that it does not, in the aggregate, exceed $2,000 per individual per year; b. stock; c. a partnership interest; d. land or an interest in land; and e. an interest in a settlement trust.

OTHER INCOME - Any other income that a Federal law or regulation requires to be disregarded.

(MRG)

(income)(page-129)Page 129#

UPDATED: NOVEMBER 2007

226

INCOME

SSI-RELATED DISREGARDS

Act; and Netherlands Reparation Payments based on Nazi, but not Japanese, persecution.

PLAN TO ACHIEVE SELF-SUPPORT (PASS) - For certified blind or certified disabled persons under 65 years of age and for certified blind or certified disabled persons aged 65 or over who received SSI payments or aid under the State Plan for the certified blind or certified disabled for the month preceding the month of their 65th birthday, any remaining countable income may be set aside for a plan to achieve self-support. The plan must:

a. specify planned savings and/or expenditures to achieve a designated feasible occupational objective and a specific period of time to achieve the objective; b. provide for identification and segregation of money and goods, if any, being accumulated and saved; c. be current, in writing and approved by the local commissioner of social services for not more than 18 months, with the possibility of an extension for an additional 18 months. A second extension for an additional 12 months may be allowed in order to fulfill a lengthy educational or training program; and d. be followed by the individual.

PREVENTATIVE HOUSING SERVICE - Payments provided as a preventive housing service under 18 NYCRR 423.4(l).

RADIATION EXPOSURE COMPENSATION TRUST FUND PAYMENTS - Payments for injuries or deaths resulting from exposure to radiation from nuclear testing and uranium mining.

REDUCED (LIMITED) $90 VETERANS' ADMINISTRATION PENSION.

REFUNDS - Any refund received from a public agency of taxes paid on real estate or food purchases

RELOCATION ASSISTANCE PAYMENTS – interest/dividend income generated from unspent State or local government

(MRG)

(income)(page-130)Page 130#

UPDATED: JUNE 2010

227

INCOME

SSI-RELATED DISREGARDS

relocation assistance payments (not federal or federally assisted funds) for 9 months following the month of receipt.

REPLACEMENT OF ASSISTANCE ALREADY PAID - Replacement of assistance already paid, such as a lost or stolen check.

RETROACTIVE BENEFITS UNDER THE SSI PROGRAM.

ROOM/BOARD (LODGER) INCOME - The first $90 per month of any income from each boarder or roomer (lodger). If the A/R can document that the actual expenses incurred in providing the room or board exceeds the $90 per month, actual documented expenses are disregarded.

STATE OR LOCAL RELOCATION ASSISTANCE PAYMENTS - State or local relocation assistance payments received on or after May 1, 1991. The payments must be comparable to payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

STUDENTS’ INCOME – Earned Income – The allowable monthly and annual income effective in January each year can be found in the REFERENCE DISREGARDS, SSI-DISREGARDS STUDENT INCOME. The amount is the earned income allowed to be earned by a student under 22 years of age (regardless if s/he is married or the head of a household) who is regularly attending a school, college, university, or a course of vocational or technical training.

Educational-Related Income - Any portion of a grant, scholarship, fellowship or gift used to pay the cost of tuition and other education-related fees at any educational (including technical or vocational) institution. This disregard does not apply to any portion set aside or actually used for food, clothing or shelter.

(MRG)

(income)(page-131)Page 131#

UPDATED: JUNE 2011

228

INCOME

SSI-RELATED DISREGARDS

When the assistantship is considered employment, the A/R receives any appropriate earned income disregards (See INCOME SSI-RELATED DISREGARDS), but additional deductions for educational expenses are not allowed.

School Meals - The value of free school meals.

Student Loans - Student loans received by a graduate or undergraduate student.

SUPPLEMENTAL SECURITY INCOME (SSI) - Any SSI payments received by the A/R.

THIRD PARTY INSURANCE PAYMENTS - Insurance payments paid directly to a third party such as a loan company or a bank to cover loan or installment payments in case of death or disability (example: mortgage insurance).

TITLE III, FEDERAL ECONOMIC OPPORTUNITY ACT - Any loan made to a family under Title III of the Federal Economic Opportunity Act.

UNEARNED INCOME - Only one $20 disregard is permitted per month per couple. A certified blind or a certified disabled child living with parents is entitled to a separate $20 disregard from his/her total unearned income. If an A/R’s unearned income is under $20, the balance will be deducted from earned income.

U.S. CENSUS - Earnings from census employment.

(MRG)

(income)(page-132)Page 132#

UPDATED: JUNE 2010

229

INCOME

SSI-RELATED DISREGARDS

VETERANS - Payments to veterans for Aid & Attendance (A&A) or payments for Unusual Medical Expenses (UME).

Children - Monthly allowances paid to certain Vietnam Veterans’ Children with Spina Bifida.

VISTA - Payments received by VISTA volunteers.

VOCATIONAL REHABILITATION ACT - Any payments made under the Vocational Rehabilitation Act.

VOLUNTEER PROGRAM PAYMENTS - Payments received by participants in volunteer programs under Title II of P.L. 93-113 (Domestic Volunteer Services Act of 1973). These include: retired senior volunteer, foster grandparent, senior companion and senior health aide programs. Payments made in the form of stipends, allowances and/or reimbursements for incurred expenses are disregarded when determining Medicaid eligibility.

WIC PROGRAM - The value of benefits under the WIC program.

References:

SSL Sect. 366.2 366.3

Dept. Reg. 352.22 360-4.6(a)(1) 360-4.6(a)(2)

(MRG)

(income)(page-133)Page 133#

UPDATED: JUNE 2011

230

INCOME

SSI-RELATED DISREGARDS

ADMs

94 ADM-13 92 ADM-42 92 ADM-32 91 ADM-23 91 ADM-8 83 ADM-17 81 ADM-38

INFs

95 INF-30 90 INF-33

LCM

92 LCM-120

GISs

11 MA/004

06 MA/029

05 MA/001

04 MA/030

04 MA/027

00 MA/012

98 MA/017 98 MA/016 97 MA/022 95 MA/001

Interpretation: The types of income listed previously are not considered in determining eligibility for Medicaid for the SSI-related category. Only available income is counted in the determination of eligibility. OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILITY discusses availability of income in more detail.

Documentation: The source and amount of income disregards are documented in the case record and a notation is made that this income is not to be considered in determining eligibility for Medicaid.

(MRG)

(income)(page-134)Page 134#

UPDATED: FEBRUARY 2005

231

INCOME

SSI-RELATED BUDGETING METHODOLOGY

Description: New York State has contracted with the Social Security Administration so that eligibility for SSI generally means automatic eligibility for Medicaid. The SSI recipient does not need to file an application for Medicaid.

There is a group of people, however, who do not receive SSI but who meet the categorical requirements of the program. These persons are: aged (65 or over), certified blind, or certified disabled. Generally, these individuals must apply for Medicaid separately and have their eligibility determined by the local social services district where they live. In determining eligibility for these SSI-related persons, the SSI-related budgeting methodology is used. This methodology is patterned after the method used by the Social Security Administration to determine eligibility for SSI.

Policy: SSI-related budgeting is used to determine eligibility for those persons who are aged (65 or over), certified blind or certified disabled and not in receipt of Supplemental Security Income (SSI). (See CATEGORICAL FACTORS SSI-RELATED)

SSI-related budgeting is used for Medicaid A/Rs for whom payment or part payment of the Medicare premiums, coinsurance and deductibles is made. (See INCOME MEDICARE SAVINGS PROGRAM)

When determining eligibility for the Medicaid Buy-In Program for Working People with Disabilities, SSI-related budgeting, including allocation and deeming is used.

Persons potentially eligible for COBRA continuation of their health insurance when employment ends and those applying for the AIDS Health Insurance Program have their income and resources budgeted in accordance with the SSI-related methodologies.

Disregards of income for SSI-related persons are discussed and listed in INCOME SSI-RELATED DISREGARDS and the determination of eligibility for SSI-related persons is described in INCOME DETERMINATION OF ELIGIBILITY.

References: SSL Sect.

366

Dept. Reg.

360-3.3(a)(3) 360-3.3(b)(1) and (2) 360-4.2

(MRG)

(income)(page-135)Page 135#

UPDATED: FEBRUARY 2005

232

INCOME

SSI-RELATED BUDGETING METHODOLOGY

ADMs

04 OMM/ADM-5

03 OMM/ADM-4

93 ADM-28 91 ADM-53 91 ADM-27

83 ADM-17

Interpretation: SSI-related children are budgeted as a household of one, using their own income and any income deemed from their parent(s). SSI-related adults, who are unmarried or not living with a spouse, are budgeted as a household of one.

An SSI-related couple is budgeted as a household of two.

SSI-related adults, who reside with a non-SSI-related spouse, are budgeted as a household of two for income, unless the income of the non-SSI-related spouse (after allocation) is less than the difference between the Medicaid income level for a two-person household and the Medicaid income level for an individual. If it is below that amount, the non-SSI-related spouse and his/her income are not counted and the SSI-related person is budgeted as a household of one.

SSI-related adults who reside with a spouse of any category are always budgeted as a household of two for resources.

Persons in receipt of cash assistance (PA or SSI) are not considered in the household count nor are their income considered when determining income eligibility.

SSI-related budgeting takes the needs and income of other family members into consideration by the process of allocation and deeming. This process is discussed in detail in the sections that follow:

Allocation

Deeming

(MRG)

(income)(page-136)Page 136#

UPDATED: AUGUST 1999

233

INCOME SSI-RELATED BUDGETING METHODOLOGY

ALLOCATION

Description: Allocation is the budgeting process that sets income aside for the needs of non-SSI-related children under the age of 18 and for the needs of parents (regardless of category) of SSI-related children.

The allocation amount to a non-SSI-related child is the difference between the Medicaid income level for a two-person household and the Medicaid income level for an individual.

NOTE: Although parents are financially responsible for their non- disabled children under the age of 21, allocation to dependent children ceases at age 18.

In determining eligibility for an SSI-related child, the allocation amount to a single parent is the federal benefit rate (FBR) for an individual. The allocation amount to a two-parent household is the FBR for a couple.

When an SSI-related parent and a non-SSI-related parent reside with an SSI-related child and at least one non-SSI-related child, the amount allocated to the parents in determining the SSI-related child's eligibility, is the federal benefit rate (FBR) for a couple living alone, plus the SSI State supplement for an individual living with others.

Policy: Allocation is the first step in the deeming process (See INCOME DEEMING) and the first step in the SSI-related budgeting process. Allocation is used when:

• there is a non-SSI-related adult, his/her SSI-related spouse and a non-SSI-related child living in the same household;

• there is an SSI-related child, a non-SSI-related child, and at least one parent (regardless of category) in the household who is not receiving cash assistance; or

• an SSI-related child is living with one or both parents (regardless of category) and those parents are not receiving cash assistance.

(MRG)

(income)(page-137)Page 137#

UPDATED: NOVEMBER 2009

234

INCOME

ALLOCATION

The allocation amounts, effective January 1st each year, can be found in the REFERENCE INCOME ALLOCATION.

Allocation to

How Determined

Non-SSI Child

2005: Difference between Medicaid income standard for one and two 2006 and 2007: Difference between the Federal Benefit Rate (FBR) for one and two

Single parent (regardless of category)

Federal SSI Benefit Rate (FBR) for one

Two parents (regardless of category)

Federal SSI Benefit Rate (FBR) for two

An SSI-related parent and a non- SSI-related parent residing with an SSI-related child and a non- SSI-related child

The Federal SSI Benefit Rate (FBR) for two, living alone, plus the SSI State supplement for one, living with others

Interpretation: Allocation is the first step in the SSI-related budgeting process. Allocation is used in the family situations previously described. Allocation is not used when determining eligibility for:

• a single SSI-related person living alone;

• an adult couple one or both of whom may be SSI-related; or

• SSI-related parents living with a non-SSI-related child.

(1) The process of allocating to non-SSI-related children is as follows:

(a) The amount allocated to each non-SSI-related child is the difference between the Medicaid Income standard for one and two;

(MRG)

(income)(page-138)Page 138#

UPDATED: NOVEMBER 2009 235

INCOME

ALLOCATION

(b) This allocation amount is offset on a dollar for dollar basis by any other income the child receives in his/her own right (whether or not the child is applying);

(c) In determining eligibility for an SSI-related adult, the remaining allocation amount, not offset by the non-SSI- related child's own income, is allocated from the unearned income of the non-SSI-related parent after deducting any court-ordered support paid by the non- SSI-related spouse from his/her unearned income. When the non-SSI-related parent does not have sufficient unearned income to meet the allocation, the remaining allocation is made from the non-SSI-related parent’s earned income after deducting any court- ordered support paid by the non-SSI-related spouse from his/her earned income.

(d) In determining eligibility for an SSI-related child, the remaining allocation amount not offset by the non-SSI- related child’s own income is allocated from the unearned income of the parents after deducting any court-ordered support paid by the parents from his/her unearned income. When the parents do not have sufficient unearned income to meet the allocation, the remaining allocation is made from the parents’ earned income after deducting any court-ordered support paid by the parents from his/her earned income.

(2) The process of allocating to parents is as follows:

(a) In determining eligibility for an SSI-related child, after allocating to any non-SSI-related children, as shown above in step (1), the remaining income of the parents, whether earned, unearned or a combination, is computed;

NOTE: If there is no allocation to any non-SSI-related child, subtract any court-ordered support paid by either parent before combining the parents’ earned and unearned income.

(MRG)

(income)(page-139)Page 139#

UPDATED: NOVEMBER 2009 236

INCOME

ALLOCATION

(b) After applying the SSI-related disregards a portion of the parents' remaining income is allocated to meet their needs. The amount allocated to the parent(s) is the Medicaid income standard for an individual or couple. (See REFERENCE SSI BENEFIT LEVELS)

(MRG)

(income)(page-140)Page 140#

UPDATED: AUGUST 1999

237

INCOME SSI-RELATED BUDGETING METHODOLOGY

DEEMING

Description: The basis for deeming is inherent in the concept that husbands and wives living together have a responsibility to each other and generally share income. Parents living with their children also have a responsibility for their children and generally provide income for their needs.

Policy: Deeming is the budgeting process by which the income of a legally responsible relative (LRR), in the household, is considered available to the SSI-related individual. Deeming is used in the SSI-related budgeting process to determine the amount of support and maintenance furnished by an LRR.

Interpretation: (1) Deeming is used in the following situations:

(a) parent to child. When determining eligibility for an SSI- related child under age 18, a portion of the parent's income is deemed to the child unless the parent receives cash assistance. Deeming is used whether or not the parent is SSI-related;

(b) spouse to spouse. When determining eligibility for an SSI-related person with a non-SSI-related spouse and the non-SSI-related spouse has sufficient income.

(2) Deeming is not used when:

(a) determining eligibility for an SSI-related person living alone;

(b) determining eligibility for two SSI-related spouses;

NOTE: Although deeming is not used in the budgeting process for an SSI-related couple, the income of both spouses is considered mutually available.

(d) determining eligibility for an SSI-related person whose spouse receives an SSI or PA cash grant;

(MRG)

(income)(page-141)Page 141#

UPDATED: JULY 2008

238

INCOME SSI-RELATED BUDGETING METHODOLOGY DEEMING

(e) determining eligibility for an SSI-related child who is between the ages of 18 and 21. When the child is married, income may be deemed from the spouse.

(3) Deeming is performed as follows:

(a) income is allocated to any non-SSI-related children in the household after deducting any court-ordered support paid by the non-SSI-related spouse as described in INCOME UNEARNED SUPPORT PAYMENTS.

(b) in determining eligibility for an SSI-related adult, the remaining income of the non-SSI-related spouse is deemed to the SSI-related spouse, provided the income is equal to or greater than the difference between the Medicaid level for two and the Medicaid level for one. If the income of the non-SSI-related spouse is not deemed, because the remaining net income is less than the difference between the Medicaid level for two and the Medicaid level for one, then only the income of the SSI-related spouse is considered in determining eligibility.

Subtract any allowable disregards from the SSI-related spouse's income. Compare the SSI-related spouse's net income to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial. If income is deemed from the non-SSI-related spouse, subject to any allowable disregards from the couple’s combined income, compare the remaining net income to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial.

(c) in determining eligibility for an SSI-related child, the parents’ remaining net income, after allocating to any non-SSI-related child, is subject to the appropriate disregards as described in INCOME SSI-RELATED DISREGARDS, and steps C-2 through C-8. The remaining income is deemed to the SSI-related child. The deemed income is added to any income of the SSI- related child and the eligibility process is continued as described in steps C-9 and C-10. (See INCOME DETERMINATION OF ELIGIBILITY for steps)

(MRG)

(income)(page-142)Page 142#

UPDATED: AUGUST 1999

239

INCOME SSI-RELATED BUDGETING METHODOLOGY

HEALTH INSURANCE PREMIUMS

Description: Health insurance premiums are premiums paid for insurance which covers hospital, medical, dental, drug and/or other charges for medical care and services.

Policy: In determining eligibility for SSI-related persons, health insurance premiums are deducted if they are paid by the A/R.

References: SSL Sect.

366.2(a)(6)

Dept. Reg.

360-4.6(a)(2)(vii)

ADMs

93 ADM-28 91 ADM-54 91 ADM 53 91 ADM-27

Interpretation: Health insurance premiums are deducted from the kind of income from which they are being paid. If it is not possible to determine if the health insurance premiums are paid from earned or unearned income, the deduction is made where it is most advantageous to the client.

Policies, which indemnify the A/R against loss of income due to illness or disability, may be considered for this disregard. These include: income protection insurance, medical liability insurance and any other insurance which offsets the loss of wages due to illness or hospitalization. A policy, which pays the A/R a certain amount of money for each day s/he is hospitalized, but does not cover specific hospital services, may be eligible for this disregard. The policy must be assignable (See RESOURCES THIRD PARTY RESOURCES ASSIGNMENT AND SUBROGATION) to a hospital and be cost effective for its premiums to be considered as a deduction. A policy belonging to a non-applying spouse does not have to be assignable in order to receive the premium disregard.

(MRG)

(income)(page-143)Page 143#

UPDATED: AUGUST 1999

240

INCOME SSI-RELATED BUDGETING METHODOLOGY

HEALTH INSURANCE PREMIUMS

RESOURCES THIRD PARTY RESOURCES ENROLLMENT IN GROUP HEALTH INSURANCE contains information on the eligibility requirement that A/Rs obtains any health insurance available through their employer. When the health insurance is cost-effective and the A/R is below the income/resource level, the local districts may pay the recipient's premium, unless it is an income protection policy.

When to Verify: (a) When the A/R declares in the application that s/he or other family members are covered by health insurance;

(b) When the A/R declares in the application that s/he or other family members are covered by Medicare, Part A or B;

(d) When the A/R or absent parent is employed;

(e) When the A/R is receiving RSDI; and

(f) When the A/R is receiving a pension.

Verifications: Health insurance premiums may be verified by:

(a) The health insurance policy;

(b) The health insurance card; or

Documentation: Sufficient to establish an audit trail:

(a) Amount of premium, frequency of paycheck stub or envelope, policy number and employer's name;

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(b) For privately paid policies, amount, date and frequency of payment, insurance company name and policy number; and

Disposition: When the amount of health insurance premiums paid is indicated, that amount is disregarded to determine net available income.

(MRG)

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UPDATED: APRIL 2008

242

INCOME SSI-RELATED BUDGETING METHODOLOGY

IMPAIRMENT-RELATED WORK EXPENSES

Description: Impairment-related work expenses are non-medical expenses directly related to enabling the disabled SSI-related individual to work. The cost of these expenses is paid by the disabled individual and is not reimbursable from another source. (See INCOME SSI-RELATED BUDGETING METHODOLOGY BLIND WORK EXPENSES for work expenses of the blind.)

Policy: For SSI-related persons, impairment related work expenses are subtracted from earned income after the $65 deduction, but before the one-half of the remaining income disregard.

NOTE: Medical impairment related work expenses are not deductions in the SSI-related budgeting methodology but rather may be used to reduce excess income after the budget calculations are complete (See INCOME EXCESS). Where applicable, medical impairment-related work expenses are combined with other incurred medical bills to reduce excess income available to meet medical costs and services. If there is no excess income, medical impairment-related work expenses may be paid by Medicaid.

References: Dept. Reg.

360-4.6(a)(2)(v)

ADMs

83 ADM-65

83 ADM-17

Disability Manual

Interpretation: Examples of non-medical impairment-related work expenses that may be used as a deduction for SSI-related persons are:

• Cost of modifications made to a car in order to permit a handicapped person to drive to work;

• Wheel chair ramps;

• Cost of special foods needed to maintain dietary restrictions while at work;

• Work-related equipment such as one-hand typewriters, page turning devices, telecommunication devices for the deaf, Braille devices, and

• Interpreters for the deaf.

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IMPAIRMENT-RELATED WORK EXPENSES

• specially designed work tools.

• Residential modifications in the form of changes to the exterior of his/her home in order to create a working space to accommodate an impairment (e.g., enlargement of a doorway leading into the office, modification of work space to accommodate problems in dexterity).

NOTE: For a self-employed person, any cost deducted as a business expense cannot be deducted as an impairment-related work expense.

• Costs of a Seeing Eye dog, including food, licenses and veterinarian services.

• Costs of structural or operational modifications to a vehicle required by an individual in order to get to and from work;

• Mileage allowance for an approved vehicle limited to travel related to employment; AND,

• Cost of driver assistance or taxicabs where such special transportation is not generally required by an unimpaired individual in the community.

These kinds of expenses are generally not covered by Medicaid.

An impairment-related work expense is allowed when it is necessary for employment, even though the A/R may use the “item” outside of work and/or his/her family may benefit from it. For example, the expense of special equipment on a car, needed by a paraplegic for transportation to and from work, is

(MRG)

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IMPAIRMENT-RELATED WORK EXPENSES

an allowable impairment related work expense even though s/he uses the car on weekends to transport his/her family. The entire expense of the special equipment may be deducted as an impairment-related work expense.

NOTE: For self-employed A/Rs, if the cost of an item has been deducted in calculating net earnings from self-employment, the expense cannot be deducted as an impairment-related work expense.

NOTE: When determining if an individual is doing Substantial Gainful Activity (SGA), both medical and non-medical impairment-related work expenses are deducted from earned income before applying the SGA test (See REFERENCE SUBSTANTIAL GAINFUL INCOME for maximum amount. See DISABILITY MANUAL and CATEGORICAL FACTORS SUBSTANTIAL GAINFUL ACTIVITY (SGA) for further information.

Examples of medical impairment-related work expenses that can be deducted when calculating the amount of the A/Rs spenddown: (See INCOME EXCESS for more detail on excess income).

• Assistance in traveling to and from work or while at work, assistance with personal functions (e.g., eating, toileting), or with work-related functions (e.g., reading, communicating).

• Assistance at home with personal functions (e.g., dressing, administering medications) in preparation for going to and returning from work. Payments made to a family member for attendant care services may be deducted only if such family member, in order to perform the services, incurs an economic loss by terminating his/her employment or by reducing the number of his/her work hours.

• Medical devices such as wheelchairs, hemodialysis equipment, canes, crutches, inhalators and pacemakers.

• Prosthetic devices such as artificial replacements of arms, legs and other parts of the body.

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IMPAIRMENT-RELATED WORK EXPENSES

• Devices or appliances which are essential for the control of a disabling condition either at home or in the work setting and are verified as medically necessary.

• Drugs or medical services including diagnostic procedures needed to control the individual’s impairment. The drugs or services must be prescribed or used to reduce or eliminate symptoms of the impairment or to slow down its progression. The diagnostic procedures must be performed to ascertain how the impairment(s) is progressing or to determine what type of treatment should be provided for the impairment(s).

Some examples of deductible drugs and medical services are:

• Anticonvulsant drugs, antidepressant medication for mental disorders, radiation treatment or chemotherapy, corrective surgery for spinal disorders, and tests to determine the efficacy of medication.

• Expendable medical supplies such as catheters, elastic stockings, face masks and disposable sheets and bags.

• Physical therapy required because of impairment and which is needed in order for the individual to work.

• Payments for transportation costs to attend medical appointments.

When to Verify: (a) When the A/R indicates that s/he has special equipment in his/her vehicle, home or workplace that assists him/her in performing work;

(b) When the A/R indicates special dietary needs.

Verification: Non-medical impairment-related work expenses may be verified by:

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IMPAIRMENT-RELATED WORK EXPENSES

(a) Seeing a bill or statement from a provider of special equipment;

(b) Seeing a statement from the A/R's physician regarding special dietary needs or special equipment needed to permit the A/R to work.

Documentation: Sufficient to establish an audit trail:

Name of provider or doctor, date, equipment or service provided and cost.

(MRG)

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UPDATED: JANUARY 2011

247

INCOME SSI-RELATED BUDGETING METHODOLOGY

BLIND WORK EXPENSES

Description: For persons who are certified blind, work expenses include any expenses reasonably attributable to earning of income.

Policy: After applying the $65 plus one-half of the remainder earned income disregard, persons who are certified blind (See CATEGORICAL FACTORS BLINDNESS for categorical requirements) are entitled to a work expense disregard.

References: Dept. Reg.

360-4.6(a)(2)(xi)

ADMs

83 ADM-17

Interpretation: Certified blind A/Rs are entitled to a deduction from earned income for work expenses. Work expenses for blind A/Rs include mandatory deductions FICA, taxes, New York State Disability Insurance and lunch, transportation, union dues, uniforms, and other expenses. It includes expenses related to a guide dog, special visual aid equipment and other expenses necessary to maintain employment.

When to Verify: When a certified blind person declares that s/he is employed.

Verification: (a) Seeing bills or receipts for work-related expenses such as visual aid equipment or food for a guide dog;

(b) Seeing bills or receipts for uniforms or tools;

Documentation: Sufficient to establish an audit trail:

(a) Name and address of employer, dates of employment, copies of receipts for equipment, dog food or veterinarian services, name and address of the provider of special equipment.

(b) Returned clearance in case record.

(MRG)

(income)(page-151)Page 151#

UPDATED: AUGUST 1999

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INCOME SSI-RELATED BUDGETING METHODOLOGY

PLAN TO ACHIEVE SELF-SUPPORT (PASS)

Policy: After all other disregards are deducted, the remaining income of certain certified blind or certified disabled individuals (See CATEGORICAL FACTORS SSI-RELATED DISABILITY) may be disregarded if such income is needed to fulfill a plan for achieving self- support.

This disregard applies to certified blind or certified disabled individuals under 65 years of age, and to certified blind or certified disabled individuals age 65 or over who received SSI payments or aid under the State Plan for the certified blind or certified disabled for the month preceding the month of their 65th birthday.

References: SSL Sect.

366.2(b)

Dept. Reg.

360-4.6 (a)(2)(xxiv)

ADMs

83 ADM-17

Disability Manual

Interpretation: The local social services district assists a certified blind or certified disabled A/R who appears to have the potential to benefit from PASS and who is interested in setting up a self-support. The plan must:

(1) contain specific planned savings and/or expenditures to achieve a designated feasible occupational objective and the period of time for achieving the objective;

(2) provide for the identification and segregation of money and goods, if any, being accumulated and saved;

(3) be current, in writing and be approved by the local commissioner of social services for not more than 18 months with the possibility of an extension for an additional 18 months; a further extension of 12 months may be allowed in order to fulfill a plan for a lengthy education or training program; and

(4) be followed by the individual.

Some examples of goals that an A/R may be striving to meet which are acceptable for self-support plans are:

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PLAN TO ACHIEVE SELF-SUPPORT (PASS)

• saving money for a vehicle specially equipment for handicapped persons;

• accumulating money to start a small business in line with the person's training or background;

• accumulating funds for further education; or

• any other goal which would make the individual more self sufficient and lessen the person's need for assistance.

Disposition: When a PASS meets the above conditions, the stated amounts for meeting the goals are disregarded after all other applicable disregards have been exempted in determining eligibility for Medicaid. Eligibility is re-evaluated prior to the end of the time period of the plan.

An approved PASS has reports written periodically which indicate how the A/R is progressing and to verify that the A/R is acting in accordance with the provision(s) of his/her plan.

A complete description of how to initiate a PASS as well as other requirements is contained in the DISABILITY MANUAL.

(MRG)

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UPDATED: JULY 2008

250

INCOME SSI-RELATED BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

Policy: Eligibility for persons who are SSI-related is determined by comparing the net available income of the A/R to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial. The resources of the A/R are also considered. A discussion of resources is found RESOURCES.

References: SSL Sect.

366

ADMs

94 ADM-13 91 ADM-27 83 ADM-17

Interpretation: SSI-related persons who meet the requirements of any other category (LIF, ADC-related, under age 21 or pregnant) have a choice between LIF, ADC-related budgeting or SSI-related budgeting. A/Rs are informed of this choice by the eligibility worker and shown which budgeting method is more advantageous. Once the A/R chooses a particular method of budgeting, the same method is used for resources as well as income.

The SSI-related budgeting methodology (as described in this Guide) is divided into three parts. Part A describes the determination of countable income for SSI-related A/Rs. Part B describes the determination of eligibility for an SSI-related adult when income is allocated to meet the needs of non-SSI-related children in the household. It also includes the budgeting disregards applicable to an SSI-related adult, whether or not allocation or deeming is appropriate. It is important to carefully review RESOURCES ALLOCATION and DEEMING to determine if allocation and deeming are necessary in each case. Part C describes the eligibility determination process for an SSI-related child living with at least one parent. It includes the process by which a portion of the parent’s income is allocated to any non-SSI-related children in the household as well as the allocation to the parent. It also describes how the parent’s income is deemed to the SSI-related child before eligibility is determined for that child.

A. General steps applicable to all SSI-related A/Rs.

Determine the monthly income of the individual or couple. All income from all sources is reviewed to determine if it is

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DETERMINATION OF ELIGIBILITY

counted when determining eligibility. Certain kinds of income are disregarded in whole or in part (See INCOME SSI- RELATED DISREGARDS) when determining monthly income.

B. Determining eligibility for an SSI-related adult.

B-1 In determining eligibility for an SSI-related adult, income is first allocated to meet the needs of any non-SSI-related children in the household. Allocation is described INCOME ALLOCATION AND DEEMING. If the non-SSI-related adult has no income, no allocation is made to the children.

B-2 Determine whether or not income is deemed from a non-SSI-related spouse. If after allocating to any non-SSI- related children, the non-SSI-related spouse's remaining income is less than the difference between the monthly medically needy income level for two and the monthly medically needy level for an individual (See INCOME MEDICALLY NEEDY INCOME LEVEL), no income is deemed to the SSI-related spouse and only the income of the SSI- related spouse is considered in determining his/her eligibility.

If after allocating to any non-SSI-related children, the income of the non-SSI-related spouse equals or exceeds the difference between the monthly medically needy level for two and the medically needy level for a single individual, the non- SSI-related spouse’s income is deemed to the SSI-related spouse. The non-SSI-related spouse's remaining unearned income is combined with the unearned income of the SSI- related spouse and the non-SSI-related spouse's earned income is combined with any earned income of the SSI- related spouse.

B-3 Unearned Income – Deduct the $20 income disregard. If the unearned income is less than $20, the remainder of the disregard is subtracted as the first deduction from earned income; and

Deduct health insurance premiums if paid from unearned income. If the health insurance premium is greater than the amount of unearned income, the reminder is subtracted from earned income.

(MRG)

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INCOME SSI-RELATED BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

B-4 Earned Income – • Deduct the balance of the $20 income disregard, if it is not offset by unearned income; • Deduct $65; • Deduct any impairment related work expenses (See INCOME SSI-RELATED BUDGETING METHODOLOGY IMPAIRMENT-RELATED WORK EXPENSES); • Deduct one-half of the remaining earned income. (The one-half deduction is rounded up to the nearest dollar); • Deduct work expenses for certified blind individuals (See INCOME SSI-RELATED BUDGETING METHODOLOGY BLIND WORK EXPENSES); and • Deduct health insurance premiums, if not deducted from unearned income.

B-5 Any remaining earned income is added to the remaining unearned income. Deduct any amount set aside for an approved plan to achieve self-support. (See INCOME SSI- RELATED BUDGETING METHODOLOGY PLAN TO ACHIEVE SELF-SUPPORT (PASS))

B-6 The resulting net income is then compared to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial. For an SSI-related adult, not married or not living with a spouse, the A/R is budgeted as a household of one. SSI-related couples are budgeted as a household of two. In both instances the income deductions noted in B-1 – B-5 are applied.

NOTE: For purposes of SSI-related budgeting, a certified blind or certified disabled child age 18 or over is budgeted as an SSI-related adult.

C. Determining eligibility for an SSI-related child (under age 18).

C-1 In determining eligibility for an SSI-related child income is first allocated to meet the needs of any non-SSI related children in the household as follows:

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DETERMINATION OF ELIGIBILITY

When the SSI-related child resides with a non-SSI-related child and only one parent, income is first allocated from the parent’s unearned income (after subtracting any court ordered support paid out from unearned income). If the unearned income is insufficient, the remaining allocation amount is subtracted from the parent’s earned income (after subtracting any court ordered support paid out from earned income).

The amount allocated to the non-SSI-related child is the difference between the monthly medically needy level for two and the monthly medically needy level for a single individual. The allocation amount is first offset on a dollar-for-dollar basis by any income of the child. The allocation amount is then subtracted from the parent’s income (first unearned income then earned income). The remaining parental income is used in the deeming process.

When the SSI-related child resides with a non-SSI-related child and either two non-SSI-related parents or two SSI- related parents, the parents' unearned income is combined and the allocation is made first from the combined unearned income (after subtracting any court ordered support paid out from unearned income). If there is not sufficient unearned income, the parents' earned income is combined and the balance of the allocation is made from earned income (after subtracting any court ordered support paid out from earned income). The remaining parental income is used in the deeming process.

When the SSI-related child resides with a non-SSI-related child, a non-SSI-related parent and an SSI-related parent, income is first allocated from the non-SSI-related spouse’s unearned income (after subtracting any court ordered support paid out from unearned income). If the unearned income is insufficient, the remaining allocation amount is subtracted from the parent’s earned income (after subtracting any court ordered support paid out from earned income). After allocating to the non-SSI-related child, the non-SSI-related spouse's remaining unearned income is

(MRG)

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DETERMINATION OF ELIGIBILITY

combined with the unearned income of the SSI-related spouse and the non-SSI-related spouse's earned income is combined with any earned income of the SSI-related spouse. The deductions listed in steps B-3 – B-5 are then subtracted. The remaining parental income is used in the deeming process starting with the deduction of the parental allocation (See note under C-2 on this page).

C-2 To determine the amount of parental income to deem available to an SSI-related child, when a parent has income remaining after allocating to any non-SSI-related children:

Deduct the $20 income disregard from the remaining unearned income. (See INCOME SSI-RELATED DISREGARDS) When the unearned income is insufficient, or there is only earned income, the balance of the $20 income disregard is subtracted first from any earned income.

Deduct any health insurance premiums, if paid from unearned income. If the health insurance premium is greater than the amount of unearned income, the reminder is subtracted from earned income.

Deduct $65 from earned income, then subtract one-half of any remaining earned income. (The one-half deduction is rounded up to the nearest dollar.)

Deduct any health insurance premiums, if paid from earned income or any balance remaining from unearned income.

Add any remaining countable unearned income to any remaining countable earned income and deduct the appropriate parental allocation, the Federal Benefit Rate (FBR). (See REFERENCE SSI BENEFIT LEVELS)

• Single parent – FBR for an individual Two parent household – FBR for a couple

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DETERMINATION OF ELIGIBILITY

NOTE: In cases where the SSI-related child is residing with a non-SSI-related parent, SSI-related parent and a non-SSI- related child, the parent allocation is the FBR for a couple, plus the state supplement for an individual.

Any income remaining after deducting the parent allocation is deemed available to the SSI-related child. If there is more than one SSI-related child in the household, divide the deemed amount of income evenly.

C-3 Any parental income that is deemed available to the SSI- related child is added to any unearned income of the child, after any disregards. (See INCOME SSI-RELATED DISREGARDS)

C-4 Deduct the SSI-related child’s $20 income disregard. The child is allowed the $20 income disregard regardless of whether or not s/he has any income of his/her own.

C-5 Deduct any health insurance premiums paid out of the child’s unearned income.

C-6 Deduct one-third of any court-ordered support payments received by the SSI-related child from an absent parent.

C-7 If the SSI-related child has earned income, s/he is allowed the appropriate earned income disregards listed in Steps B-4 – B-5.

C-8 The remaining income is then compared to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial.

Disposition: After all appropriate allocation, deeming and the deduction of disregards, the remaining income of the SSI-related individual is compared to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial. Any excess income remaining after applying the appropriate level, is considered available to meet the cost of medical care and services. (See INCOME EXCESS)

(MRG)

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UPDATED: NOVEMBER 2007

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INCOME

MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES (MBI-WPD)

Policy: The federal poverty level is used to determine eligibility for MBI-WPD. The net countable income of the A/R is compared to 250% of the federal poverty level for the appropriate family size of a household for one or two.

SSI-related budgeting, including, disregards, allocation and deeming, is used for determining net available income. (See INCOME: SSI- RELATED DISREGARDS, SSI-RELATED BUDGETING METHODOLOGY, INCOME ALLOCATION, DEEMING, HEALTH INSURANCE PREMIUMS, IMPAIRMENT-RELATED WORK EXPENSES, BLIND WORK EXPENSES, PLAN TO ACHIEVE SELF- SUPPORT (PASS), and DETERMINATION OF ELIGIBILITY and REFERENCE INCOME ALLOCATION for a discussion of SSI-related budgeting.)

Reference: See CATEGORICAL FACTORS and RESOURCES: MEDICAID BUY- IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES, and OTHER ELIGIBILITY REQUIREMENTS MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES PREMIUM PAYMENTS for a discussion of other eligibility criteria for MBI-WPD.

SSL Sect. 366(1)(a)(12) & (13)

ADMs 04 OMM/ADM-5 03 OMM/ADM-4

NOTE: See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for a chart displaying the Medicaid Levels and Federal Poverty Levels.

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INCOME

S/CC DISREGARDS

Description: Disregards of income are not considered in whole or in part in determining eligibility for Medicaid.

Policy: The following types of income are disregarded in the determination of gross monthly income for Medicaid: (See REFERENCE INCOME DISREGARDS for chart)

AMERICORPS - Child care allowances and other benefits and services including payments for living expenses provided by Americorps VISTA.

Child care allowances and all other benefits and services except payments for living expenses, provided by Americorps USA and Americorps NCCC.

ASSISTANCE BASED ON NEED - Any regular cash assistance payments based on need received by the A/R and furnished as supplemental income by the federal government, a State or political subdivision.

BONA FIDE LOAN - A bona fide loan received by the A/R from an institution or person not legally liable for the support of the A/R. The loan must be a written agreement, signed by the A/R and the lender. The written agreement must indicate: the A/R's intent to repay the loan within a specific time; and how the loan is to be repaid, by specific real or personal property, held as collateral, or from future income. The loan remains an exempt resource as long as it retains the characteristics of a bona fide loan. Any interest accrued by the A/R is considered unearned income in the month received.

CASH ASSISTANCE INCOME - Any income of a cash assistance recipient in the A/R’s household. However, any room/board such cash assistance recipient may pay to an S/CC A/R is countable, after applicable disregards (i.e., $90-work expense (See INCOME S/CC BUDGETING METHODOLOGY $90 WORK EXPENSE

(MRG)

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INCOME

S/CC DISREGARDS

DISREGARD) and the $60-boarder or $15-roomer disregard. (See INCOME S/CC DISREGARDS)

CHILDCARE INCOME - Five dollars a day per child for a A/R who provides family day care for children other than his/her own is disregarded from the total amount of childcare payments received.

CHILDCARE SERVICES PAYMENTS- Payments made to the A/R for childcare services or the value of any childcare services provided by the A/R to a recipient of employment-related and JOBS-related childcare services. Transitional child care services, at-risk low income child care services or child care and development block grant services.

Payments received from Child and Adult Care Food Program (CACFP).

CHILD SUPPORT ARREARAGE PAYMENTS – Child support arrearage payments received by the A/R are not counted if the child is not a member of the MA case and/or the child is over 21 and/or not residing in the household.

DONATED FOODS - The value of federally donated foods.

EARNED INCOME TAX CREDIT PAYMENTS.

EMERGENCY SAFETY NET PAYMENTS.

FEDERAL ECONOMIC OPPORTUNITY ACT, TITLE III - Any loan made to a family under Title III of the Federal Economic Opportunity Act.

FEDERAL ENERGY ASSISTANCE PAYMENTS.

FEDERAL RELOCATION ASSISTANCE - Any payment received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

FOSTER PARENT PAYMENTS - Payments received for a child boarded out in the home of a recipient by an agency or a relative of the child.

FOOD STAMPS - The value of food stamps.

(MRG)

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INCOME

S/CC DISREGARDS

FREE MEALS - The value of free meals, other than school meals, except when more than one meal a day is furnished or when the A/R receives an allowance for meals away from home.

GARDEN PRODUCE OR LIVESTOCK - The value of produce from a garden or livestock when used exclusively by the A/R and members of his/her household.

GI BILL DEDUCTION - That portion of a military person's pay which is deducted by mandate to help fund the GI Bill.

HOUSING AND URBAN DEVELOPMENT (HUD) COMMUNITY BLOCK GRANT FUNDS.

INCOME TAX REFUNDS – Any income tax refund or federal advance payment received by an A/R is disregarded in the month received and considered an exempt resource in the following month.

JOB CORPS - Money received by a family based on the enrollment of a child in the Job Corps.

NATIVE AMERICAN PAYMENTS - Seneca Nation Settlement Act payments made by the State and Federal governments, under P.L. 101-503, to the Seneca Nation.

Alaskan Native Claims Settlement Act (ANCSA) distributions - The following distributions from a native corporation formed pursuant to ANCSA are exempt as income or resources:

a. cash, to the extent that it does not, in the aggregate, exceed $2,000 per individual per year;

b. stock;

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INCOME

S/CC DISREGARDS

c. a partnership interest;

d. land or an interest in land; and

e. an interest in a settlement trust.

NYS DEPARTMENT OF LABOR PAYMENTS - Payments from Youth Education, Employment and Training Programs (Department of Labor programs).

PREVENTATIVE HOUSING SERVICE - Payments provided as a preventive housing service under 18 NYCRR 423.4(l).

(MRG)

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UPDATED: FEBRUARY 2005

261

INCOME

S/CC DISREGARDS

STUDENTS - Earned Income - Student earned income is generally countable.

NOTE: Persons under age 21 are not related to the S/CC category. They are generally categorically related to ADC/LIF categories.

When an A/R is in receipt of a graduate assistantship, the local district receives verification from the financial aid office involved to determine if the assistantship is considered employment or an educational grant. If the assistantship is a grant, it is treated as outlined in the previous paragraph. When the assistantship is considered employment, the A/R receives any appropriate earned income disregards (See INCOME S/CC DISREGARDS), but additional deductions for educational expenses are not allowed.

School Meals - The value of free school meals.

Student Loans - Student loans received by a graduate or undergraduate student.

Undergraduate Educational Grants, Scholarships or Work- Study - Educational grants, scholarships, fellowships or work- study for undergraduate students.

NOTE: This does not apply to V.A. Educational Grants which are a part of the G.I. Bill and which provide a monthly allowance for support while veterans are enrolled in school. Only specific education-related expenses such as tuition, books, school fees, transportation, etc., are exempt for recipients of G.I. Bill educational money. The remainder is considered available unearned income in determining eligibility for Medicaid.

(MRG)

(income)(page-165)Page 165#

UPDATED: JUNE 2010

262

INCOME

S/CC DISREGARDS

SUPPLEMENTAL SECURITY INCOME (SSI) - Any SSI payments received by the A/R.

U.S. CENSUS - Earnings from census employment.

Children - Monthly allowances paid to certain Vietnam Veterans’ Children with Spina Bifida.

(MRG)

(income)(page-166)Page 166#

UPDATED: JUNE 2010

263

INCOME

S/CC DISREGARDS

WORK EXPENSE - $90 work expense from earned income (See INCOME S/CC BUDGETING METHODOLOGY $90 WORK EXPENSE DISREGARD)

Payments for supportive services paid under JTPA to any A/R to defray costs attributable to training such as transportation, meals, childcare, etc.

References: SSL Sect.

366.2 366.3

Dept. Reg.

352.22 360-4.6(a)(1) 360-4.6(a)(3)

ADMs

01 OMM/ADM-6

OMM/ADM 97-2 97 ADM-23 94 ADM-10 92 ADM-43 92 ADM-42

92 ADM-32

(MRG)

(income)(page-167)Page 167#

UPDATED: JUNE 2011

264

INCOME

S/CC DISREGARDS

92 ADM-11 91 ADM-8 90 ADM-3 84 ADM-21 84 ADM-1 81 ADM-38

INFs

95 INF-30 94 INF-7 90 INF-33

LCMs

95 LCM-53 92 LCM-120

GISs

11 MA/004

98 MA/017 98 MA/016 95 ES/DC006

Interpretation: The kinds of income listed previously are not considered in determining eligibility for Medicaid for the S/CC category. Only available income is counted in the determination of eligibility. (See OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILITY for a more complete discussion of the availability of income)

Documentation: The source and amount of income disregards are documented in the case record and a notation is made that this income is not to be considered in determining eligibility for Medicaid.

(MRG)

(income)(page-168)Page 168#

UPDATED: JULY 2008

265

INCOME

SINGLES/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY

Policy: Single individuals or childless couples who are: (1) at least age 21, but not yet 65; (2) not certified blind or certified disabled; (3) not pregnant; and (4) not caretaker relatives of children under age 21 are determined eligible for Medicaid using the S/CC budgeting methodology.

References: SSL Sect.

366.1(a)

Dept. Reg.

352 360-4.6 370

ADMs

OMM/ADM 97-2 97 ADM-21

GIS

08 MA/022

Interpretation: Eligibility using S/CC budgeting is determined as follows:

(1) determine the monthly income of the person or household as described in OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION. Certain kinds of income are disregarded in whole or in part (See INCOME S/CC DISREGARDS);

(2) compare the monthly income to 185% of the Public Assistance Standard of Need (See INCOME S/CC BUDGETING METHODOLOGY 185% MAXIMUM INCOME LIMIT). If the income exceeds 185% of the Medicaid Standard, the A/R is not eligible for Medicaid. If the monthly income is equal to or less than 185% of the Medicaid Standard; then

(3) compare the monthly income to 100% of the federal poverty level. If the income exceeds 100% of the federal poverty level the A/R is not eligible for Medicaid. If the monthly income is equal to or less than 100% of the federal poverty level, then

(4) deduct the $90 work expense disregard;

(5) deduct mandatory items from unearned income;

(6) deduct that part of income from self-employment or a small business as described in INCOME EARNED SELF- EMPLOYMENT OR SMALL BUSINESS INCOME of this guide. Depreciation, personal business and entertainment

(MRG)

(income)(page-169)Page 169#

UPDATED: JULY 2008

266

INCOME

SINGLES/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY

expenses, personal transportation, personal income tax, purchase of capital equipment and payment on the principal of loans are not excluded or disregarded;

(7) deduct the $100 spousal support payment disregard, (See INCOME S/CC DISREGARDS);

(8) compare the resulting net income to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial.

Disposition: To determine eligibility for Medicaid, using S/CC budgeting methodology, the net income of the A/R, after all appropriate disregards have been deducted, is compared to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart as appropriate) whichever is most beneficial. (See REFERENCE MBL LIVING ARRANGEMENT CHART and REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS). If the A/R's income equals or exceeds the Medicaid Standard, s/he is ineligible for Medicaid.

(MRG)

(income)(page-170)Page 170#

UPDATED: JULY 2008

267

INCOME S/CC BUDGETING METHODOLOGY

185% MAXIMUM INCOME LIMIT

Description: The maximum income limit allowed for an S/CC A/R is 185% of the Medicaid Standard (including additional allowances).

Policy: When using S/CC budgeting, an A/R's total income, after subtracting any disregards, must be less than or equal to 185% of the applicable Medicaid Standard.

References: Dept. Reg.

352.18

ADMs

OMM/ADM 97-2 97 ADM-21 85 ADM-33 83 ADM-38 82 ADM-49 81 ADM-55

GIS

08 MA/022

Interpretation: Individuals and childless couples who are S/CC cannot have gross income exceeding 185% of the Medicaid Standard. (See INCOME MEDICAID STANDARD) All income disregards (See INCOME S/CC DISREGARDS) except the $90 work expense are deducted before determining if the A/R meets the 185% maximum income test. The Public Assistance Source Book for Regulations contains a more detailed description of income excluded from the 185% income limit.

NOTE: S/CC persons in Congregate Care (all levels) are not required to pass the 185% income test.

This income test is performed by multiplying the Medicaid Standard, for the appropriate size household, by 185%. The income of the A/R as described above, is then compared to this figure. If the income exceeds this figure, the individual or childless couple is ineligible for Medicaid. If the gross income is less than or equal to 185% of the Medicaid Standard then the budgeting procedures described in INCOME SINGLE/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY are followed.

(MRG)

(income)(page-171)Page 171#

UPDATED: AUGUST 1999

268

INCOME SINGLES/CHILDLESS COUPLES BUDGETING METHODOLOGY

100% MAXIMUM INCOME TEST

Description: The 100% maximum income test is a test performed after the S/CC household passes the 185% income test. Earned and unearned income is compared to 100% of the federal poverty level for a household of the appropriate size.

Policy: The income of the S/CC applicant household, after disregards, must be less than or equal to 100% of the federal poverty level.

References: ADMs OMM/ADM 97-2 97 ADM-23

Interpretation: S/CC A/Rs cannot have income exceeding 100% of the federal poverty level. All disregards noted in INCOME S/CC DISREGARDS except the $90 work expense, are disregarded before determining if the client meets the 100% test.

NOTE: Persons in Congregate Care (Levels I, II, and III) are not required to pass the 100% income test.

This income test is performed by comparing the income of the S/CC household with the federal poverty level for the appropriate household size (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for the federal poverty levels). If the income exceeds this figure, the household is not eligible for Medicaid under S/CC budgeting. If the gross income is less than or equal to 100% of the federal poverty level then the budgeting procedures described in INCOME SINGLES/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY DETERMINATION OF ELIGIBILITY.

(MRG)

(income)(page-172)Page 172#

UPDATED: AUGUST 1999

269

INCOME S/CC BUDGETING METHODOLOGY

$90 WORK EXPENSE DISREGARD

Policy: In determining eligibility for Medicaid, the first item deducted from the monthly earnings is $90 of earned income for those individuals engaged in full-time or part-time employment (including those not employed throughout the month).

NOTE: Whenever an A/R has earned income, the first $90 per month is disregarded even though the A/R may not currently be employed or working.

References: SSL Sect.

366

Dept. Reg.

352.19

ADMs

OMM/ADM 97-2 90 ADM-3 87 ADM-32

GISs

89 MA028 87 MA0028

Interpretation: When determining net earned income using S/CC budgeting (See INCOME SINGLES/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY) subtract $90 for each person working full-time or part-time. The $90 work expense is given regardless of the amount of the work expenses incurred.

When the A/R earns less than $90 per month, disregard the entire amount.

Although the A/R may have more than one job, only one $90 disregard for work-related expenses is allowed.

(MRG)

(income)(page-173)Page 173#

UPDATED: JUNE 2010

270

INCOME SINGLES/CHILDLESS COUPLES (S/CC) BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

Policy: Eligibility for single persons and childless couples who are over the age of 21, but under the age of 65, and who are not certified blind, certified disabled or pregnant is determined by comparing the net available income of the A/R to the Medicaid Standard (and MBL Living Arrangement Chart as appropriate). (See REFERENCE MEDICAID STANDARD and MBL LIVING ARRANGEMENT CHART) In order for such a person to be eligible for Medicaid, s/he must meet the eligibility criteria for S/CC. (See CATEGORICAL FACTORS SINGLES/CHILDLESS COUPLES (S/CC))

NOTE: Effective April 1, 2008, the Medicaid standard is used to determine Medicaid eligibility for single individuals and childless couples, regardless of their living arrangement, since medical care is now considered an unmet need. Therefore, it is not necessary to determine if there is an unmet need. References: SSL Sect. 366

Dept. Reg. 360-3.3(a) (1)

ADMs OMM/ADM 97-2

GIS

08 MA/022

Interpretation: Eligibility for S/CC persons is determined as follows:

(1) Determine the A/R's household size by counting those persons who are applying and their legally responsible relatives (See RESOURCES PERSONAL NEEDS ALLOWANCE). An S/CC household cannot be larger than two. (2) Determine the gross monthly income of the person or household. All income from all sources is reviewed to determine if it is to be included in the eligibility determination. The income of a non-applying spouse who lives in the same household is counted in the eligibility determination process, unless such spouse refuses to make his/her income available. Certain kinds of income are disregarded in whole or in part. (See INCOME S/CC DISREGARDS) The income is converted to a monthly figure. (3) Compare the monthly income to 185% of the Medicaid Standard as described in REFERENCE MEDICAID STANDARD. If the income exceeds 185% of the Medicaid

(MRG)

(income)(page-174)Page 174#

UPDATED: NOVEMBER 2009 271

INCOME S/CC BUDGETING METHODOLOGY

DETERMINATION OF ELIGIBILITY

Standard, the A/R is ineligible for Medicaid and the determination of eligibility goes no further. If the income is less than or equal to 185% of the Medicaid Standard, the eligibility determination continues. (4) Compare the monthly income to 100% of the federal poverty level. If the A/R’s income exceeds the poverty level, the A/R will not be eligible under S/CC (See 97 ADM-23). In situations requiring special allowances (housing, restaurant, etc.) which bring the Medicaid Standard above the federal poverty level there will be no 100% federal poverty level test.

(5) Deduct the applicable disregards from the monthly income in the following order: (a) $90 work expense disregard. (See INCOME S/CC BUDGETING METHODOLOGY $90 WORK EXPENSE DISREGARD);

(b) where applicable, the first $100 of spousal support payments is disregarded. (See INCOME S/CC DISREGARDS)

(6) Compare remaining income to the Medicaid Standard. If the income is less than the Medicaid Standard, the A/R is income eligible for Medicaid. If the income equals or exceeds the Medicaid Standard, the A/R is ineligible for Medicaid.

NOTE: If a family’s countable income exceeds the Medicaid Standard, the family may not spend down to the Medicaid Standard. However, eligibility may exist and should be evaluated under one of the Medically Needy or Expanded Eligibility (poverty level) programs or Family Health Plus.

(MRG)

(income)(page-175)Page 175#

UPDATED: JUNE 2010

272

INCOME

FAMILY HEALTH PLUS (FHPlus)

Policy: All adults age 19-64, who apply for Medicaid and appear to be ineligible for reasons of excess income.

References: SSL Sect. 369-ee

ADM 01 OMM/ADM-6

GIS

07 MA/021

Interpretation: Eligibility for FHPlus is determined as follows.

(1) Determine that the A/R is financially ineligible for Medicaid. (2) Determine the gross monthly income of the A/R. Certain types of income are not counted when determining gross monthly income for FHPlus. For all applicants, income received from the following is not counted when determining eligibility:

• AMERICORPS/VISTA; • ASSISTANCE BASED ON NEED; • BONAFIDE LOANS; • CASH ASSISTANCE INCOME; • CHILD AND ADULT CARE FOOD PROGRAM (CACFP); • CHILD SUPPORT ARREARAGE PAYMENTS; • DONATED FOODS; • EARNED INCOME OF FULL-TIME STUDENTS UNDER THE AGE OF 21; • EARNED INCOME TAX CREDIT; • FEDERAL ECONOMIC OPPORTUNITY ACT (Title III); • FEDERAL ENERGY ASSISTANCE PAYMENTS; • FEDERAL RELOCATION ASSISTANCE; • FOOD STAMPS; • FOSTER CARE PAYMENTS; • FREE MEALS; • GARDEN PRODUCE OR LIVESTOCK FOR PERSONAL USE; • GI BILL DEDUCTION; • GRADUATE/EDUCATIONAL GRANTS (for educational expenses) OR UNDERGRADUATE EDUCATIONAL GRANTS, SCHOLARSHIPS OR WORK STUDY;

(MRG)

(income)(page-176)Page 176#

UPDATED: JANUARY 2012

273

INCOME

FAMILY HEALTH PLUS (FHPlus)

• HUD COMMUNITY BLOCK GRANTS; • INCOME TAX REFUNDS (in month received); • IN-KIND MAINTENANCE (such as rent, groceries, etc.) not from a legally responsible relative and not for goods or services rendered; • JOB CORPS; • JOB TRAINING PARTNERSHIP ACT PAYMENTS (WORKFORCE INVESTMENT ACT (WIA); • NATIVE AMERICAN PAYMENTS (including Alaskan Native payments); • NYS DEPARTMENT OF LABOR PAYMENTS: i.e. Youth Education and Employment and Training Programs; • PERSECUTION PAYMENTS (German/Austrian/Netherlands Reparation payments, and payments to Japanese-Americans, Aleuts or Pribilof Islanders); • PREVENTATIVE HOUSING SERVICE PAYMENTS; • SCHOOL MEALS AND STUDENT LOANS; • SUPPLEMENTAL SECURITY INCOME (SSI); • VIETNAM VETERANS AGENT ORANGE SETTLEMENT FUND and payments to Children with Spina Bifida; • VOLUNTEER PROGRAM PAYMENTS UNDER THE VOLUNTEERS SERVICES ACT (foster grandparents, SCORE, ACE); • WOMENS, INFANT, CHILDREN (WIC)

In addition, for parents living with their children under the age of 21, and persons age 19 and 20, income received from the following is not counted when determining eligibility for FHPlus:

• BLOOD PLASMA SETTLEMENTS; • DISASTER RELIEF; • INSURANCE PAYMENTS- Moneys from insurance payments for the purpose of repairing or purchasing disregarded resource, which was lost, damaged or stolen, are disregarded. Any interest received from such payments is also disregarded.; • RADIATION EXPOSURE COMPENSATION

NOTE: See INCOME ADC RELATED DISREGARDS for further definition of each of the above income types.

(MRG)

(income)(page-177)Page 177#

UPDATED: JUNE 2010

274

INCOME

FAMILY HEALTH PLUS (FHPlus)

(3) Determine the gross monthly income of the A/R, as follows:

Compare the gross countable income to the appropriate federal poverty level. The gross countable income of parents or persons age 19 and 20 who live with their parents is compared to 150% of the federal poverty level for the appropriate family size. For single individuals and childless couples, both disabled and non-disabled, and for 19 and 20 year-olds not residing with their parents, gross countable income is compared to 100% of the federal poverty level for the appropriate family size.

Documentation: Documentation of income is the same as for the regular Medicaid program. The source and amount of income is documented in the case record.

(MRG)

(income)(page-178)Page 178#

UPDATED: NOVEMBER 2007 275

INCOME PERSONS IN MEDICAL FACILITIES

ASSESSMENT/DETERMINATION OF INCOME AVAILABLE FOR THE COST OF CARE

Policy: Either spouse may request an assessment/determination of:

• the community spouse's monthly income allowance; • any family allowances; • any contribution requested from the community spouse toward the institutionalized spouse's care; and • the methods used to determine any allowances.

An assessment may be requested at the beginning or after the commencement of a continuous period of institutionalization. The request may or may not be accompanied by an application for Medicaid.

References: SSL Sect.

366

Dept. Reg.

360-4.3(f) 360-4.9 360-4.10

ADMs

89 ADM-47

INFs

90 INF-19

GIS

05 MA/002

Interpretation: Income solely in the name of the institutionalized spouse or the community spouse is considered available only to that spouse. When income is in the name of both spouses, or when ownership of the income cannot be established, one half (1/2) is considered available to each spouse. Income in the name of one or both spouses and in the name of another person is considered available to each spouse in proportion to that spouse's interest. When the income is in the name of both spouses and no share is specified, one half (1/2) of the joint share is considered available to each spouse. Income from a trust is considered available to each spouse as directed by the trust. If the trust is not specific, the above guidelines are followed.

(MRG)

(income)(page-179)Page 179#

UPDATED: NOVEMBER 2007

276

INCOME PERSONS IN MEDICAL FACILITIES

ASSESSMENT/DETERMINATION OF INCOME AVAILABLE FOR THE COST OF CARE

The community spouse is allowed a Minimum Monthly Maintenance Needs Allowance (MMMNA). (See REFERENCE MMMNA) This amount may be increased as the result of a fair hearing or court order.

When determining the community spouse's otherwise available monthly income, only the following deductions are allowed from his/her income: • actual incapacitated adult/child care expenses; • court-ordered support payments; and • health insurance premiums.

When the community spouse's otherwise available monthly income is less than the MMMNA, the institutionalized spouse's income may be used to bring the community spouse's income up to the MMMNA. (See REFERENCE MMMNA)

When a family member (See RESOURCES PERSONAL NEEDS ALLOWANCE) resides with the community spouse and has over 50% of his/her maintenance needs met by either spouse, the family member may be eligible for a family member allowance (FMA) from the institutionalized spouse. When determining the family member's otherwise available monthly income, only the following deductions are allowed: • actual incapacitated adult/child care expenses; • court-ordered support payments; and • health insurance premiums.

If the family member is eligible for a FMA, the institutionalized spouse's income may be made available to the family member. (See REFERENCE FAMILY MEMBER ALLOWANCE for current maximum dollar amount)

NOTE: German, Austrian, and Netherlands reparation payments are to be disregarded in determining the otherwise available income of the community spouse and family members.

(MRG)

(income)(page-180)Page 180#

UPDATED: NOVEMBER 2007

277

INCOME PERSONS IN MEDICAL FACILITIES

ASSESSMENT/DETERMINATION OF INCOME AVAILABLE FOR THE COST OF CARE

No other disregards are allowed when determining the community spouse's or family member's otherwise available income. All types of income are counted, except Public Assistance. When determining income available from self-employment or rental property, the community spouse/family member is allowed SSI-related disregards. (See REFERENCE SSI-RELATED DISREGARDS)

When the community spouse's otherwise available monthly income exceeds the MMMNA plus any family member allowance(s), the community spouse is requested to contribute twenty-five percent (25%) of the excess income to the cost of care for the institutionalized spouse.

An institutionalized spouse will not be denied Medicaid because the community spouse refuses or fails to make his/her income available to meet the cost of necessary care or assistance. However, the local social services district may seek to recover the cost of any Medicaid provided for the institutionalized spouse from the community spouse.

An A/R or his/her community spouse may request a fair hearing if either is dissatisfied with the determination of the community spouse monthly income allowance, the family allowance or the amount of monthly income otherwise available to the community spouse. If either spouse establishes that the community spouse needs income above the MMMNA, based upon exceptional circumstances which result in significant financial distress, the local district, pursuant to a fair hearing or court order, substitutes an amount adequate to provide additional necessary income from the income available to the institutionalized spouse. When the MMMNA is increased, based on exceptional needs, the case is closely monitored. If the exceptional need decreases or ceases, the case is re-evaluated, the appropriate adjustment made to the MMMNA and both spouses adequately and timely notified of the change.

(MRG)

(income)(page-181)Page 181#

UPDATED: JUNE 2010

278

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INSTITUTIONALIZED SPOUSES

Policy: Chronic care budgeting procedures are used for institutionalized spouses in permanent absence status. References: SSL-Sect. 366

366-ee

Dept. Reg. 360-4.9

360-4.10

ADMs 10 OHIP/ADM-01

95 ADM-19

92 ADM-32

89 ADM-47

GISs

09 MA/027

01 MA/021 Interpretation: An institutionalized spouse as defined in the Glossary is in permanent absence status as of the month of institutionalization or the month s/he begins receiving home and community-based waivered services. Chronic care budgeting begins the first day of the first month following the establishment of permanent absence.

NOTE: Spousal rules and definitions apply to an institutionalized S/CC or ADC-related individual who has a community spouse and is seeking Medicaid coverage. For such individuals, there will be no coverage for nursing home care until the individual has been certified disabled. An institutionalized spouse's eligibility for Medicaid and the amount of his/her income applied to the cost of his/her medical care are determined by making the appropriate deductions from his/her available monthly income. The local district may not require that the following income of the A/R be applied toward the cost of care:

CASH ASSISTANCE INCOME - SSI benefits paid under Section

(MRG)

(income)(page-182)Page 182#

UPDATED: JUNE 2010

279

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INSTITUTIONALIZED SPOUSES

1611(e)(1)(E) of the Social Security Act.

INSURANCE PAYMENTS - Moneys from insurance payments for the purpose of repairing an exempt resource, which was lost, damaged or stolen, are exempt in the month received and for six (6) months following the month of receipt. Any interest received from such payments is also exempt. If the A/R uses the insurance money to purchase a countable resource prior to the expiration of the six months, the value of the countable resource is considered immediately.

MONEY FROM RESIDENTIAL HEALTH CARE FACILITY LEGAL ACTION - Money received as the result of a legal action against a residential health care facility because of improper and/or inadequate treatment.

PLAN TO ACHIEVE SELF SUPPORT - Income necessary to achieve a plan of self support (See INCOME PLAN TO ACHIEVE SELF-SUPPORT (PASS) for details);

RADIATION EXPOSURE COMPENSATION TRUST FUND PAYMENTS - Payments for injuries or deaths resulting from exposure to radiation from nuclear testing and uranium mining;

VETERANS - Payments to veterans for Aid and Attendance (A&A) or payments for Unusual Medical Expenses (UME).

(MRG)

(income)(page-183)Page 183#

UPDATED: JUNE 2010

280

INCOME PERSON IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INSTITUTIONALIZED SPOUSES

personal injuries sustained by veterans resulting from exposure to dioxin or phenoxy herbicide in connection with the war in Indochina in the period of January 1, 1962 through May 7, 1975.

Children - Monthly allowances paid to certain Vietnam Veterans’ Children with Spina Bifida.

To determine the institutionalized spouse's eligibility for Medicaid and the amount of his/her income to be applied to the cost of care, deductions are made in the following order: (a) An amount to meet the personal needs (PNA) of the institutionalized spouse.

The first month or partial month of permanent absence, determine the institutionalized spouse's income and subtract SSI-related disregards from income to arrive at the countable monthly income. Subtract the Medically Needy Income level for one or the Medicaid Standard for one, whichever is higher.

The month following the month in which permanent absence is established, subtract the appropriate Personal Needs Allowance (PNA) from the institutionalized spouse’s income. The A/R is no longer allowed the SSI-related income disregards.

When the A/R has no earned income and resides in a medical facility as defined by Article 28 of Public Health Law, deduct $50.00 for the PNA.

When the A/R has no earned income and resides in a medical facility regulated by Article 31 of Mental Hygiene Law, deduct $35.00 for the PNA.

When the A/R has no earned income and is receiving home and community-based waiver services or is a non-institutionalized participant in the Program of All Inclusive Care for the Elderly (PACE), deduct the PACE PNA amount (found in REFERENCE PACE PNA). (See GLOSSARY for a definition of PACE) This amount equals the difference between the Medically Needy Income level for a household of two and the level for one.

(MRG)

(income)(page-184)Page 184#

UPDATED: JUNE 2010

281

INCOME PERSON IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INSTITUTIONALIZED SPOUSES

When the A/R has earned income, the PNA consists of $50.00, $35.00 or PACE PNA amount (See REFERENCE PACE PNA) as applicable, plus the SSI-related earned income disregards listed on INCOME SSI-RELATED DISREGARDS. The total PNA amount may not exceed the Medicaid income level or Standard for one.

When a waiver or non-institutionalized PACE participation recipient is not living with his/her spouse and does not make his/her income and resources available to the spouse, the local district uses community budgeting procedures to determine the waiver recipient's Medicaid eligibility.

(b) When the community spouse's otherwise available monthly income is less than the minimum monthly maintenance needs allowance (MMMNA), deduct the amount required to bring the community spouse's otherwise available monthly income up to the MMMNA (See REFERENCE MMMNA for the current amount) from the institutionalized A/R's income. (See GLOSSARY for the determination of otherwise available income). This deduction is only allowed if the A/R is or will be actually making the income available to his/her community spouse.

(MRG)

(income)(page-185)Page 185#

UPDATED: NOVEMBER 2007

282

INCOME PERSON IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INSTITUTIONALIZED SPOUSES

(c) When the A/R has a dependent family member(s) (See GLOSSARY), deduct a family member allowance for each family member. The family member allowance is deducted for each dependent whether or not the income is actually made available to the family member. The family member allowance is first deducted from any excess income of the community spouse. If the community spouse’s income is insufficient to cover a family member allowance then the remainder is deducted from the income of the institutionalized individual.

(d) Deduct any expenses incurred for health insurance, medical care, services or supplies and/or remedial care for the institutionalized spouse, not paid by Medicaid or a third party. Any remaining available income of the institutionalized spouse and any amount actually contributed from the community spouse is applied to the cost of care on a monthly basis.

A community spouse or family member who is also applying for Medicaid may not refuse to accept his/her monthly income allowance or family member allowance in order to qualify for Medicaid. However, an otherwise eligible community spouse or family member who is under age 21, pregnant, SSI-related or ADC-related and a legally responsible relative of the institutionalized spouse may achieve Medicaid eligibility by contributing any excess income to the cost of the institutionalized spouse's care.

(MRG)

(income)(page-186)Page 186#

UPDATED: JANUARY 2011

283

INCOME PERSONS IN MEDICAL FACILITIES

BUDGETING FOR INSTITUTIONALIZED SPOUSES IN SPECIFIED HOME AND COMMUNITY BASED WAIVERS (HCBS)

Policy: Spousal budgeting procedures used for institutionalized spouses in permanent absence status who are also participants in the Traumatic Brain Injury (TBI), Nursing Home Transition and Diversion (NHTD), and Office for People with Developmental Disabilities (OPWDD) Home and Community Based Service (HCBS) waivers differ from those used in all other permanent absence status situations including other HCBS waivers. References: SSL Sect.

366-c (4)

Dept. Reg.

360-4.9 360-4.10

ADMs

08 OLTC-01

95 ADM-19 92 ADM-32 89 ADM-47

GISs

08 MA/024

01 MA/021 Interpretation: An institutionalized spouse as defined in the GLOSSARY is in permanent absence status as of the month s/he begins receiving home and community-based waivered services. For participants in the TBI, NHTD, OPWDD HCBS waiver, spousal impoverishment eligibility rules are used to determine the waiver participant’s eligibility but post eligibility/chronic care deductions are not applied. To determine the waiver participant’s eligibility for Medicaid and the amount of his/her income to be applied to the cost of care, deductions are made from the waiver A/R’s income in the following order:

a) Deduct all applicable SSI-related disregards (See INCOME SSI-RELATED DISREGARDS).

(MRG)

(income)(page-187)Page 187#

UPDATED: JANUARY 2009

284

INCOME PERSONS IN MEDICAL FACILITIES

BUDGETING FOR INSTITUTIONALIZED SPOUSES IN SPECIFIED HOME AND COMMUNITY BASED WAIVERS (HCBS)

b) Compare the resulting figure to the Medicaid Income Level for One or the Medicaid Standard and MBL Living Arrangement Chart, as appropriate, whichever is most beneficial. (See REFERENCE MEDICALLY NEEDY INCOME AND FEDERAL POVERTY LEVELS for Medicaid Standard and MBL LIVING ARRANGEMENT CHART for Congregate Care Levels) NOTE: In instances where 2 spouses are participating in the waiver, the resulting income of the two spouses is compared to the appropriate household for two. c) Income of the non-waiver spouse is not considered available. d) No income is deducted to bring the non-waiver spouse’s income up to the Minimum Monthly Maintenance Needs Allowance (MMMNA). e) No family member allowance is deducted. If there is any remaining available income, the waiver participant may spend down. (See INCOME EXCESS) A non-waiver spouse or family member who is also applying for Medicaid must have their eligibility determined as a separate household from the waiver participant.

(MRG)

(income)(page-188)Page 188#

UPDATED: JUNE 2010

285

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS

Policy: Chronic care budgeting procedures are used for institutionalized individuals in permanent absence status. References: SSL- Sect. 366

366-ee

Dept. Reg. 360-1.4(c), (k) and (p)

360-4.9

ADMs 10 OHIP/ADM-01

89 ADM-47

GIS

09 MA/027

08 MA/022 Interpretation: For chronic care budgeting purposes, an institutionalized individual is a person in permanent absence status who does not have a community spouse. (See the GLOSSARY for the definition of community spouse and the definition of permanent absence)

NOTE: When both members of a couple are in permanent absence status, they are each budgeted as individuals.

When an A/R enters a medical facility on a permanent basis, the first month or partial month of permanent absence, the A/R and any persons residing in his/her former household are budgeted as a community household. Appropriate disregards are used to determine monthly net income. The monthly income of the A/R and his/her household (if any) is compared to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial.

Unmarried ADC and S/CC-related recipients who are temporarily placed in a nursing home and subsequently become “permanently absent” will be budgeted using community budgeting rules until a disability determination is completed. Any excess income for the ADC-related recipient is the individual’s liability toward his/her nursing home care pending the disability determination.

(MRG)

(income)(page-189)Page 189#

UPDATED: JUNE 2010

286

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS

NOTE: A person must be a resident of a medical facility as of 12:01 a.m. on the first day of the month for that month to be considered a full month.

Beginning the month following the month in which permanent absence is established, the A/R's income is budgeted using the chronic care budgeting methodology. The following income of the A/R is not applied toward the cost of care:

CASH ASSISTANCE INCOME – SSI benefits paid under Section 1611(e)(1)(E) of the Social Security Act.

(MRG)

(income)(page-190)Page 190#

UPDATED: AUGUST 1999

287

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS

MONEY FROM RESIDENTIAL HEALTH CARE FACILITY LEGAL ACTION - Money received as the result of a legal action against a residential health care facility because of improper and/or inadequate treatment;

PLAN TO ACHIEVE SELF SUPPORT – Income necessary to achieve a plan of self support (See INCOME PLAN TO ACHIEVE SELF-SUPPORT (PASS) for details);

RADIATION EXPOSURE COMPENSATION TRUST FUND PAYMENTS – Payments for injuries or deaths resulting from exposure to radiation from nuclear testing and uranium mining;

VETERANS – Payments to veterans for Aid and Attendance (A&A) or payments for Unusual Medical Expenses (UME); and

Reduced (limited) $90 Veterans' Administration pension;

VIETNAM VETERANS – Agent Orange Settlement fund - Payments from the Agent Orange Settlement Fund or any other fund established pursuant to the Agent Orange product liability litigation, and payments from court proceedings brought for personal injuries sustained by veterans resulting from exposure to dioxin or phenoxy herbicide in connection with the war in Indochina in the period of January 1, 1962 through May 7, 1975;

Children - Monthly allowances paid to certain Vietnam Veteran’s Children with Spina Bifida;

(MRG)

(income)(page-191)Page 191#

UPDATED: JULY 2008

288

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS

To determine the individual's eligibility for Medicaid and the amount of his/her income to be applied to the cost of care, deductions are made in the following order:

(a) Subtract the appropriate Personal Needs Allowance (PNA) from his/her available income. The A/R is no longer allowed the SSI-related income disregards.

When the A/R has no earned income and resides in a medical facility as defined by Article 28 of Public Health Law, deduct $50 for the PNA.

When the A/R has no earned income and resides in a medical facility regulated by Article 31 of Mental Hygiene Law, deduct $35.00 for the PNA. When the A/R has earned income the PNA consists of $50.00 or $35.00 as applicable, plus the SSI-related earned income disregards. The total PNA amount may not exceed the Medically Needy Income level or Medicaid Standard for one.

(b) Deduct an amount to cover any third party health insurance premium;

(c) The needs of any children under 21 years of age for whom the A/R is legally responsible, in his/her former family household are then considered. The A/R's income is used to bring such children’s income up to the appropriate Medically Needy Income level or Medicaid Standard, whichever is higher.

NOTE: The maintenance needs of children for whom the A/R is legally responsible, in his/her former family household are considered, regardless of their resources. (d) Deduct any expenses incurred for medical care, services or supplies and/or remedial care, not paid by Medicaid or a third party.

(MRG)

(income)(page-192)Page 192#

UPDATED: JULY 2008

289

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS

Any remaining income is applied to the cost of care on a monthly basis.

When an individual enters a medical facility on a temporary basis and is expected to return to the community, s/he is considered temporarily absent. S/he and any persons residing in his/her household are budgeted as a community case. His/her income is compared to the Medically Needy Income level or the Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial.

(MRG)

(income)(page-193)Page 193#

UPDATED: AUGUST 1999

290

INCOME PERSONS IN MEDICAL FACILITIES

PERSONAL NEEDS ALLOWANCES (PNA) FOR PERSONS TRANSFERRED OR DISCHARGED

Policy: For persons in psychiatric facilities, developmental centers or intermediate care facilities regulated by Article 31 of the Mental Hygiene Law, the Personal Needs Allowance (PNA) is $35.00, rather than the $50 PNA allowed to persons in facilities regulated by Article 28 of Public Health Law. When a recipient transfers between facilities with different Personal Needs Allowance (PNA) levels, s/he is allowed the applicable PNA for the facility in which s/he was residing on the first of the month. The PNA is not pro-rated.

For example:

Mr. Smith has resided in a facility regulated by Article 31 of the Mental Hygiene Law since November 6, 1998. On March 10, 1999, he is transferred to a nursing home. His PNA for March, 1999 is $35.00. Effective April 1, 1999 his PNA increases to $50.

On June 15, 1999, Mr. Smith returns to the Article 31 facility. His PNA is $50 for June, 1999. Effective July 1, 1999 his PNA decreases to $35.00.

Individuals (other than institutionalized spouses) discharged from a medical facility into the community are entitled to community budgeting as of the calendar month of discharge.

For example:

Miss Brown is discharged from a nursing home to the community on August 20, 1998. She is entitled to community budgeting for the entire month of August.

Institutionalized spouses discharged from a medical facility into the community are entitled to community budgeting as of the month following the month of discharge. Institutionalized spouses are budgeted as chronic care cases in the month of discharge.

For example:

Mrs. Jones is discharged from a nursing home to the community on August 20, 1998. She is budgeted as a chronic care case for the month of August. Effective September 1, spousal impoverishment rules no longer apply.

(MRG)

(income)(page-194)Page 194#

UPDATED: NOVEMBER 2007 291

INCOME PERSONS IN MEDICAL FACILITIES

COMMUNITY SPOUSE AND FAMILY MEMBER ALLOWANCES

Policy: The minimum monthly maintenance needs allowance was established October 1, 1989 at $1,500. It is increased annually by the same percentage as the percentage increase in the federal Consumer Price Index. The amount, effective each January 1st, can be found in the REFERENCE INCOME COMMUNITY AND INSTITUTIONALIZED and FAMILY MEMBER ALLOWANCE.

A higher MMMNA amount may be established by court order or fair hearing.

The family allowance for each family member is an amount equal to one-third (1/3) of the amount by which one twelfth (1/12) of the applicable percentage of the annual federal poverty level for a family of two exceeds the amount of the otherwise available monthly income of the family member. The maximum Family Member Allowance (FMA) can be found in the REFERENCE FAMILY MEMBER ALLOWANCE.

References: Dept. Reg.

360-4.10

ADMs

06 OMM/ADM-3 04 OMM/ADM-4 89 ADM-47

GISs

07 MA/001

06 MA/029 05 MA/013 05 MA/002

04 MA/032

(MRG)

(income)(page-195)Page 195#

UPDATED: FEBRUARY 2005

292

INCOME

FAMILY PLANNING BENEFIT PROGRAM (FPBP) BUDGETING METHODOLOGY

Policy: Depending on the A/R's category, s/he is allowed the budgeting disregards/exemptions for LIF/ADC-related or S/CC.

After appropriate categorical disregards, an FPBP A/R’s net income is compared to 200% of the federal poverty level. (For LIF see INCOME LIF DISREGARDS and INCOME LIF BUDGETING METHODLOGY, for ADC see INCOME ADC-RELATED DISREGARDS and INCOME ADC-RELATED METHODOLOGY, for S/CC see INCOME S/CC DISREGARDS and INCOME S/CC BUDGETING METHODOLOGY)

References: SSL Sect.

366(1)(a)(11)

ADM

02 OMM/ADM-7

Interpretation: SSI budgeting methodology is not used in determining eligibility for the FPBP. For example if a certified disabled individual living alone is ineligible for Medicaid, his/her eligibility for FPBP is determined using S/CC income disregards/exemptions.

When a person under the age of 21 who lives with his/her parents does not have his/her parent's financial information, eligibility for the A/R is determined using only the income of the A/R under the age of 21 and, if applicable, the income of the A/R's spouse.

Applicants cannot spend down to 200% of the federal poverty level to qualify for the Family Planning Benefit Program.

(MRG)

(income)(page-196)Page 196#

UPDATED: JANUARY 2011

293

INCOME

EXCESS

Description: Excess income or “spenddown” is available net income in excess of an individual’s Medicaid level or standard. When determining Medicaid eligibility for A/Rs who are SSI-related, ADC-related, under age 21 or pregnant, any available monthly income in excess of the Medically Needy Level or Medicaid Standard whichever is higher is considered available to meet the cost of medical care and services. Policy: When the available income of the A/R is greater than the Medically Needy Level or Medicaid Standard whichever is higher, the excess is considered available to meet the cost of medical care and services. In order to become eligible for Medicaid, ADC-related, SSI-related, under age 21 or pregnant A/R(s) may:

• pay or incur medical expenses equal to or greater than their excess income; or • pay the amount of the excess income directly to a local district; or • use a combination of paid or incurred medical bills and pay directly to the local district.

There are two types of Medicaid Coverage available under the Excess Income Program:

• Outpatient Coverage- Provided to an A/R who meets his/her spenddown on a monthly basis. • Inpatient and Outpatient Coverage- Provided to an A/R who meets a six-month excess. To meet either the one or six-month excess, the A/R must demonstrate that he/she has either paid or incurred the amount of the excess income toward a medical need (met the excess income). This is done by submitting paid or incurred medical bills or by paying the excess amount to the LDSS.

The amount and type of the medical bill(s) submitted by the A/R determines the length of time for which the Medicaid coverage (either outpatient-only, or inpatient and outpatient coverage) is granted. In determining an individual’s eligibility, local districts use accounting periods: • Accounting Period- a period of time from one to six months, over which medical bills are applied to excess income;

(MRG)

(income)(page-197)Page 197#

UPDATED: NOVEMBER 2009

294

INCOME

EXCESS

• First Prospective Period- the first accounting period that includes the month of application; o Medical expenses paid in the retro period that exceed the A/R’s excess income may be carried forward into the first prospective period; • Current Period- an accounting period that occurs after the first prospective period.

There are a variety of factors that affect the ability to apply/use bills in the eligibility determination including: timeframes, paid vs. unpaid bills (viability), the type of bill, the prioritization of the bill and the accounting period.

In addition to other medical bills, not paid by the A/R, bills that are paid by a public program of the State (such as EPIC or ADAP) or its political subdivisions may be used to meet an A/R’s excess income liability.

A/Rs who meet their excess income must spend down to the appropriate Medically Needy Income Level or Medicaid Standard whichever is higher. A/Rs are not permitted in any instance to spend down income to the Federal Poverty Levels. This includes applicants applying for coverage under the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD).

A/Rs with income in excess of the applicable Family Health Plus (FHPlus) standard cannot meet their excess to attain FHPlus eligibility. Applicants who are ADC-related, SSI-related, under age 21 or pregnant who have medical expenses which would allow them to meet their excess to obtain coverage under Medicaid, and who are eligible for FHPlus, complete an application and enrollment form, and are given the choice of participating in either in the Medicaid Spenddown Program or FHPlus. Persons eligible for both Medicaid spenddown and FHPlus are informed of the differences in services provided by each program and all the Medicaid requirements.

References: SSL Sect.

366(1)(a)(12) & (13)

366 (2)(b)

369-ee

Dept. Reg.

360-4.8

ADMs

04 OMM/ADM-5

(MRG)

(income)(page-198)Page 198#

UPDATED: JUNE 2010

295

INCOME

EXCESS

03 OMM/ADM-4

01 OMM/ADM-6

96 ADM-15 91 ADM-11 87 ADM-4

Interpretation: A/Rs who meet their excess income on a monthly basis are eligible for Outpatient Coverage only. A/Rs who meet a six month excess are eligible for both Inpatient and Outpatient coverage. Any A/R with excess income requesting coverage of an inpatient bill must first meet a six month excess.

The use of medical expenses to offset excess income is known as “spenddown”. The direct payment of excess income to the local district is known as “Pay-In”.

A/Rs who can participate in the Excess Income Program include: • Individuals who are in a federally participating category (SSI-related, ADC-related or a child under the age of 21) and SSI-related are who also eligible under the appropriate Medicaid Resource Level.

NOTE: SSI-related individuals eligible to participate in the Excess Income Program who also have excess resources may spend down their excess resources (See RESOURCES EXCESS RESOURCES). Bills must be applied to excess resources first. Any remaining bills or portions of bills may then be used to reduce excess income.

When the income of a legally responsible relative is counted in the eligibility determination process, medical expenses, which are the legal responsibility of the relative, may also be used to offset any excess income of the applicant. Such expenses may include the medical expenses of the legally responsible relative as well as medical expenses of other family members for whom such relative is legally responsible.

Excess Income or Spenddown is met by:

Showing the LDSS either a paid bill or an incurred bill.

(MRG)

(income)(page-199)Page 199#

UPDATED: NOVEMBER 2009

296

INCOME

EXCESS

Types of bills that can be used to meet the Excess/ Spenddown: a) Medicare and other health insurance deductibles or other coinsurance charges; b) Necessary medical and remedial services that are recognized under State law but are not covered by Medicaid, e.g. chiropractic care; and c) Necessary medical and remedial services that are covered under the Medicaid Program (See REFERENCE MEDICAID COVERED SERVICES).

Such expenses include: • Medical Expenses • Medical Transportation • Prescription Drugs • Surgical Supplies/Medical Equipment/Prosthetic Devices • Non-Participating Provider Services (Once Medicaid coverage is authorized, the recipient MUST receive services from Medicaid providers in order for the Medicaid payment to be made. Credit or refunds will NOT be provided for covered services rendered to the recipient by non-participating providers.) • Over-the-counter drugs when ordered by a physician • Medical expenses paid/incurred by a public program, e.g. ADAP and EPIC • Copays • Non-covered services • Medical expenses for an individual for whom the A/R is legally responsible • Medical expenses from a legally responsible relative whose income is available to the A/R

When the A/R presents a combination of bills, the local district uses its judgment in selecting the most appropriate alternatives in order to satisfy program requirements.

(MRG)

(income)(page-200)Page 200#

UPDATED: NOVEMBER 2009

297

INCOME

EXCESS

A Prioritization/Hierarchy is applied to bills when evaluating the spenddown: • Bills not payable by the Medicaid Program such as: o Paid bills- Bills paid in the pre-retroactive period (the period prior to the first day of the third month prior to the month of application) cannot be used to grant eligibility. Paid expenses are “anchored”/deducted from the income in the accounting period in which it is paid. Exception: An exception is made for expenses incurred and paid in the three-month retroactive period. When no part of the retroactive period is included in the first prospective accounting period, expenses incurred and paid during the retroactive period, which have not been used previously to establish eligibility can be deducted from income in the first prospective accounting period.

Credit for paid bills may be carried forward for no more than six months, or until there is a break in coverage.

o Non-covered services o Non-participating providers o Medical Expenses from a legally responsible relative whose income is available to the A/R o Co-pays • Unpaid medical bills o Must be viable (the provider continues to seek payment and has not “written-off” the expense) and not previously used to establish eligibility. o Credit can be given in a subsequent accounting period if the individual’s liability is met in an accounting period without deducting all incurred, unpaid expenses and the bill is NOT payable by the Medicaid program.

(MRG)

(income)(page-201)Page 201#

UPDATED: NOVEMBER 2009

298

INCOME

EXCESS

o Unpaid bills may be carried forward until there is a break in coverage. o Unpaid bills from both the retroactive and pre-retroactive periods can be used to grant eligibility • Medical bills payable by Medicaid.

NOTE: An expense paid or incurred by a public program can be used to provide no more than six months of Medicaid coverage at a time.

The following subjects are covered in this section: • Six-month; and • Pay-In.

(MRG)

(income)(page-202)Page 202#

UPDATED: NOVEMBER 2009

299

INCOME EXCESS

SIX-MONTH

Policy: When determining eligibility for acute in-patient care in a medical facility, the excess income for a six-month period is considered available for meeting the cost of medical care and services.

NOTE: If a person meets the definition of an institutionalized spouse, the excess income liability is computed on a monthly basis.

References: SSL Sect.

366 (2)(b)

Dept. Reg.

360-4.8(c)

ADMs

96 ADM-15 91 ADM-11 90 ADM-46 87 ADM-4

Interpretation: When an A/R has a spenddown, and has or expects to have an acute in-patient care expense, excess income for a period of six months is considered available to meet the cost of such in-patient care. Any outstanding medical bills for which a provider is actively seeking payment may be used to reduce the six-month excess. (See INCOME EXCESS for the hierarchy of the application of medical bills)

For purposes of Medicaid coverage for an acute in-patient stay, the six-month consecutive period must include the month of hospitalization; however, it cannot include any month prior to the three-month retroactive period. Once an A/R incurs a six-month excess liability, the A/R is eligible for Medicaid coverage of both inpatient and outpatient care and services for that period.

For any acute in-patient stay in which the A/R’s liability for payment (excess income) for medical care exceeds the Medicaid payment rate for the length of the stay, but is less than the private charges for care, one of the procedures outlined below must be utilized:

I. For acute stays where the Medicaid payment rate is calculated utilizing a MEDICAID PER DIEM RATE:

(MRG)

(income)(page-203)Page 203#

UPDATED: AUGUST 1999

300

INCOME EXCESS

SIX-MONTH

(1) Determine the average private per diem rate by dividing the total private charges by the length of the stay (date of admission until, but not including, date of discharge); (2) Calculate the number of hospital days fully covered by the A/R’s liability by dividing the average private per diem rate into the patient liability;

(3) Apply the remaining liability, if any, to the next acute day. (a) If the remaining liability exceeds the Medicaid per diem, no portion of that day will be paid by Medicaid. Enter the following day in the Service FROM Date field on the Principal Provider Subsystem (PPS), the date of discharge as the Service TO Date, and enter zero in the Net Available Income (NAMI) field. (b) If the remaining liability is less than the Medicaid per diem rate, Medicaid will pay the difference between the remaining liability and the Medicaid per diem rate. Enter this day (commonly referred to as a "partial day") in the Service FROM Date field, the date of discharge as the Service TO Date, and enter the remaining liability in the NAMI field on PPS;

(4) Instruct the hospital to bill only for the days covered by Medicaid, and to enter the remaining liability, if any, in the surplus field of the claim form.

II. For hospital stays where the Medicaid payment rate is calculated utilizing DIAGNOSTIC RELATED GROUPS (DRG): (1) Determine the percentage of the hospital stay covered by the A/R’s liability by dividing the liability by the private pay charges;

(MRG)

(income)(page-204)Page 204#

UPDATED: NOVEMBER 2009

301

INCOME EXCESS SIX-MONTH

(2) Determine the percentage of the hospital stay to be covered by Medicaid (100% minus the percentage covered by the A/R’s liability);

(3) Multiply the DRG case payment amount by the Medicaid percentage to arrive at the Medicaid payment amount;

(4) Subtract the Medicaid payment amount from the DRG case payment amount. Enter this amount as the Net Available Monthly Income (NAMI) in the Principal Provider Subsystem (PPS). Please note: the amount entered in the PPS will be different from the client's actual liability. Local districts must ensure that the case record, client notices, and the notice to the hospital reflect the actual liability; (5) Enter the actual dates of service in the Principal Provider Subsystem (PPS);

(6) Instruct the hospital to enter the adjusted client liability as the surplus on the claim form, and complete the rest of the claim form according to normal procedures.

90 ADM-46 contains a more detailed description of "Watkins" cases using the Medicaid per diem rate, or Diagnostic Related Groups (DRG) case payment amount and includes some case examples.

When to Verify: When an SSI-related, ADC-related, under age 21 or pregnant A/R, has income in excess of the Medically Needy level or Medicaid Standard whichever is higher and:

(1) Declares in the application that s/he has unpaid acute in-patient expenses; or

(2) Indicates in the application that any member of the family household is in, or will require acute in-patient care, or has acute in-patient expenses.

(MRG)

(income)(page-205)Page 205#

UPDATED: NOVEMBER 2009 302

INCOME EXCESS

SIX-MONTH

Verification: Expenses for acute in-patient care may be verified by:

(1) Seeing hospital bills;

(2) Seeing Medicare or insurance explanation of benefits;

(3) Clearing with the medical provider.

Documentation: Sufficient to establish an audit trail: (1) Date, length of stay, amount of charge and name of medical facility;

(2) Date and type of service, amount of charge and name of provider;

(3) If a third party insurer is involved, the amount of the third party payment or the denial of benefits, and the net amount of the A/R's responsibility. Disposition: Once an A/R with excess income has paid or incurred a charge for acute in-patient care, his/her six-month excess income is computed. Medicaid is authorized for all or any part of the cost of acute in-patient care, which is greater than the A/Rs’ spenddown amount. Once the A/R has incurred expenses equal to or greater than his/her excess income for a six-month period, s/he is eligible for Medicaid coverage during this period.

If income and/or household composition (See OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION) changes during this six-month period, the amount of the excess is recomputed prospectively and the appropriate notice is sent to the A/R. NOTE: If the A/R is covered by Third Party Health Insurance (e.g., Medicare, Blue Cross/Blue Shield, etc.) the amount of health insurance available for medical bills does not reduce the liability of the A/R. S/he is personally liable for medical bills equal to the amount of his/her excess.

(MRG)

(income)(page-206)Page 206#

UPDATED: JANUARY 2012

303

INCOME EXCESS

PAY-IN

Policy: Local social services districts are required to offer individuals with excess income the opportunity to reduce their excess income by pre- paying to the district the amount by which their income exceeds the Medically Needy Income level or Medicaid Standard, whichever is higher. Participation in the Pay-In program is optional on the part of the A/R. The A/R may elect to pay-in for periods of one to six months. When the pay-in period is longer than one month, the individual may pay the full excess income amount at the beginning of the period or may pay in monthly installments.

References: SSL. Sect.

366(2)(b)

Dept. Reg.

360-4.8

ADMs

96 ADM-15 94 ADM-17

Interpretation: In order to obtain coverage, the participant pays to the local social services district the amount by which his or her net available income exceeds the Medically Needy Income level or Medicaid Standard, whichever is higher, for the appropriate period. In determining this amount, the district deducts from income any necessary medical expenses incurred during the period which are not payable by the Medicaid program. The A/R may elect to pay-in for periods of one to six months.

For pay-in periods of less than six months, inpatient coverage will not be authorized; instead outpatient coverage will be authorized. When the A/R pays the full excess income liability for a six-month period, inpatient and outpatient coverage will be authorized for that period.

If the individual has paid his/her liability to the local district and subsequently incurs expenses during the covered period for services not covered by the Medicaid program, the local district either refunds to the recipient the amount of the medical expense from the recipient’s account, or may credit the amount to the recipient’s account in a subsequent excess income period.

(MRG)

(income)(page-207)Page 207#

(MRG)

UPDATED: NOVEMBER 2009

304

INCOME EXCESS

PAY-IN

NOTE: Once the individual has paid in the amount of his/her excess income to the local social services district, s/he is treated like any other Medicaid recipient. Thus, the recipient must receive services from Medicaid providers in order for Medicaid payment to be made. Expenses paid or incurred from non-participating providers will not provide credit or refunds for covered services rendered to the recipient.

The local district establishes a special account to safeguard the funds paid by the individuals. Such amounts are not retained in interest-bearing accounts.

Local districts periodically reconcile the amount in the Medicaid recipient’s account with the amount of Medicaid payments made on the recipient’s behalf. The amount in the account is compared to the Medicaid payments made for services provided during the covered period. Any unused pay-in amounts are refunded to the recipient or credited to a subsequent excess income period.

NOTE: When reconciling the individual’s Pay-In account, local districts take into consideration any off-line payments made on behalf of a participant, since these payments will not be reflected in the Adjudicated Claims history report.

Verification: Expenses for outpatient medical care, including prosthetic appliances, may be verified by:

(1) Seeing medical bills;

(2) Seeing cancelled checks or receipts;

(3) Seeing Medicare or insurance explanation of benefits;

(4) Clearing with the medical provider.

Documentation: Sufficient to establish an audit trail:

(1) Date and type of services, amount of charge and name of provider; and (2) If a third party insurer is involved, the amount of the third party payment or the denial of benefits and the net amount of the A/R’s responsibility.

(introduction)New York Medicaid Reference Guide: Introduction to the Medicaid Reference Guide and Instructions for Use#

(introduction)(page-1)Page 1#

UPDATED: NOVEMBER 2007

INTRO 1

(MRG) INTRODUCTION TO THE MEDICAID REFERENCE GUIDE AND INSTRUCTIONS FOR USE

The Medicaid Reference Guide (MRG) was designed for local social services districts in New York State. Its purpose is to assist districts in determining eligibility for applicants/recipients of Medicaid.

It is not intended to be a thorough training course in Medicaid, but a reference book, like a dictionary or an almanac. It is not intended to be read from cover to cover, but used at a worker’s desk, consulted as needed. It is not intended to replace eligibility workers or supervisors, but to increase their effectiveness and improve their job performance.

The Medicaid Reference Guide is arranged in five sections: Categorical Factors; Income’ Resources; Other Eligibility Requirements and Reference. Marked tabs separate the sections. At the end of each section there is also an index to that section. Within each of the five sections there are subsections, the titles are in bold print at the top of each page. The pages are numbered consecutively through all five sections. A Glossary is found at the front of the manual and a cumulative/master index at the end of the book.

The subsections contain some or all of the following headings in the left margin of each page:

Description: A statement of the subject covered in the subsection. This may include a definition, means of identification or other statements, which generally describe and set the subject apart from other subjects.

Policy: A brief statement of the policy governing the situation. This may be derived from one or more sections of the Law or Department Regulations.

References: A listing of the Laws and Regulations consulted when determining the policy, which applies to the situation. For more information refer to these sections of Law or Regulations.

Interpretation: A statement of what to do when confronted by a specific situation. An expansion of policy as it relates to case situations and why certain policies are applied as they are.

When to Verify: The case circumstances when information must be verified. This relates to the application form, the case record and the circumstances of the applicant/ recipient.

Verification: Acceptable sources of verification in the order of acceptability and advice on the type of information to be recorded. References to specific documents

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UPDATED: NOVEMBER 2007

INTRO 2

(MRG) may be made. Verification is the dual responsibility of the applicant and the local district.

Documentation: The information included in the case record to support the statements made in the applications. Documentation should always be sufficient to establish an audit trail; an auditor reviewing the eligibility determination process should be able to obtain the documents upon which the decision was based (in all cases, photocopies constitute acceptable documentation).

Disposition: What to do once the facts are established and a decision is made. What action is to be taken?

Exception: (May occur anywhere in the text.) Individual situations in which the general policy does not apply.

Note: (May occur anywhere in the text.) Points to remember, references to other sections, helpful hints and rules of thumb.

Standard abbreviations are used throughout, such as A/R (Applicant/Recipient), LRR (Legally Responsible Relative), PA (Public Assistance), RSDI (Retirement Survivors Disability Insurance), etc.

The Medicaid Reference Guide is intended only to express Department policies and Interpretations. The final authority remains Book 52A of McKinney’s Consolidated Laws of New York and Title 18 of the Codes, Rules and Regulations of the State of New York.

In addition to this document, other resource materials are available to local social services districts. The Medicaid New Worker Training Manual is a training tool for new examiners. Information concerning the use of the WMS System Medical Assistance Budget Logic (MBL) for budget calculations is found in the MBL manual.

Information in the Medicaid Reference Guide is revised and updated on a regular basis.

The electronic version can be found at http://www.health.state.ny.us/health_care/medicaid/reference/index.htm. Replacement pages for the paper version are issued to Medicaid staff and other persons on the Medicaid Reference Guide mailing list. The date on the left top of each page will indicate the date of printing or revision. The pace of change within the Medicaid programs makes such periodic replacement essential for the continued validity of the Medicaid Reference Guide. Between issuances of replacement pages, Administrative Directives, Regulations, General Information System (G.I.S.) messages and MBL transmittals will provide necessary notification of changes affective Medicaid eligibility.

Wherever a conflict arises between the Regulations, Social Services Law, Administrative Directives, G.I.S. messages or a MBL Transmittal, local district staff

(introduction)(page-3)Page 3#

UPDATED: NOVEMBER 2007

INTRO 3

(MRG) should contact their Medicaid County Representative or their New York City Representative for guidance.

(master-index)New York Medicaid Reference Guide: Cumulative/Master Index#

(master-index)(page-1)Page 1#

MASTER INDEX JANUARY 2012

A AABD, (Aid to the Aged, Blind or Disabled), See Categorical Factors, 81, 89-90

AHCP, AIDS Home Care Program, See Other Eligibility Requirements, 729-730

Abandonment, See Categorical Factors, Continued absence, 20-22, See Other Eligibility Requirements, 513, 534, 570

Absence, See Categorical Factors, 6, 8, 12-13, 15-16, 20-22, 59, 72 , See Income, 172, 278, 280, 283, 285-286, See Resources, 318, 337, 398,-399, 450, See Other Eligibility Requirements, 518-519, 546, 558, 570 Continued absence, 6, 8, 15, 20-22 Temporary absent from legal residence, 518-519, 546

Absent parent, See Categorical Factors, 20, 22, 84, See Income, 213, 221, 240, 255, See Resources, 413, 421, See Other Eligibility Requirements, 465, See Other Eligibility Requirements, Legally Responsible Relative (LRR), 557, 559, 561-567

ACCESS NY Healthcare and Supplement A, See Categorical Factors, 63.1, 75, 77, See Resources, 374, 435-436, See Other Eligibility Requirements, 466, 470, 496, 565, 711

Active Military Duty, See Income, 147, 224, See Other Eligibility Requirements, Citizenship, 591, 612, 634-635

Definition of, See Glossary

ADC, Aid to Dependent Children, See Categorical Factors, 6, 28, 37, 54, 84, 89, See Income, 193, 261, 285, 292, See Resources, 381, 399, See Other Eligibility Requirements, 630

ADC-related assistance, See Aid to Dependent Children-related assistance (ADC-related assistance), See Categorical Factors, 7-25, 29, 37, 52, 54, 58-59, 84, 89, See Income 115, 118, 144, 156, 158, 161, 171-172, 196-217, 278, 282, 285, 292-295, 301, See Resources, 309-310, 372, 378, 380-381, 399, 408, 440, See Other Eligibility Requirements, 466, 475, 491, 572-575, 631, 726, See Reference, 748-752, 761, 791, 796-797 Budgeting methodologies, See Income, 207-217 $30 and 1/3 Earned Income Disregard (EID), 200, 207, 209-210, 212, 216 $90 Work Expense Disregard, 197, 200, 204, 207-209, 216 Child or dependent care cost, 216 Child/incapacitated adult care cost, 207, 211-212, 216 Determination of Eligibility, 215-217 Health insurance premiums, 212-214 Disregards, See Income under specific type, ADC-related assistance, 196-206

(MRG) 1

(master-index)(page-2)Page 2#

MASTER INDEX JANUARY 2012 ADC-U, See Categorical Factors, Aid to Dependent Children-related assistance (ADC- related assistance), 23

Addiction, drug or alcohol, See Categorical Factors, 18, 35 Definition of, See Glossary

Adoption, See Categorical Factors, 3, 10-11, 25, 53, See Income, 218-219, See Other Eligibility Requirements, 522, 567-568, 573-575, 592-593, 600, 605 Adoption Assistance, See Categorical Factors, 3, See Income, 218, See Other Eligibility Requirements, 575 Adopted children, See Income, 218-219, See Other Eligibility Requirements, 514 Adoption subsidy, See Income, 219, See Other Eligibility Requirements, 573-574 Title IV-E, See Categorical Factors, 71-72, 85, See Income, 218-219, See Other Eligibility Requirements, 504, 514, 562, 574, 592

Adult care facility, See Other Eligibility Requirements, 511, 518, 521, See Reference, 793

Adult day health care, See Resources, 377 Definition of, See Glossary

Age, See Categorical Factors, 6, 24-26, 30-31, 52-54, 59-60, 68, 87, 97, See Income, 104, 158-161, 163, 171-172, 180-181, 185, 187, 201, 207, 215, 217, 226, 231, 248, 250, 261, 265, 293-294, 301, See Other Eligibility Requirements, 465, 468, 474, 477, 485, 486, 491, 504, 506-507, 509-510, 520, 522, 526, 535-536, 538, 540, 543, 550, 554, 556-557, 559-562, 564-566, 569, 573, 575-577, 580, 584, 594, 632, 676, 701, 709-713, 720, 732, 645 65 and over, See Categorical Factors, 24-26, 30-31, 68, 87, See Income, 171, 226, 231, 248, See Resources, 359-361, 384, 414, 421, See Other Eligibility Requirements, 465, 474, 535, 540, 576 Under age 19, See Other Eligibility Requirements, 468, 474, 486, 491, 504, 520, 701, 710- 713 Under age 21, See also Aid to Dependent Children-related assistance (ADC-related assistance), Age; Children, See Categorical Factors, 6, 52-53, 59-60, 62, 87-97; See Income, 104, 158-161, 163, 171-172, 180-181, 185, 187, 201, 207, 215, 217, 250, 261, 265, 283, 293-294, 301, See Resources, 309, 370-373, 278, 280, 408, 440, See Other Eligibility Requirements, 477, 491, 506, 510, 522, 526, 535-536, 540, 543, 550, 554, 556, 559, 561, 564-566, 569, 573, 575, 577, 594, 645, 680.2-680.3, 680.6-680.7, 685, See Reference, 788, 793 Income, Levels, Medicaid expanded, 161-165

Agency Delay, See Other Eligibility Requirements, Retroactive Eligibility Period, 472.1, 495.3-495.5, 495.7

Agency Error, See Other Eligibility Requirements, Retroactive Eligibility Period, 472.1, 495.4-495.5, 495.7

(MRG) 2

(master-index)(page-3)Page 3#

MASTER INDEX JANUARY 2012 Agent Orange Settlement Fund, See Income, ADC-related assistance, 203, Chronic care, 279- 280, 287, FHPlus, 273, LIF, 182, S/CC, 262, SSI-related assistance, 229; See Resources, 385, See Reference, 752

AHIP (AIDS Health Insurance Program), See Categorical Factors, 54, See Income, 231, See Resources, 309, 373, 378, 380, 409, 440, See Other Eligibility Requirements, 549.2, Citizenship and Immigration Status, 580, See PRUCOL, 642, See Reference, 762, 796- 797

Aid and Attendance, Retroactive Veterans benefits, See Income, 279, 287, See Resources, 387

AIDs Home Care Program (AHCP), See Other Eligibility Requirements, 729-730

Aid to the Aged, Blind or Disabled (AABD), 81, 89-90

Aid to Dependent Children (ADC), See Categorical Factors, 6, 28, 37, 54, 84, 89, See Income, 193, 261, 285, 292, See Resources, 381, 399, See Other Eligibility Requirements, 630

Aid to Dependent Children (ADC-related assistance), See Categorical Factors, 7-25, 29, 37, 52, 54, 58-59, 84, 89, See Income, 115, 118, 144, 156, 158, 161, 171-172, 196-217, 278, 282, 285, 292-295, 301, See Resources, 309-310, 372, 378, 380-381, 399, 408, 440, See Other Eligibility Requirements, 466, 475, 491, 572-575, 631, 726, See Reference, 748-752, 761, 791, 796-797 Age of child, 8 Budgeting methodologies, See Income, 207-217 $30 and 1/3 Earned Income Disregard (EID), 200, 207, 209-210, 212, 216 $90 Work Expense Disregard, 197, 200, 204, 207-209, 216 Child or dependent care cost, 216 Child/incapacitated adult care cost, 207, 211-212, 216 Determination of Eligibility, 215-217 Health insurance premiums, 212-214 Caretaker relatives, 6, 8, 9-18, 22, 97 Cash category (ADC), 6-7 Definition of, See Glossary Deprivation of parental support or care, 6-8, 10, 14-23, 50, 84 Continued absence, 6, 8, 15, 20-22 Death of a parent, 15, 17, 59 Extensions, 84 Incapacity of a parent, 18-19, 59 Disregards, See Income under specific type, ADC-related assistance, 196-206, 748-752 Families with dependent children under age 21, 3–4, 12-13, 16, 54, 59, 67-68, 87, 97-98 Income and resource levels, See Reference, 761 Living arrangements, 12-14, 59, See also Household composition, 13-14 Living with Specified Relative, 12-14 (MRG) 3

(master-index)(page-4)Page 4#

MASTER INDEX JANUARY 2012 Multiple children Differing deprivation factors, 15 Relationship of child to caretaker relative, 10-11 Un/under employed two parent household, 8, 15, 23, 59

Aid to the Aged, Blind or Disabled (AABD), See Categorical Factors, 81, 89-90

AIDS/ AIDS Health Insurance Program (AHIP), See Categorical Factors, 54, See Income, 231, See Resources, 309, 373, 378, 380, 409, 440, See Other Eligibility Requirements, 549.2, Citizenship and Immigration Status, 589, See PRUCOL, 642, See Reference, 762, 796-797

Alien(s), See Other Eligibility Requirements, 545, 608, 611-613, 645, 648-655, 659-662, 666, 669-670, 672-675, 697, 688, See Reference, 791 Battered, See Glossary, 611, 613, 618-628, 791 Definition, See Glossary PRUCOL, See Glossary, 34, 589, 591, 608, 641-658, 662-664, 669-671 Qualified(s), See Glossary, 611-640, See Reference, 791 Special Non-Immigrant, 591, 669-671 Temporary Non-immigrant, 591, 666-668, 672-674 Temporary Protected Status (TPS), See Glossary, 591, 643, 647-648, 658, 661-664

Aliessa v Novello, See Categorical Factors, 31, See Other Eligibility Requirements, Citizenship and Immigration status, 641

Alimony, See Categorical Factors, 20, See Income, 140, 182, 203, 207, 216, 262

Allocation, See Categorical Factors, 43, See Income, 168, Supplemental Security Income- related assistance (SSI-related assistance), Budgeting methodologies, 231-236, 250- 251, 253-256, See Resources, 390, 437, See Other Eligibility Requirements, 576, See Reference, 755

ALP (Assisted Living Program), See Resources, 377, 416, See Reference, 793

Definition of, See Glossary

American Recovery and Reconciliation Act (AARA), See Income, 122

Amerasian immigrants, See Other Eligibility Requirements, Citizenship and Immigration status, 611-612, 616, 624, 629, 631-632, See Reference, 791

Americorps, See Income, ADC-related assistance, 196, FHPlus, 272, LIF, 173, S/CC, 257, SSI-related assistance, 220, See Reference, 748

Amortization, See Income, 113, 115-116

(MRG) 4

(master-index)(page-5)Page 5#

MASTER INDEX JANUARY 2012 Annuities, See Income, 135, See Resources, 316, 452-454, See Other Eligibility Requirements, 680.1, 680.5, See Reference, 785.2 Definition of, See Glossary Life Expectancy Table, 785.2

Application, See Other Eligibility Requirements, Applications, certification and renewal, 461-485, See Reference, 796

Acceptance, 488-489

Automated, 76, 77

Breast and Cervical Cancer Program, 465

Community coverage, 470-471, 481, 485, 493

Decision and Notification, 486-493

Definition of, See Glossary Denial, 490-491

Discontinuance or Reduction, 493-495

Facilitated Enrollers, 463-464.1, 468, 474, 594, 711-712

Family Planning Benefit Program (FPBP), 476-477, 481-483

Medicaid Buy-in Program for Working People with Disabilities, See Categorical Factors, 43

Medicare Part D Low Income Subsidy application, 478

Medicare Savings Program, See Categorical Factors, 76-77

New application, 465-475 Pre-need Funeral Agreements, 367 Presumptive eligibility application, 473 Reapplication, 479-480 Renewal, 461-468, 494, 496, 504, 565, 567, 715 SSN application, 698 Timely notice, 495 Trust funds, See Categoical Factors, 43 Withdrawal, 486, 492

Assessment Definition of, See Glossary

Assessment/determination of income available for the cost of care, See Income, Persons in medical facilities (chronic care), 275-291

Asset Definition of, See Glossary

Assignment and subrogation, See Resources, Third Party, 425-426

Assistance based on need, See Income, ADC-related assistance, 196, FHPlus, 272, LIF, 173, S/CC, 257, SSI-related assistance, 220, See Reference, 748

(MRG) 5

(master-index)(page-6)Page 6#

MASTER INDEX JANUARY 2012 Assistance to persons temporarily absent, See Other Eligibility Requirements, State residence and district responsibility for assistance, 531-532

Assistance to persons temporarily in state, See Other Eligibility Requirements, State residence and district responsibility for assistance, 533-534

Assistance to persons who change residency, See Other Eligibility Requirements, State residence and district responsibility for assistance, 524-530

Continuous Coverage, 504-505, 523, 527

District of fiscal responsibility, 525, 527

Family Health Plus (FHP), 524, 529-530

Homeless, 528

Managed Care, 529

Medicare, 530

Presumptive Eligibility, 526

Third Party, 530

Assisted Living Program (ALP), See Resources, 377, 416, See Reference, 793 Definition of, See Glossary

Asylees, See Other Eligibility Requirements, Citizenship and Immigration status, 614, 629, 631, 791

Attest/attestation, See Categorical Factors, 24, 43, 47, See Income, 134, 181, 261, See Resources, 309, 364, 373, 374-375,, 377, 381, 437, See Other Eligibility Requirements, 471-472.1, 479, 483-485.1, 587, 604, 619, 624, 628, 704, 710, 713, See Reference, 790, 796-797

Authorization, See Categorical Factors, 63, 98, See Resources, 423, See Other Eligibility Requirements, 461, 464, 468, 481, 483, 488, 504-506, 524, 530, 547, 562, 713, 723, 729 Employment/Work Authorization, See Other Eligibility Requirements, 614-619, 625, 628, 635, 638, 640, 649, 656, 658, 661, 663-664, 668-669, 671, 699

Auto Assignment, See Categorical Factors, Family Health Plus Premium Assistance Program, 65-66, See Other Eligibility Requirements, 469

Automobiles and other vehicles, See Resources, 346, 348-350, See also Property, Personal, SSI-related assistance, 382

Availability, See Categorical Factors, 98, See Income, 103-104, 127, 130, 138, 205; See Resources, 308, 311, 326-327, 364, 373, See Other Eligibility Requirements, Ownership and availability, 498-503

(MRG) 6

(master-index)(page-7)Page 7#

MASTER INDEX JANUARY 2012

B Balanced Budget Act of 1997 (BBA), See Categorical Factors, 70, See Other Eligibility Requirements, 634-635

Basic Coverage Group, See Categorical Factors, Medicaid Buy-in for Working People with Disabilities, 43-49

Battered qualified aliens, See Citizenship and Immigration status, 611, 613, 618-628, 791 Alien number requirement, 627

Definition of, See Glossary, 620 Evidence of Abuse, 621

Five Year Ban to Benefits, 617, 626

Non-Residency with batterer, 622-623

Substantial Connection, 620-621

Verification of Immigration Status, 624-625

Bearer Bonds, coupon bond, See Resources, 332

BENDEX (Beneficiary Data Exchange), See Income, 129, See Other Eligibility Requirements, 464, 580

Birth-control, See Categorical Factors, 63

Birth Verification Indicator (BVI), See Other Eligibility Requirements, 594, See Reference, 795

Blind/Blindness, See Categorical Factors, 3, 18-19, 24-25, 27-28, 44, 50, 52, 72, 80,-82, 84, 87-89, 95, See Income, 128, 171-172, 221, 226, 228, 231, 242, 247-248, 252, 265, 270, See Resources, 337, 339, 381, 384, 402, 406-407, 442, 446, See Other Eligibility Requirements, 466, 474, 535, 550, 556-558, 562, 569-570, 576-577, 629, 678, 680.6, 685, 732, See Reference, 745, 748 Definition of, See Glossary

Blind work expenses. See Income Supplemental Security Income-related assistance (SSI- related assistance), Budgeting methodologies, 242, 247-248

Blood Plasma settlements, See Income, ADC-related assistance, 196, Chronic Care, 278, 286, FHPlus, 273, LIF, 173, S/CC, 258, 260, SSI-related assistance, 220; See Resources, SSI-related assistance, 382, See Reference, 748

Boarder or roomer (lodger) income, See Income, 105,118-120, ADC-related assistance, 197, 200, LIF, 180, S/CC, 258, 260, SSI-related assistance, 220, 227, See Reference, 530.4, 768

(MRG) 7

(master-index)(page-8)Page 8#

MASTER INDEX JANUARY 2012 Bona Fide Loan, See Income, 132, ADC-related assistance, 196, FHPlus, 272, LIF, 173, S/CC, 257; SSI-related assistance, 221, See also Resources, Promissory Notes, 308, 333-334, 357, 443, See Reference, 748

Bonds, See Income, 130-131, 133, See Resources, 308, 311, 317, 327-333, See Other Eligibility Requirements, 499, 680.4 Coupon bonds (bearer bonds), 332 Zero coupon bonds, 131, 327, 331-332

Breast and Cervical Cancer, Medicaid Cancer Treatment Program (MCTP), See Categorical Factors, 67-69, See Resources, 309, 372, 380, 409, 440, See Other Eligibility Requirements, 465, 470, 483, 484.1

Definition of, See Glossary Levels, See Reference, 764

Bridges to Health (B2H), See Other Eligibility Requirements, 725-726

Budget methodology, See Income, See Resources ADC-related assistance, 171, 196-217 Chronic care, 172, 278-289 Family Health Plus (FHPlus), 272-274 Family Planning Benefit Program (FPBP), 292 LIF, 171, 185-195 S/CC, 172, 257-271 SSI-related assistance, 171, 231-256

Budgeting Definition of, See Glossary

Budgeting for legally responsible relatives (LRR), See Resources, 406-407

Burial funds/burial arrangement (excluded), See Categorical Factors, 5, 43, See Income, SSI- related assistance, 221, See Resources, 365-368.1, 369-371, 382, 447, See Other Eligibility Requirements, 680.8, See Reference, 748, 796

Burial Spaces, See Resources, 365-366, 368, 371, 382, 447, See Other Eligibility Requirements, 680.8

Burial trusts Definition of, See Glossary

Business income, See Income, 105, 113-120, 144, 243, 249, 265

Business property, See Resources, 328, 242-343, 346, 350-352, 383, 385

(MRG) 8

(master-index)(page-9)Page 9#

MASTER INDEX JANUARY 2012 BVI, Birth Verification Indicator, See Other Eligibility Requirements, 594, See Reference, 795

C Cancer Services Program Partnership (CSSP), See Categorical Factors, 67-69

Card Issuance, See Other Eligibility Requirements, 506-507

Care at Home (CAH) waiver, See Resources, 377, 407, 452, See Other Eligibility Requirements, 720-721

Caretaker relatives, See Categorical Factors, Aid to Dependent Children-related assistance (ADC-related assistance), 6, 8-18, 22, 97-98, See Income, 193, 211, 265, See Other Eligibility Requirements, 507, 567, 573, 577, 580, 587, 594, 604, 698, 710

Cash assistance income, See Income, ADC-related assistance, 197, FHPlus, 272, LIF, 174, Persons in medical care facilities (Chronic Care), 278, 285, S/CC, 257, SSI-related assistance, 221, 232-233, 237, See Reference, 748

Cash payments for medical services or social services, See Resources, 386

Cash surrender value (CSV), See Resources, Life insurance, 324-326

Cash value of life insurance, See Resources, 325-326, 328, 366, 369-370 Definition of, See Glossary

Categories/Categorical Factors, 3-98 Age, 6, 24-26, 30-31, 52-54, 59-60, 68, 87, 97 Age of child, 8 65 and over, 24-26, 30-31, 68, 87 Under age 21, 6, 52-54, 59-60, 87, 97 Aid to the Aged, Blind or Disabled (AABD), 81, 89-90 Aid to Dependent Children, (ADC), 6, 28, 37, 54, 84, 89 Aid to Dependent Children-related assistance (ADC-related assistance), 7-25, 29, 37, 52, 54, 58-59, 84, 89 AHIP (AIDS Health Insurance Program), 54 Basic Coverage Group, 43-49 Blind/Blindness, 3, 18-19, 24-25, 27-28, 44, 50, 52, 72, 80,-82, 84, 87-89, 95, Breast and Cervical Cancer, Medicaid Cancer Treatment Program (MCTP), 67-69 Caretaker relatives, 6, 8-18, 22, 97-98 CBIC (Common Benefit Identification Card), 64, 76 CBVH (Commission for the Blind and Visually Handicapped), 28, 50 Child Health Plus (CHPlus), 70 (MRG) 9

(master-index)(page-10)Page 10#

MASTER INDEX JANUARY 2012 CATEGORICAL FACTORS continued

COBRA (Consolidated Omnibus Budget Reconciliation Act), 64 Colorectal and Prostate Cancer, Medicaid Cancer Treatment Program (MCTP), 67-69 Continued absence, 6, 8, 15, 20-22 Continuing Disability Reviews (CDR), 34, 36-37, 45, 47-50 Creditable coverage, 67-68 Death of a parent, 15, 17, 95 Deprivation of parental support or care, 6-8, 10, 14-23, 50, 84 Continued absence, 20-22 Death of a parent, 15, 17, 95 Incapacity of a parent, 18-19, 59 Un/under employed two parent household, 8, 15, 23, 59 Disabled Adult Child (DAC) Beneficiaries, 80, 86, 95-96 Disabled, certified, 3, 19, 24-25, 27-29, 34-35, 37, 40-41, 44-48, 50, 52, 72, 80-82, 84, 87, 89, 93, 95 Employment subsidies, 42 Employer Sponsored Health Insurance, 64-65 Excess Income, 49, 54, 64, 70, 73, 75, 86 Expanded Poverty Level programs, 52 Extended period of eligibility (EPE), 49 Extensions/Continuations, 4, 81-98 Disabled Adult Child (DAC), 80, 86, 95-96 Family Planning Extension Program (FPEP), 83 Pickle Amendment (Section 503)/Eligibles, 80-86, 91-92, 96 Section 249E of the Public Law 92-603, 86, 89-90, See Reference, 737 Separate Health Care Determination,87 Notice of intent, 87 Rosenberg (PA case closing), 86-87 Section 249E of Public Law 92-603, 86, 89-90, See Reference, 737 Stenson (SSI case closing), 86, 88 Supplemental Security Income-related assistance (SSI-related assistance), 82, 84, 86, 88 Transitional Medicaid (TMA), 86, 97-98 Widows/Widowers, 93-94 Family Health Plus (FHPlus), 24, 52, 54-55, 62, 64-66, 76, 83, 97 Definition of, See Glossary Family Health Plus Premium Assistance Program (FHP-PAP), 64-66 Auto Assignment, 65-66 Definition, See Glossary FHP/Premium Assistance Rates, See Reference, 738-741 Family Planning Benefit Program (FPBP), 23, 52, 55-56, 61-63.1, 83 Family Planning Extension Program (FPEP), 83 Families living with dependent children, 3-4, 12-13, 16, 54, 59, 67-68, 87, 97-98 Federal Poverty Levels, 3, 43-45, 52, 54, 56-59, 62, 67-68, 77-78, 8, 86-87, 98 FNP Parents, 3-4, 54, 58 (MRG) 10

(master-index)(page-11)Page 11#

MASTER INDEX JANUARY 2012 CATEGORICAL FACTORS continued

Foster Care, 71-72, 85-86 Incapacity, 6, 8, 13-16, 18-19, 59 Infants Under 1, 52, 55 IRWES, Impairment Related Work-Expenses, 47 Legally Recognized Same-Sex Marriages, 5 Living with specified relative, 8, 12-14 Low birth weight babies, 57 Low Income Families (LIF), 3-4, 6, 52, 54, 59, 67-68, 97 Low-Income Subsidy (LIS), 75-77 Managed Care, 56, 85 MBI-WPD (Medicaid Buy-in for Working People with Disabilities), 24, 28-30, 37-38, 43- 50 Medicaid Cancer Treatment Program (MCTP), 54, 67-69 Medical Improvement Group, 43.1, 45, 46-48, 51 Medical support, 20 Medically needy, 7, 24, 28, 35, 37, 54, 58, 86, 96 Definition of, See Glossary Levels, 756-759 Medicare, 25, 50, 54, 73-80, 93, 96 Medicare Buy-in, 80 Medicare Improvement for Patients and Providers Act (MIPPA) of 2008, 74 Medicare Part A, 73-74, 76, 93 Medicare Part D, 75 Medicare Savings Program, 54, 73-77 QDWI, 74-75 QI, 54, 74, 76-77 QMB, 54, 73, 75-77 SLIMB, 54, 73, 75-77 Newborns, 53, 55-57 Pickle Eligibles, 80, 86, 91-92, 96 Pregnancy/Pregnant woman, 6, 18, 54-57, 63, 67, 82-83, 86-87 Prescription drugs, 64, 74 Presumptive Eligibility, 57 Relationship of child to caretaker relative, 10-11 Same-sex marriages, 5 Section 249E of Public Law 92-603, 86, 89-90, See Reference, 737 Separate health care coverage determinations, 87-88 Separate Medicaid determinations, 71-72, 86-88 Singles/Childless Couples (S/CC), 4, 31, 54, 61, 87 Spenddown, 31, 48, 54, 58-59, 75, 85-86, 91, 96 SSI 1619b, 50, 96 SSI-related, 3-5, 24-43, 47, 49, 52, 54, 80, 82, 84-89, 91-93, 95-97

Age (65 or older), 24-26

Blindness, 27-28 (MRG) 11

(master-index)(page-12)Page 12#

MASTER INDEX JANUARY 2012 CATEGORICAL FACTORS continued

Disability, 29-37

Employment Subsidies, 42 Substantial Gainful Activity, 29, 34, 38-45, 80, 82

Trial Work Period, 40-41, 49 State Disability Review Team, 29-31, 34, 36, 38, 45, 48-50 Stenson (SSI case closing), 86-88 Substantial Gainful Activity (SGA), 29, 34, 38-39, 41-42, 48, 80, 82, See Reference, 745 Supplemental Security Income-related assistance (SSI-related assistance), 3-5, 24-43, 47, 49, 52, 54, 80, 82, 84-89, 91-93, 95-97 Age (65 or older), 24-26

Blindness, 27-28

Disability, 29-37

Employment Subsidies, 42 Substantial Gainful Activity, 29, 34, 38-45, 80, 82 Trial Work Period, 40-41, 49 Transitional Medicaid (TMA), 86, 97-98.1 Trial Work Period, 40-41, 49 Amount, See Reference, 746 Under Age 21, 6, 52-54, 60, 62, 87, 97 Un/Under Employment Two-Parent Household, 8, 15, 23, 59 Widow/Widowers, 93-94

CBIC (Common Benefit Identification Card), See Categorical Factors, 64, 76, See Other Eligibility Requirements, (CBIC), 495.3-495.7, 506-507, 713

CBVH (Commission for the Blind and Visually Handicapped), See Categorical Factors, 28, 50

CDC (Center for Disease Control), See Categorical Factors, 67

Certified blind or certified disabled, See Categorical Factors, 3, 24-25, 27, 50, 72, 80, 82, 84, 87-89, 95, See Income, 171-172, 221, 224.1, 226, 228, 231, 247-248, 252, 265, See Resources, 337, 339, 381, 384, 390, 402, 406-407, See Other Eligibility Requirements, 466, 474, 535, 550, 556-558, 562, 569-570, 576-577, 629, 678, 680.6, 685,, 732, See Reference, 748

Certified blind reasonable work-related expenses, See Income, 221, See Reference, 748

Certified Home Health Agencies (CHHA), See Resources, 373, 377, 402, See Other Eligibility Requirements, 506, 511, 673, 701-706, See Reference, 788-789

Definition of, See Glossary

Chaffee Children, See Other Eligibility Requirements, 481.1, 526, 573, See also Foster Care

(MRG) 12

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MASTER INDEX JANUARY 2012 CHAMPUS (Civilian Health and Medical Plan for Uniformed Services), See Income, 147, See Resources, Third party resources, 419

Chapter 621 Eligible, See Other Eligibility Requirements, State and Federal Charges, 691

Child and Adult Care Food Program (CACFP), See Income, ADC-related, 197, FHPlus, 272, LIF, 174, S/CC, 258, See Reference, 748

Child Assistance Program, (CAP) Definition of, See Glossary

Childcare Income, See Income, ADC-related assistance, 197, LIF, 174, S/CC, 258, See Reference, 749

Childcare services payments/child care agencies, See Income, ADC-related assistance, 197, LIF, 174, S/CC, 258, SSI-related assistance, 221, See Other Eligibility Requirements, 506, 725, See Reference, 749

Child Health Plus (CHPlus), See Categorical Factors, Insurance, 70, See Resources, 410, See Other Eligibility Requirements, 464-465, 477, 491, 563, 575, 608, 639-640, 661, 669- 671, 675, 712, See Reference, 777

Child/incapacitated adult care cost, See Income, 174, 187-189, 193, 195, 197, 207, 211-212, 216, 276, Aid to Dependent Children-related assistance (ADC-related assistance), Budgeting methodologies, 216, Income Disregards, 197, Low Income Families (LIF), Budgeting methodologies, 187-189, 195, Income Disregards, 174, See Reference 748

Child/Children, See Categorical Factors, 6-18, 20-23, 29, 31, 42, 52-54, 57-61, 67-68, 70, 72, 80, 82, 87, 95-98, See also Custody, 12-13, 20-21, 23, 71, 85 Blindness, 19, 52, 95 Born out-of-wedlock, 10, See also Paternity, 10, 20, 140 Child, Definition of, See Glossary Child Health Plus (CHPlus), 70, 410, 464-465, 477, 491, 563, 575, 608, 639-640, 661, 669-671, 675, 712, 777 Disability, 19, 29, 42, 52, 84, 95 Foster Care, 71-72, 85-86 Infants under age one, 52, 55 Under age 21, 6, 52-54, 60, 62, 87, 97, See Income, 104, 158-160, 163, 171-172, 180, 185, 187, 194, 201, 207, 215, 217, 250, 261, 265, 282, 293,-294, 301, See Resources, 309, 372-373, 380, 408, 440, See Other Eligibility Requirements, 477, 491, 506, 510, 522, 526, 535-536, 540, 543, 550, 554, 556, 559, 561, 564-566, 569, 573, 575, 577, 594, 645, 680.2-680.3, 680.6-680.7, 685, See Reference, 788, 793, 796-797

Children eligible for continuous Medicaid coverage, See Other Eligibility Requirements, 504-505, 523, 527

(MRG) 13

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MASTER INDEX JANUARY 2012 Children with Physical Disabilities Program, See Resources, 411

Child's savings account, See Resources, 312, SSI-related assistance, 385

Child Support, See Income, 207, 216, See Other Eligibility Requirements, 559-561, 564, 566- 567, 708, 711, 732

Child Support Arrearage Payment, See Income, ADC-related, 197, FHPlus, 272, LIF, 174, S/CC, 258, See Reference, 749

Child Support Enforcement Unit (CSEU), See Income, 139, See Resources, 407, 413, See Other Eligibility Requirements, 469, 554, 557, 559-561, 564, 567, 681 Definition of, See Glossary

Chronic care budgeting, See Income, 133, 136, 172, 278-282, 285-289, See Resources, 399 Budgeting methodologies for individuals, See Income, Persons in medical facilities (chronic care), 172, 283, 285-289 Budgeting methodologies for institutionalized spouses, See Income, Persons in medical facilities (chronic care), 275-285 Budgeting for Institutionalized Spouses in HCBS Waivers, 282-284 Community Spouse and Family Member Allowance, 276, 282, 284, 291 Definition of, See Glossary Personal Needs Allowances (PNA) for Persons Transferred or Discharged, 291

Citizen, See Other Eligibility Requirements, 578, 583-584, 592-605, 607, 614, 632, 638, 661, 664, 669 Definition of, See Glossary

Citizenship and Immigration status, See Other Eligibility Requirements, 589-675, See Reference, 791, 795 AIDS, 589, 642 Aliessa v Novello, 641 Birth Verification Indicator (BVI), 594, See Reference, 795 Citizens, 578, 583-584, 592-605, 607, 614, 632, 638, 661, 664, 669 Definition of, See Glossary Deferred Enforced Departure (DED), 647, 659, 661, 664 Department of Homeland Security, 579, 583, 641, 650, 654, 662 Domestic Violence/Domestic Violence Liaison (DVL), 521, 619, 621, 623-624, 628, See Reference, 792 Enhanced Driver’s License, 579, 595 Federal Five Year Ban, See Categorical Factors, 31, See Other Eligibility Requirements, 608, 611, 617 Native Americans, 579, 587, 591, 595, 604-607, 614; See also State/Federal Charges American Indian born in Canada, 605-607, 614, Definition of, See Glossary Living on the reservation, 687-689 Non-citizen member of a federally-recognized tribe, 605, 614 (MRG) 14

(master-index)(page-15)Page 15#

MASTER INDEX JANUARY 2012 CITIZENSHIP AND IMMIGRATION STATUS continued

Newborns, 589, 592-593 Non-Immigrants admitted on a temporary basis, 591, 666-668, 672-673 Permanent Residence under Color of Law (PRUCOL) aliens, 589, 591, 608, 641-658, 662- 664, 669-671 Documentation Guide, 659-661 Qualifieds, 611-640, See Reference, 791 Amerasian immigrants, 611-612, 616, 624, 629, 631-632, 791 Asylees, 614, 629, 631, 791 Battered qualified aliens, 611, 613, 618-628, 791 Conditional entrants, 617 Cuban and Haitian entrants, 611-612, 615, 629, 631-632, 644, 659, 687-688, 791 Definition of, See Glossary Lawful permanent residents, 617, 620, 624-625, 633, 638, 645-648, 657, 660, 665, 669, 671 Parolees, 522, 548, 615, 617 Persons granted indefinite stays of deportation, 643-645, 656, 659 Persons on active duty in the U.S. Armed Forces, 611-612, 616, 634-635, 715 Persons under Order of Supervision, 643-644, 656, 659 Refugees, 530, 540, 611-612, 614, 617, 629-633, 636-639, 644, 659, 665, 671, 687- 688 Refugee Medical Assistance (RMA), 629-633, 791 Satisfactory Immigration Status, 578, 589, 591, 593, 609-619 SAVE (Systematic Alien Verification to Entitlements), See Other Eligibility Requirements, Citizenship and Immigration Status, PRUCOL, 625, 649 Special Non-Immigrant, 591, 669-671 Temporary Non-Immigrant, 591, 666-668, 672-673 Temporary Protected Status (TPS), 591, 643, 647-648, 658, 661-664 U.S. Armed Forces active duty and veterans, 611-612, 616, 634-635, 715 Undocumented/illegal aliens, 589, 591, 672-675, 697 Emergency Medical Condition, 581, 589, 591, 599, 609-610, 638, 666-668, 672-674 Chemotherapy, 673

Organ transplant, 672 Radiation therapy, 673 Veterans of the U.S. Armed Forces, 611-612, 616, 634-635, 715 Victims of Trafficking, 591, 611-612, 617, 629, 632-633, 636-640, 665, 671, See Reference, 791 Certified Victims (Federal Office of Refugee Resettlement), 616, 630, 632, 637, 639- 640

Confirmed Victims (State), 638 Visa Statuses, 591, 621, 631, 665, 670 Voluntary departure, See Other Eligibility Requirements, Citizenship and immigration status, 643, 645-647, 650, 656-657, 659, 661-662

Claims, See Other Eligibility Requirements, Liens, 680.5, 680.7-680.8, 683-685 (MRG) 15

(master-index)(page-16)Page 16#

MASTER INDEX JANUARY 2012

CNS (Client Notice System), See Categorical Factors, 76-77, See Other Eligibility requirements, 481

COBRA (Consolidated Omnibus Budget Reconciliation Act), See Categorical Factors, 64, See Income, 219, 231, See Resources, 309, 380-381, 427, See Other Eligibility Requirements, 547, 549.2, 716-718, See Reference, 762 COBRA Continuation Program, 231, 309, 380-381, 717, See Reference, 762

Coinsurance, See Categorical Factors, 73, 80, See Income, 166-167, 171, 231, 296, See Resources, 416-417, 435-436, See Other Eligibility Requirements, 680.8, See Reference, 788

COLA (Cost of Living Adjustment), See Categorical Factors, 38, 40, 89-91, 93, See Reference, 745-746

Collective Naturalization, See Other Eligibility Requirements, 583, 588

Colorectal and Prostate Cancer, Medicaid Cancer Treatment Program (MCTP), See Categorical Factors, 67-69, See Other Eligibility Requirements, 465, 483, 484.1, See Reference, 764

Commission for the Blind and Visually Handicapped (CBVH), See Categorical Factors, 28, 50

Commissions, Bonuses and Similar Payments, 110-112

Common Benefit Identification Card (CBIC), See Categorical Factors, 64, 76, See Other Eligibility Requirements, 495.3-495.7, 506-507, 713

Community based organization, See Other Eligibility Requirement, 473, 491

Community Coverage care with community-based long-term care, See Resources, 372, 375- 376, See Other Eligibility Requirements, 471, 484.1, 485, 493, 545, See Reference, 796-797

Community Coverage without community-based long term care, See Resources, 364, 367, 372-373, 375-376, 401, 439, See Other Eligibility Requirements, 470-471, 484.1, 485, 493, 545-546, See Reference, 796-797

Community Residence (CR), See Other Eligibility Requirements, 511, 522, 535, 541, 642, 690, 693, 695, 731

Community spouse, See Income, Persons in medical facilities (chronic care), 275-278, 281- 282, 285, See Resources, 316-317, 392-396, 398, 405, 408, 434, 439, 442, 447, 450, 452 (MRG) 16

(master-index)(page-17)Page 17#

MASTER INDEX JANUARY 2012 Amounts, See Reference, 773 Budgeting methodology for individuals, 278-282, 285-289, 291 Budgeting methodology for institutionalized spouses, 275-285 Definition of, See Glossary Family member allowances, See Income, Persons in medical facilities (chronic care), 291 Allowances, See Reference, 773 Monthly income allowance, 275, 281 Definition of, See Glossary Resource Allowance (CSRA), 317, 392, 394, 396, 405, 408, 447, 450

Community Transition Service (CTS), See Other Eligibility Requirements, 733

Comprehensive Medicaid Case Management, See Other Eligibility Requirements Definition of, See Glossary

Computer Matching, See Other Eligibility Requirements, 719

Conditional entrants, See Other Eligibility Requirements, Citizenship and Immigration status, 617

Confinement and Pregnancy Related Expense, See Other Eligibility Requirements, 681-682

Congregate Care/Congregate Care Levels, See Income, 187-188, 267-268, See Other Eligibility Requirements, 521, 535, 538, 732, See Reference, 768-770

Consolidated Omnibus Budget Reconciliation Act (COBRA), See Categorical Factors, 64, See Income, 219, 231, See Resources, 309, 380-381, 427, See Other Eligibility Requirements, 547, 716-718, See Reference, 539 COBRA Continuation Program, 231, 309, 380-381, 717, See Reference, 762

Consumer Directed Personal Assistance Program (CDPAP), See Other Eligibility Requirements, 723

Definition of, See Glossary

Contiguous property, See Resources, Real property, 336-338, 340-341, 383 Definition of, See Glossary, 340

Continuations, See Categorical Factors, Extensions/Continuations, 4, 81-98

Continued absence, See Categorical Factors, 6, 8, 15, 20-22 Permanent absence status, See Categorical Factors, 72, See Income, 172, 278, 283-285, See Resources, 318, 298-299 Definition of, See Glossary Temporary absence, 518-519, 546 Definition of, See Glossary From homestead, See Resources, 337 (MRG) 17

(master-index)(page-18)Page 18#

MASTER INDEX JANUARY 2012

Continuing Care Retirement Community Contracts (CCRCC), See Resources, 404-405

Continuing Disability Reviews (CDR), See Categorical Factors, 34, 36-37, 45, 47-50

Continuous Medicaid coverage, See Other Eligibility Requirements, 504-504, 523, 527

Continuous period of institutionalization, See Income, 275, See Resources, 392-393, See Reference, 779 Definition of, See Glossary

Co-pay/copayment, Medicaid, Managed Care and FHPlus, See Categorical Factors, 64, See Income, 296-297, See Resources, 413-419, See Other Eligibility Requirements, 478, 509-511, 563, 676, 717, See Reference, 787 Exemptions, 510 OTC, 509-510, 787

COPS (Comprehensive Outpatient Program), See Other Eligibility Requirements,680.2, 685

Cost of Living Adjustment (COLA), See Categorical Factors, 38, 40, 89-91, 93, See Reference, 745-746

Countable Resources, See Income, 131, 135, 156, 279, See Resources, 310, 312, 315-216, 319, 321-323, 326-327, 332, 335, 337-338, 342, 345-346, 348, 353-355, 369, 379, 381- 382, 387, 389-394, 399, 402, 406-409, 428, 447, 452, See Reference, 779 Definition of, See Glossary

Coupon bonds (bearer bonds), See Resources, 332

Creditable coverage, See Categorical Factors, 67-69

Crime Victims' Compensation Program, See Resources, 411

Crime Victims' Fund payments, See Income, 222, See Reference, 749

CSEU (Child Support Enforcement Unit), See Income, 139, See Other Eligibility Requirements, 469, 554, 557, 559-561, 564, 567, 681

Cuban and Haitian entrants, See Categorical Factors, 85, See Other Eligibility Requirements, 611-612, 615, 629, 631-632, 644, 659, 687-688, See Reference, 791

Custodial parent, See Categorical Factors, 13, 22, See Other Eligibility Requirements, 563

Custody, See Categorical Factors, 12-13, 20-21, 23, 71, 85, See Other Eligibility Requirements, 504, 517, 559, 561, 573 Definition of, See Glossary (MRG) 18

(master-index)(page-19)Page 19#

MASTER INDEX JANUARY 2012 Foster Care, 71-72, 85-86 Care and custody, 71, 517, 725 Joint or shared, 12-13, 21 Removal from, 20

D DAC, (Disabled Adult Child), See Categorical Factors, Disability, Extensions/Continuations, 80, 86, 95-96

Death of a parent, See Categorical Factors, 15, 17, 95

Debtor and Creditor Law, See Other Eligibility Requirements, 678

Decision and notification, See Other Eligibility Requirements, 486-495 Acceptance, 488-489 Denial, 490-491 Discontinuance or reduction, 493-495 Timely notice, 495 Fair hearing rights, 472, 474, 487, 490, 494, 517, 523, 677, 681 Notice of intent, 462, 486, 493-494 Withdrawal of application, 486, 492

Deductible(s), See Resources, 311, 315-316, 413, 415-419, 435-436, See Other Eligibility Requirements, 680.8

Deeming, See Categorical Factors, 43, See Income, Supplemental Security Income-related assistance (SSI-related assistance), Budgeting methodologies, 231-232, 237-239, 250, 253-255, 256, See Resources, 384, 389-391, See Other Eligibility Requirements, 498, 721, 732

Deferred Enforced Departure (DED), See Other Eligibility Requirements, Citizenship and Immigration Status, PRUCOL, 647, 659, 661, 664

Deficit Reduction Act (DRA), See Other Eligibility Requirements, 578, 592

Delinquent, See Categorical Factors, 71 Definition of, See Glossary

Department of Correctional Services (DOCS), See Other Eligibility Requirements, 545-546, 548

Department of Homeland Security, See Other Eligibility Requirements, Citizenship and Immigration Status, 579, 583, 641, 650, 654, 662 (MRG) 19

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MASTER INDEX JANUARY 2012

Definition of, See Glossary

Deprivation of parental support or care, See Categorical Factors, 6-8, 10, 14-23, 50, 84, See Income, 217

Developmental Centers (DC), See Other Eligibility Requirements, 642, 695

DFR, See Other Eligibility Requirements, 475, 514-525, 528, 536, 539, 543-544, See Reference, 792-794

Disabled Adult Child (DAC), See Categorical Factors, Extensions/Continuations, 80, 86, 95- 96

Disabled/Disability, See Categorical Factors, 3, 18-19, 24-25, 27-38, 40-52, 66-68, 72, 80-82, 84, 87, 89, 93, 95-96, See Income, 103-104, 121, 124-129, 135-136, 138, 167, 169, 171-172, 212, 221, 224, 226, 228, 231, 233, 237, 243, 245, 248, 252, 265, 270, 274, 278, 285, 292, See Resources, 381, 399, 441-442, See Other Eligibility Requirements, 465, 474-475, 486-487, 498, 500, 556-558, 562, 569-570, 576-577, 581, 587, 604, 622, 629, 678, 680.5-680.6, 685,, 690, 712, 720, 722, 726, 728-729, 732 Categories, 34 Certification, 3, 19, 24-25, 27-29, 34-35, 37, 40-41, 44-48, 50, 52, 72, 80-82, 84, 87, 89, 93, 95 Definition of, 29, See Glossary Determination process, 29-32, 34, 36 Disabled Adult Child (DAC), 80, 86, 95-96 Employment subsidies, 42 Group I/Group II, 34, 36-37, 50 Medicaid Buy-in for Working People with Disability, 29-30, 42-50 N.Y.S. Disability Benefits, 19, 103-104, 121, 124-125, 498 Review Team, 29-31, 34, 36, 38, 45, 48-50 Retirement, Survivors and Disability Insurance (RSDI), 18-19, 29-30, 35-37, 89-92, 121, 126-129, 132, 213, 240, 499, 719, See Reference, 737 Social Security Disability, 28, 35, 37, 50, 121, 126-129, 592 Veterans’ Disability Benefits, 18-19 Waiver, 720-724, 729-733 Workers’ Compensation, 18-19, 20, 35, 66

Disability Review Team, (state and local), See Categorical Factors, 29-31, 34, 36, 38, 45, 48- 50 Definition of, See Glossary

Disaster Relief Act of 1974, See Income, 174, 197, 222, See Resources, 382

Disaster Relief and Emergency Assistance, See Income, ADC-related assistance, 197, FHPlus, 272, LIF, 174, SSI-related assistance, 222; See Resources, 382-383, See Reference, 749 (MRG) 20

(master-index)(page-21)Page 21#

MASTER INDEX JANUARY 2012

Disregards, See Income under specific type, ADC-related assistance, 196-206, FHPlus, 272- 273, LIF, 173-192, S/CC, 257-264, SSI-related assistance, 220-230; See Resources under specific type, MBI-WPD, 391, SSI-related, 314, 321, 358, 360, 366, 382-388, See Reference, 743-744, 748-754

District of Fiscal Responsibility (DFR), See Other Eligibility Requirements, 475, 514-525, 528, 536, 539, 543-544, See Reference, 792-794

District placement rule, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 520

Dividend/Interest Income, See Income, 121, 130-134, SSI-related, 223-224.1, 226, See Reference, 749

Divorce, See Categorical Factors, Marriage termination, 10, 20, See Income, 126-127, 139, See Other Eligibility Requirements, 570, 578, 580, 587, 604, 716

Dollar for Dollar Partnership policies, See Resources, 402, 430-434, 452, See Other Eligibility Requirements, 680, 680.3, 685

Domestic violence/Domestic Violence Liaison (DVL), See Resources, 423, See Other Eligibility Requirements, 521, 619, 621, 623-624, 628, See Reference, 792

Donated foods, See Income, ADC-related assistance, 197, FHPlus, 272, LIF, 174, S/CC, 258, SSI-related assistance, 223, See Reference, 749

DRA, (Deficit Reduction Act), See Other Eligibility Requirements, 578, 592

Drug or alcohol addiction/screening, See Categorical Factors Addiction, drug or alcohol, 18, 35

E Earned income, See Income, 104-120, See Reference, 749 Commissions, Bonuses and Similar Payments, 110-112 Income from Roomers (Lodgers) and Boarder, 118-120 Self-employments or Small Business Income, 114-117 Tips, 108-109 Wages, Salaries and Contractual Income, 106-107

Earned Income Disregards, See Income, ADC-related assistance, 183, 187, 190, 197, 200- 202, Chronic Care, 280-281, LIF, 175, 183, 191-192, 204 S/CC, 261, 263, 268, SSI- related assistance, 223, 225-228, 242, 247, 252-255 (MRG) 21

(master-index)(page-22)Page 22#

MASTER INDEX JANUARY 2012 Amount, See Reference, 753 Definition of, See Glossary Student Income: ADC-related, 200-202, FHPlus, 272, LIF, 180-181, S/CC, 261, SSI- related, 227-228, See Reference, 751 , 754 WIA (Workforce Investment Act), LIF, 183, S/CC, 263 Work Expense, ADC-related, 183, 187, 190, 197, LIF, 204, 208-210, S/CC, 263, 269, SSI-related, 224.1, 242, 247

Earned Income Tax Credit (EITC) payments, See Income, 132, ADC-related assistance, 197, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 223; See Resources, Time Limited Resource Disregards, SSI-related assistance, 387, See Reference, 749 Definition of, See Glossary

EEOICP (Energy Employees Occupational Illness Compensation), See Resources, SSI- Related Disregards, 383

Electronic Medicaid Eligibility Verification System (EMEVS), See Other Eligibility Requirements, Restricted Recipient Program (RRP), 508

Emancipated minor, See Other Eligibility Requirements, Legally Responsible Relative (LRR), 560

EMEVS (Electronic Medicaid Eligibility Verification System), See Other Eligibility Requirements, Restricted Recipient Program (RRP), 508

Emergency Medical Condition, See Other Eligibility Requirements, 581, 589, 591, 599, 609- 610, 638, 666-668, 672-674 Chemotherapy, 673 Definition of, See Glossary, 672 Organ Transplant, 672 Radiation Therapy, 673

Emergency Safety Net payments, See Income, S/CC, 258, See Reference, 749

Employer Group Health Insurance, See Categorical Factors, 98, See Resources, 422, 429, See Other Eligibility Requirements, 716, 718

Employer Sponsored health insurance (ESI), See Categorical Factors, 64-65, See Resources, 421

Employment, See Categorical Factors, 21, 23, 27, 35-36, 38-43, 44-46, 59, 82, 85, 97, See Income, 105, 107, 111, 124, 135, 155, ADC-related assistance, 198-199, 201-203, 208 LIF, 174, 179, 181-182, S/CC, 258, 260-262, 269, SSI-related assistance, 222, 227-228, 231, 242-244, 247, See Other Eligibility Requirements, 483-484, 485 Principal wage earner, 16, 23 Self-employment, 104-105, 113-117, 144, 244, 265, 276 (MRG) 22

(master-index)(page-23)Page 23#

MASTER INDEX JANUARY 2012 Un/under employed two parent household, 8, 15, 23, 59 Unemployment, 138

Employment subsidies, See Categorical Factors 42

Energy Employees Occupational Illness Compensation (EEOICP), See Resources, SSI- Related Disregards, 383

Enhanced Driver’s License, See Other Eligibility Requirements, 579, 595

Enrollment Center, See Other Eligibility Requirements, 484

EOIR (Executive Office of Immigration Review), See Other Eligibility Requirements, 618, 621, 624-625, 628, 641, 648, 651-652, 658-659, 661, 664

Equity value of, See Resources

Personal Property, 348, 382 Real Property, 335, 340, 343-343, 345, SSI-related, 385 Trade or business, SSI-related, 383

Essential Personal Property, See Resources, 346-350, SSI-related, 382, 384

Estate, See Resources, 315, 319, 363, 430, 433, 442, See Other Eligibility Requirements, 678, 680, 680.1, 683, 685.1 Definition of, See Glossary Estate Recoveries, 680, 680.1-680.9 Life Estates, See Resources, 353-354, 357, 443, See Other Eligibility Requirements, 680.4

Estate Recoveries, See Other Eligibility Requirements, 680, 680.1-680.9

Exception Trusts, See Resources, 358-361, 363, See Other Eligibility Requirements, 680.5

Excess Income, See Categorical Factors, 49, 54, 64, 70, 73, 75, 86, See Income, 155, 166, 217, 242, 244, 255, 272, 276, 282, 285, 293-294, See Resources, 309, 372, 374, 378, 380, 408, 410, 427, 435, 440, See Other Eligibility Requirements, 485, See Reference, 777.1 Pay-in, 295, 298, 303-304 Six month, 299-302

Excess Resources, See Categorical Factors, 24, See Income, 156, 295, See Resources, 310, 341, 366, 403, 407-410, 433, See Other Eligibility Requirements, 684 Definition of, See Glossary

Executive Office of Immigration Review (EOIR), See Other Eligibility Requirements, 618, 621, 624-625, 628, 641, 648, 651-652, 658-659, 661, 664

(MRG) 23

(master-index)(page-24)Page 24#

MASTER INDEX JANUARY 2012 Expanded Eligibility Program, See Income, 185, 195, 271, See Other Eligibility Requirements, 504

Expanded poverty level programs, See Categorical Factors, 52

Expenses of obtaining income, See Income, SSI-related, 223, See Reference, 749

Extended period of eligibility (EPE), See Categorical Factors, 49

Extensions/Continuations, See Categorical Factors, 4, 81-98 Aid to Dependent Children-related assistance (ADC-related assistance), 84, 89 Blindness, 81-82, 84, 89 Cuban-Haitian, 85 Disability, 81-82, 84, 89, 91 Disabled Adult Child (DAC), 80, 86, 95-96 Section 6 of Public Law 99-643, 95 Family Planning Extension Program (FPEP), 83 FHPlus, 83, 87 Foster Care, 85-86 LIF, 82 Managed Care Organization (MCO), 85 Pickle Amendment/Eligibles (Section 503), 80, 86, 91-92, 96 Pregnancy, 83, 86-87 PRWORA, 84 Psychiatric services, 84 Refugee Assistance Program (RAP), 85 Separate Health Care determinations, 87-90 Notice of intent, 87 Rosenberg (PA case closing), 86-87 Section 249E of the Public Law 92-603, 89-90, See Reference, 737 Stenson (SSI case closing), 86-88 Supplemental Security Income-related assistance (SSI-related assistance), 82, 84, 86-88 Transitional Medicaid (TMA), 86, 97-98 Under age 19, 85 Widows/Widowers, 93-96 Disregards, 93

F Facilitated Enroller, See Other Eligibility Requirements, 463-464.1, 468, 474, 594, 711-712

Fair Market Value (FMV), See Income, 150-151, See Resources, 335, 338, 353-358, 362- 365, 401-402, 439, 442, 445-452, See Other Eligibility Requirements, 680.5, See Reference, 783 (MRG) 24

(master-index)(page-25)Page 25#

MASTER INDEX JANUARY 2012

Definition of, See Glossary

Families with dependent children under age 21, See Categorical Factors, 3-4, 12-13, 16, 54, 59, 67-68, 87, 97-98, See Income, 171-172, 183, 185, 187, 193-194, 204, 207, 211, 215-216, 233, 263, 282, See Other Eligibility Requirements, 612, 634

Family-based Treatment (FBT), See Other Eligibility Requirements, 642, 694

Family Care (FC), See Other Eligibility Requirements, 535, 642, 691, 693-695, 725, 731, See Reference, 771

Family Court Act (FCA), See Categorical Factors, 71, See Other Eligibility Requirements, 535, 563

Family Health Plus (FHP or FHPlus), See Categorical Factors, 24, 52, 54-55, 62, 64-66, 76, 83, 97, 98.1, See Income, 159, 169, 272-274, 294, See Resources, 309-310, 372, 378, 380-381, 408, 440, See Other Eligibility Requirements, 463, 465, 470, 472, 475-477, 481, 483, 484.2, 495.1-495.2, 495.4-495.5, 495.8, 496, 506-507, 509-511, 524, 526, 529-530, 545, 549.2-549.3, 608, 638, 650, 662-663, 669, 676-679, 699 Auto Assignment, 65-66 Co-payment, 509-511, 787 Definition of, See Glossary Disregards, 272-274 FHP Premium Assistance Rates, 64-66, 411, See Reference, 738-741 Levels, See Reference, 763 Persons who change residency, 524, 526, 529-530 Pharmacy Carve-out, 64 Retroactive Eligibility, 495.1-495.2, 495.4-495.5

Family Health Plus Premium Assistance Program (FHP-PAP), See Categorical Factors, 64- 66, See Resources, 411, See Reference, 738-741, See Glossary

Family member, See Categorical Factors, 56, 65, 86, See Income, 128, 172, 213, 232, 240, 244, 275-276, 282, 285, 291, 295, See Resources, 337, 366, 371, 382-383, 407, 419, 428, See Other Eligibility Requirements, 461, 549, 573, 611, 613, 616, 629, 631, 635, 656, 707, 715 Definition of, See Glossary

Family Member Allowance (FMA) for each family member, See Income, Persons in medical facilities (chronic care), 276, 282, 284, 291, See Other Eligibility Requirements, 554 Amount, See Reference, 773 Definition of, See Glossary

Family Planning Benefit Program (FPBP), See Categorical Factors, 23, 52, 55-56, 61-63.1, 83, 98.1, See Income, 159, 170, 292, See Resources, 423, See Other Eligibility (MRG) 25

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MASTER INDEX JANUARY 2012 Requirements, 465, 468, 472, 476-477, 481, 483, 484.1, 506, 509, 511, See Reference, 748-752, 764, 787, 796-797 Definition of, See Glossary Disregards, 748-752 Levels, See Reference, 764

Family Planning Extension Program (FPEP), See Categorical Factors, 83

Family size, See Income, 169-170, 256, 274, See Resources, 380, See Other Eligibility Requirements, 573, 707, See Reference, 556, See Categorical Factors and Other Eligibility Requirements, Household composition, 5, 13-14, 56, 572-577

Family type home for adults Definition of, See Glossary

FBR, Federal Benefit Rate, See Income, 233-234, 255, See Reference, 755

Federal advance payments, See Income, 175, 198, 224, 259

Federal Benefit Rate (FBR), See Income, 233-234, 255, See Reference, 755

Federal Economic Opportunity Act, Title III. See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 228, See Reference, 749

Federal Energy Assistance payments, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 228, See Reference, 749

Federal Five Year Ban, See Categorical Factors, 31, See Other Eligibility Requirements, 608, 611, 617

Federal Minimum Wage amount, See Categorical Factors, 46-47, See Reference, 766

Federal Older Americans Act of 1965, See Income, ADC-related assistance, 198, LIF, 175, SSI-related assistance, 223, See Reference, 749

Federal Poverty Level (FPL), See Categorical Factors, 3, 43-45, 52, 54, 56-59, 62, 67-68, 77, 86-87, 98, See Income, 158-159, 163-171, 185-191, 195, 215, 217, 256, 265, 268, 271, 274, 291-292, 294, See Reference, 756-759

Federal Relocation Assistance, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 174, S/CC, 258, SSI-related assistance, 223; See Resources, SSI-related assistance, 383, See Reference, 749

Federal SSI Benefit Level, See Income, 234 Levels, See Reference, 755, 770-772

(MRG) 26

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MASTER INDEX JANUARY 2012 FHPlus, Family Health Plus, See Categorical Factors, 24, 52, 54-55, 62, 64-66, 76, 83, 97, 98.1, See Income, 159, 169, 272-274, 294, See Resources, 309-310, 372, 378, 380-381, 408, 440, See Other Eligibility Requirements, 463, 465, 470, 472, 475-477, 481, 483, 484.2, 495.1-495.2, 495.4-495.5, 495.8, 496, 506-507, 509-511, 524, 526, 529-530, 545, 549.2-549.3, 608, 638, 650, 662-663, 669, 676-679, 699

Auto Assignment, 65-66

Co-payment, 509-511, 787 Definition of, See Glossary

FHP/Premium Assistance Rates, 64-66, See Reference, 738-741 Disregards, 272-274 Levels, See Reference, 763 Persons who change residency, 524, 526, 529-530 Pharmacy Carve-out, 64

Financial institution accounts. See Resources, 308-313, 451

Financial maintenance, See Other Eligibility Requirements, 496-497

FNP Parents, See Categorical Factors, 3-4, 54, 58, See Income, 171-172, 185, 187, 194, 207, 215, See Resources, 309, 373, 378, 380, 408, 440

Food stamps, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 223, See Other Eligibility Requirements, 484, 497, See Reference, 749 Definition of, See Glossary

Foster care, See Categorical Factors, 3, 71-72, 85-86, See Other Eligibility Requirements, 481, 504, 506-507, 514, 526, 535, 538, 543, 560, 574, 592, 725 Definition of, See Glossary Non-Title IV-E, 218-219, Title IV-E, 71-72, 85, 218-219, 504

Foster care assistance, See Other Eligibility Requirements, 592

Foster Care Compact Coordinator, See Other Eligibility Requirements, 514

Foster parent payments, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 223, See Reference, 750

FPBP, Family Planning Benefit Program, See Categorical Factors, 23, 52, 55-56, 61-63.1, 83, 98.1, See Income, 159, 170, 292, See Resources, 423, See Other Eligibility Requirements, 465, 468, 472, 476-477, 481. 483, 484.1, 506, 509, 511, See Reference, 748-752, 764, 787, 796-797 Definition of, See Glossary Disregards, 748-752 Levels, See Reference, 764 (MRG) 27

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MASTER INDEX JANUARY 2012

FPEP (Family Planning Extension Program), See Categorical Factors, 83

Free meals, See Income, ADC-related assistance, 195, FHPlus, 272, LIF, 174, S/CC, 258, SSI-related assistance, 224, See Reference, 750

Full Faith and Credit, Definition of, See Glossary

Funeral agreements, pre-need, irrevocable, See Resources, 365-369, 371, 373, 409, 447, See Resources, SSI-related assistance, 382, 385

G Garden produce or livestock, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 174, S/CC, 259, SSI-related assistance, 224, See Reference, 750

Garnishment, See Other Eligibility Requirements, 499 Definition of, See Glossary

GI Bill deduction, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 174, S/CC, 259, SSI-related assistance, 224, See Reference, 750

Good Cause, See Categorical Factors, 72, See Resources, 387, 415, 422-424, See Other Eligibility Requirements, 477, 561-562, 564,-568, 623, 709 Definition of, See Glossary

Graduate Education Grants or Scholarships, See Income, ADC-related, 202, FHPlus, 272, LIF, 181, S/CC, 261, See Reference, 751

Grant Diversion Definition of, See Glossary

Group I/ Group II, See Categorical Factors, 34, 36-37

Guardian/guardianship, See Resources, 311, 359-360, See Other Eligibility Requirements, 468, 499, 502, 506, 522, 578, 580, 586-587, 602, 713, 721-722, 728, See Reference, 793 Definition of, See Glossary

(MRG) 28

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MASTER INDEX JANUARY 2012 H HCBS (Home and Community Based waivered Services), See Income, 282-284, See Resources, 375, 416, 440, 452, See Other Eligibility Requirements, 506, 511, 550, 555- 558, 562, 569-571, 678, 694, 696, 720-721, 725-728, 731-733, See also Waivers

Definition of, See Glossary

Health Care Integration Agencies, See Other Eligibility Requirements, Waivers, 725

Health insurance, See Categorical Factors, 55, 64, 66, 72, 98, See Income, 124, 136, 219, 231, 282, 302, See Resources, 410-411, 413-415, 420, 423, 425, 427-429, See Other Eligibility Requirements, 472, 484, 486, 530, 547, 553, 561, 563, 566, 585, 596, 601, 702, 716-717

Health insurance premiums, See Categorical Factors, 5, See Income, ADC-related assistance, 193, 207, 212-214, 216; MBI-WPD, 256, Persons in medical facilities (chronic care), 275, 288; SSI-related assistance, 224, 239-241, 251-252, 254-255, See Resources, 416- 417, 428-429, See Other Eligibility Requirements, 485, 530, 548, 708, 711, 717, See Reference, 750

Hearing, See Income, 276-277, 291, See Resources, 392, 394-396, 402, See Other Eligibility Requirements, 472, 474, 487, 490, 494, 517, 523, 677, 681 Definition of, See Glossary

Hearing examiner Definition of, See Glossary

HEART, See Other Eligibility Requirements, 484

Home and community-based waivered services (HCBS), See Income, 282-284, See Resources, 375, 416, 440, 452, See Other Eligibility Requirements, 506, 511, 550, 555- 558, 569-571, 678, 694, 696, 725-728, 731-733, See also Waivers Definition of, See Glossary

Home Energy, See Income, ADC-related assistance, 196, LIF, 173, S/CC, 257, SSI-related assistance, 220, See Reference, 769

Home Energy Assistance Program (HEAP), See Other Eligibility Requirements, 484 Definition of, See Glossary

Home Equity, See Income, 149, See Resources, 338, 401-403, 432

Home Health, See Resources, 373, 377, 402, See Other Eligibility Requirements, 506, 511, 673, 701-706, See Reference, 788-789

Home Relief Definition of, See Glossary (MRG) 29

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MASTER INDEX JANUARY 2012

Homeless Housing and Assistance Program (HHAP) Definition of, See Glossary

Homelessness Intervention Program (HIP) Definition of, See Glossary

Homeless, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 519, 521, 528, 535, 541, 581, 598-599, 623, See Reference, 768 Definition of, See Glossary

Homeless shelter, See Other Eligibility Requirements, 541, 623, See Reference, 768

Homestead, See Categorical Factors, 5, See Income, 145, See Resources, 335-342, 345, 353, 357, 383, 400, 402, 441-442, See Other Eligibility Requirements, 680.2, 684

Hospice, 701-706 Definition of, See Glossary

Hostile Fire Pay, See Income, 224, See Reference, 750

Household composition, See Categorical Factors, 5, 13-14, 56, See Income, 165, 302, See Other Eligibility Requirements, 572-577. See also Custody, 20-23, 72, 85; See also Legally responsible relative (LRR), 498-501, 538, 550-571 Aid to Dependent Children-related assistance (ADC-related assistance), 572-575 Caretaker relatives, 573 Child Health Plus, 575 Family size (Pregnant women and children), 572-575, See Reference, 794 Low Income Families (LIF), 572-575 Singles/Childless Couples (S/CC), 572, 577 Supplementary Security Income-related assistance (SSI-related assistance), 576

Housing and Urban Development (HUD) Community Block Grant Funds, See Income, ADC-related assistance, 198, FHPlus, 273, LIF, 175, S/CC, 259, SSI-related assistance, 224, See Reference, 750

Housing Opportunities for Persons with AIDS (HOPWA) Definition of, See Glossary

HUD, Housing and Urban Development Community Block Grant Funds, See Income, ADC- related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 259, SSI-related assistance, 224, See Reference, 750

(MRG) 30

(master-index)(page-31)Page 31#

MASTER INDEX JANUARY 2012 I ICF, ICF/DD, ICF-MR, See Other Eligibility Requirements, 510, 540, 642, 696, 731

IDEA, See Other Eligibility Requirements 678

Identity, See Categorical Factors, 57, 86, See Resources, 353, See Other Eligibility Requirements, 471, 473, 485, 578-589, 592, 605, 609-610, 713

Immediate medical need, See Other Eligibility Requirements, 506-507, 666, 672, 714

Immediate Wage Withholding Definition of, See Glossary

Immigrant, See Citizenship

Definition of, See Glossary

Immigration, See Citizenship/immigration alien status

Impairment-related work expenses (IRWES), See Categorical Factors, 38-39, 46, See Income, SSI-related, 223-224.1, 242-246, 252, 256, See Reference, 750

Incapacitated adult, See Income, Child/incapacitated adult care cost, 174, 187-189, 193, 195, 197, 207, 211-212, 216, 276, See Reference, 748

Incapacity, See Categorical Factors, 6, 8, 13-16, 18-19, 59, See Income, 125, See Resources, 395

Incarcerated Individuals, See Other Eligibility Requirements, 523, 543-549, See Reference, 793 Discontinuation, 546-547 Infants Residing with Incarcerated Mothers, 523, 543-544 Mail-in Renewal Returned to District without of County Address, 548 Maintaining Medicaid Eligibility for Incarcerated Individuals, 544-549i Reinstatement, 547 Released Residing with Family Members, 549 Released to Community With Parole Supervision, 548 Released to Community Without Supervision, 547-548 Suspension of Medicaid, 544-546

Permanent absence, 546 Temporary Absence, 546

Income, 99-304, See also Other Eligibility Requirements, Renewal, 483-484, 485-485.1, Ownership and availability, 498-503; See Recoveries, 676-686 ADC-related Budgeting, 207-217 ADC-related disregards, 196-206 $90 Work Expense, 197, 200, 204, 207-209, 216 (MRG) 31

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MASTER INDEX JANUARY 2012 INCOME continued

30 and 1/3 Earned Income, 200, 207, 209-210, 212, 216 Child/Incapacitated Adult Care Cost, 174, 187-189, 193, 195, 197, 207, 211-212, 216, 276 Earned Income disregard, 200 Determination of Eligibility, 215-217 Health Insurance Premiums, 193, 207, 212-214, 216 Adopted Children, 218-219 Adoption, IV-E and non-IV-E, 218-219 Agent Orange Settlement Fund, Vietnam veterans, 182, 203, 229-230, 262, 273, 279-280, 287 Alimony, 140, 182, 203, 207, 216, 262 Allocation, 168, 231-236, 250-251, 253-256 Amounts, See Reference, 755 American Recovery and Reconciliation Act (AARA), 122 Americorps, See Reference, 748 Aid to Dependent Children-related assistance (ADC-related assistance), 196 FHPlus, 272 Low Income Families (LIF), 173 Singles/Childless Couples (S/CC), 257 Supplemental Security Income-related assistance (SSI-related assistance), 220 Amortization, 113, 115-116 Assistance based on need, See Reference, 748 Aid to Dependent Children-related assistance (ADC-related assistance), 196 Family Health Plus, 272 Low Income Families (LIF), 173 Singles/Childless Couples (S/CC), 257 Supplemental Security Income-related assistance (SSI-related assistance), 220 Availability, 103-104, 127-130, 138, 204 Blind/Blindness, 128, 171-172, 221, 226, 278, 231, 242, 247-248, 252, 265, 270 Blood Plasma settlements, See Reference, 748 Aid to Dependent Children-related assistance (ADC-related assistance), 196 Chronic Care, 278, 286 FHPlus, 273 Low Income Families (LIF), 173 S/CC, 258, 260 Supplemental Security Income-related assistance (SSI-related assistance), 220 Boarder or roomer (lodger) income, 105, 118-120, See Reference, 751, 768 Aid to Dependent Children-related assistance (ADC-related assistance), 197, 200 Low Income Families (LIF), 180 S/CC, 258, 260 Supplemental Security Income-related assistance (SSI-related assistance), 220, 227 Bona Fide Loan, See Reference, 748 Aid to Dependent Children-related assistance (ADC-related assistance), 196 FHPlus, 272 (MRG) 32

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MASTER INDEX JANUARY 2012 INCOME continued

Low Income Families (LIF), 173 Promissory Note, 308, 333-334, 357, 443 Singles/Childless Couples (S/CC), 257 Supplemental Security Income-related assistance (SSI-related assistance), 221 Budgeting, 171-172 Budgeting methodologies, 171-292 Aid to Dependent Children-related assistance (ADC-related assistance), See Aid to Dependent Children-related assistance (ADC-related assistance), Budgeting methodologies, 207-217 Chronic care, 275-291 Definition of, 171, See Glossary Family Health Plus (FHPlus), 159, 189, 272-274 Family Planning Benefit Program (FBPF), 292 Low Income Families (LIF), See Low Income Families (LIF), Budgeting methodologies, 185-195 MBI-WPD, 256 Singles/Childless Couples (S/CC), See Singles/Childless Couples (S/CC), Budgeting methodologies, 265-271 Supplemental Security Income-related assistance (SSI-related assistance), See Supplemental Security Income-related assistance (SSI-related assistance), Budgeting methodologies, 265-271 Burial funds/burial arrangement, See Reference, 748 Supplemental Security Income-related assistance (SSI-related assistance), 221 Business income, 105, 113-120, 144, 243, 249, 265, See also Resources, Business property Cash assistance income, See Reference, 748 Aid to Dependent Children-related assistance (ADC-related assistance), 197 Chronic Care, 278, 285 Family Health Plus, 272 Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 257 Supplemental Security Income-related assistance (SSI-related assistance), 221, 232- 233, 237 Certified blind or certified disabled, 171-172, 221, 224.1, 226, 228, 231, 247-248, 252, 265, 270 Certified blind reasonable work-related expenses, 221 See Reference, 748 Supplemental Security Income-related assistance (SSI-related assistance), 221 Child and Adult Care Food Program (CACFP), See Reference, 748 Aid to Dependent Children-related assistance (ADC-related assistance), 197 FHPlus, 272 Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Childcare income, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 197 (MRG) 33

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MASTER INDEX JANUARY 2012 INCOME continued

Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Childcare services payments, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 197 Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 221 Child/incapacitated adult care cost, See Income, 174, 187-189, 193, 195, 197, 207, 211- 212, 216, 276, Aid to Dependent Children-related assistance (ADC-related assistance), Budgeting methodologies, 216; Low Income Families (LIF), Budgeting methodologies, 187-189, 195, Disregards, 174, See Reference, 748 Child support, 207, 216 Child Support Arrearage Payment, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 197 Family Health Plus, 272 Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Chronic Care Budgeting Methodology for Individuals, 172, 283, 285-289 Chronic Care Budgeting Methodology for Institutionalized Spouses, 278-282 Coinsurance, 166-167, 171, 231, 296 Community spouse, See Income, Persons in medical facilities (chronic care), 275-278, 281-282, 285 Amounts, See Reference, 773 Budgeting methodology for individuals, 278-282, 285-288, 291 Budgeting methodology for institutionalized spouses, 275-285 Definition of, See Glossary Family member allowances, See Income, Persons in medical facilities (chronic care), 276, 282, 284, 291 Allowances, See Reference, 773 Monthly income allowance, 275, 281 Definition of, See Glossary Resource Allowance (CSRA), 317, 392, 394, 396, 405, 408, 447, 450 Congregate Care Levels, 187-188. 267-268 Contributions from Non-Legally Responsible Relative and Friends, 142-143, 150-153 Crime Victims' Fund payments, SSI-related, 222, See Reference, 749 Deeming, 231-232, 237-239, 250, 253-255, 256 Definition of, 103, See Glossary Disability benefits/determinations, 103-104, 121, 124-129, 135-136, 138, 167, 169, 171- 172, 212, 221, 224, 226, 228, 231, 233, 237, 243, 245, 248, 252, 265, 270, 274, 278, 285, 292, Disaster Relief and Emergency Assistance, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 197 FHPlus, 272 Low Income Families (LIF), 174 (MRG) 34

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MASTER INDEX JANUARY 2012 INCOME continued

Supplemental Security Income-related assistance (SSI-related assistance), 222 Disregards, See under specific type, ADC-related assistance, 196-206, FHPlus, 272-273, LIF, 173-192, S/CC, 257-264, SSI-related assistance, 314, 321, 358, 360, 366, 382-388 Amounts, See Reference, 743-744, 748-754 Definition of, See Glossary Dividend and Interest, 121, 130-134, SSI-related disregards, 223-224.1, 226, See Reference, 749 Donated foods, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 197 Family Health Plus, 272 Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 223 Earned Income, 104-120 Amounts, See Reference, 753 Definition of, 104 Disregards, See Earned Income Disregards ADC-related, 200-202, 204, 208-210 FHPlus, 272 LIF, 175, 180, 183, 187, 190-192, 197 S/CC, 261, 263, 268-269 SSI-related, 223, 225-228, 252, 242, 247, 255 Income from roomers (lodgers) and boarders, 118-120 Self-employment or small business income, 113-117 Tips, 108-109 Under age 21, 104 Wages and salaries, 106-108 Earned Income Disregards, See Income, ADC-related assistance, 200, 202, 204, 208-210, Chronic Care, 280-281, LIF, 175, 180-181, 183, 187, 190-192, 197, S/CC, 261, 263, 268-269, SSI-related assistance, 223, 225, 227-228, 242, 247, 252-255 Amount, See Reference, 749, 753 Definition of, See Glossary Earned Income Tax Credit (EITC) payments, 132, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 197 FHPlus, 272 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 223 Emergency Safety Net payments, S/CC, 258, See Reference, 749 Employment, 105, 107, 111, 124, 135-136, 155, ADC-related assistance, 190, 198-199, 201-203, 208, FHPlus, 273, LIF, 174, 179, 181-182, S/CC, 258, 260-262, 269, SSI- related assistance, 222, 227-228, 231, 242-244, 247 Principal wage earner, 16, 23 Self-employment, 104-105, 113-117, 144, 244, 265, 276 (MRG) 35

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MASTER INDEX JANUARY 2012 INCOME continued

Un/under employed two parent household, 8, 15, 23, 59 Unemployment, 138 Excess Income, 155, 166, 217, 242, 244, 255, 272, 276, 282, 285, 293-294 Pay-in, 295, 298, 303-304 Six-month, 295-302 Excess Resources, 156, 295 Expanded Levels, 158-159, 163-165 Expenses of obtaining income, SSI-related, 223, See Reference, 749 Family Health Plus (FHPlus), 159, 169, 272-279, 292 Definition of, See Glossary Disregards, 272-274 Family member, 87, 128, 164, 185, 193, 226-226.1, 227, 231-233.1, 240 Definition of, See Glossary Family Member Allowance (FMA) for each family member, Persons in medical facilities (chronic care), 276, 282, 284, 291 Amount, See Reference, 773 Definition of, See Glossary Family Planning Benefit Program (FPBP), 159, 170, 292 Definition of, See Glossary Levels, See Reference, 748-752 Family size, 169-170, 256, 274 FBR, Federal Benefit Rate, 233-234, 255, See Reference, 755 Federal Economic Opportunity Act, Title III, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 272 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 258 SSI-related assistance, 228 Federal Energy Assistance payments, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 272 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 223 Federal Older Americans Act of 1965, See Reference, 749 ADC-related assistance, 198 LIF, 175 Supplemental Security Income-related assistance (SSI-related assistance), 223 Federal Poverty Level (FPL), 158-159, 163-171, 185-191, 195, 215, 217, 256, 265, 268, 271, 274, 291-292, 294 Levels, See Reference, 756-759 Federal Relocation Assistance, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 272 (MRG) 36

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MASTER INDEX JANUARY 2012 INCOME continued

Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 223 Federal SSI Benefit Levels, 234 Levels, See Reference, 755, 770-772 FNP Parents, 171-172, 185, 187, 194, 207, 215 Food Stamps, See Reference, 749 Aid to Dependent Children-related assistance (ADC-related assistance), 198 Family Health Plus, 272 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 223 Foster parent payments, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 272 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 258 SSI-related assistance, 223 Free meals, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 198 Family Health Plus, 272 Low Income Families (LIF), 174 Singles/Childless Couples (S/CC), 258 Supplemental Security Income-related assistance (SSI-related assistance), 224 Garden produce or livestock, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 198 Family Health Plus, 272 Low Income Families (LIF), 176 Singles/Childless Couples (S/CC), 259 Supplemental Security Income-related assistance (SSI-related assistance), 224 Garnishment, 499 Definition of, See Glossary GI Bill deduction, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 272 Low Income Families (LIF), 172 Singles/Childless Couples (S/CC), 259 Supplemental Security Income-related assistance (SSI-related assistance), 224 Health insurance premiums Aid to Dependent Children-related assistance (ADC-related assistance), 193, 207, 212-214, 216 Chronic Care, 275, 288 Disregards, See Reference, 750 MBI-WPD, 256 (MRG) 37

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MASTER INDEX JANUARY 2012 INCOME continued

SSI-related assistance, 224, 239-241, 251-252, 254-255 Home and Community Based Services (HCBS) waiver, 282-284, Hostile Fire Pay, See Reference, 750 Supplemental Security Income-related assistance (SSI-related assistance), 224 Household Composition, 165, 302 Housing and Urban Development (HUD) Community Block Grant Funds, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 273 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 259 Supplemental Security Income-related assistance (SSI-related assistance), 224 Impairment-related work expenses, (IRWES), 223-224.1, 242-246, 252, 256, See Reference, 750 Income Allocation, 231-236, 250-251, 253-256, See Reference, 755 Income and Resource Test, See Reference, 760-763 Income Levels, 158-170 Federal Poverty Levels, 163-170 Family Health Plus, 159, 169-171, 272-279, 292 Family Planning Benefit Program, 159, 170, 292 Medicaid Expanded Income Levels, 163-165 Medicare Savings Program, 158-159, 166-168 Medicaid Standard, 158-159, 161-162, 164, 185-187, 189, 191-192, 194-195, 215, 217, 234, 236, 238, 250, 252, 255, 265-267, 269, 271, 280-281, 284-285, 288- 289, 293-294, 301, 303 Medically Needy, 160-161 Income Tax refunds, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 198 FHPlus, 273 Low Income Families (LIF), 175 Singles/Childless Couples (S/CC), 259 SSI-related (SSI), 224 Individual Development Accounts, LIF, 176, See Reference, 750 Individual Retirement Account (IRA), 133, 135 Individual Support Services, 157 Individual Taxpayer Identification Number (ITIN), See Other Eligibility Requirements, 699 Definition of, See Glossary Infrequent or irregular income, 111, SSI-related, 224, See Reference, 750 In-kind income, 142, 150-153, See Reference 750 Institutionalized spouse, 275-285, 290, 299 In HCBS waivers, 283-284 Insurance, See Categorical Factors, 66, See Income, 113, 121, 146, 212, 239, 302, 304, ADC-related assistance, 198, Chronic Care, 279, FHPlus, 273, LIF, 178, MBI- (MRG) 38

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MASTER INDEX JANUARY 2012 INCOME continued

WPD, 256, SSI-related assistance, 228, Definition of, See Glossary Health insurance premiums, 193, 207, 212-214, 216, 224, 239-241, 251-252, 254-256, 275, 288 Life insurance, 131, 133 Definition of, See Glossary Medicare, 126-128, 158-159, 166-168, 171-172, 212-213, 231, 239-240, 296, 302, 304 Medicare Savings Program, 158-159, 166-168 New York State Disability Insurance, 124-129 Retirement, Survivors, Disability Insurance, RSDI, 126-129, 132, 213, 240 Third Party Health Insurance (TPHI), 124, 219, 288, 302 Unemployment Insurance Benefits, 122-125 Insurance payments, See Reference, 530.3 ADC-related assistance, 198 Chronic care, 275, 279 FHPlus, 273, LIF, 178 SSI-related assistance, 228 Interest and Dividend payment, 121,130-134, SSI-related, 223-224.1, 226, See Reference, 749 IRWES, Impairment Related Work Expenses, 223-224.1, 242-246, 252, 256, See Reference, 750 Job Corps, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 199 FHPlus, 273 Low Income Families (LIF), 177 Singles/Childless Couples (S/CC), 259 Job Training Partnership Act (JTPA)—See Workforce Investment Act (WIA), See Reference, 752 Aid to Dependent Children-related assistance (ADC-related assistance), 204 FHPlus, 273 Low Income Families (LIF), 183 Singles/Childless Couples (S/CC), 263 Legally Responsible Relatives, (LRR), 127, 139, 147, 150-153, 163, 215, 219, 237, 270, 273, 282, 288, 295-297, See also Household composition, 165, 302 Levels, Income Congregate Care Levels, 187-188, 267-268 Expanded Levels, 158-159 Federal Poverty, 158-159, 163-171, 185-191, 195, 215, 217, 256, 265, 268, 271, 274, 291-292, 294 FPL and Medically Needy Levels, 756-759 Medicaid Standard, 158-159, 161-162, 164, 185-187, 189, 191-192, 194-195, 215, 217, 234, 236, 238, 250, 252, 255, 265-267, 269, 271, 280-281, 284-285, 288-289, 293-294, 301, 303 SSI Benefit Levels, 234 (MRG) 39

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MASTER INDEX JANUARY 2012 INCOME continued

Loan Bona Fide/Bona Fide Loan, Reference, 748 ADC-related assistance, 196 FHPlus, 272 LIF, 173 S/CC, 258, 260 SSI-related assistance, 220, 227 Low Income Families (LIF), 162, 171, 173, 195 Budgeting methodologies, 173-195 $90 Work Expense Disregard, 190-192 100% Maximum Income Test, 188, 91, 194-195 185% Maximum Income Test, 187, 191 Child/incapacitated adult care cost, 193 Earned Income Disregard, 191-192, See Reference, 753 Definition of, See Glossary Determining Eligibility, 194-195 Disregard, See Income under specific type, 173-194 Lump sum payments, 103, 124, 136, 154-155 Definition of, See Glossary Mandatory deductions/payments, 103-104 Marriage Termination, 126-127, 139 MBL Living Arrangement Chart, 158, 161-162, 164, 185, 189, 192, 194, 215, 238, 250, 252, 255, 266, 270, 284-285, 289, See Reference, 768 Meals, Free meals, ADC-related, 198, FHPlus, 272, LIF, 176, S/CC, 258, SSI-related, 224, See Reference, 750 Medicaid Buy-in for Working People with Disabilities (MBI-WPD), 159, 256, 294 Medicaid Expanded Levels, 158-159, 163-169 Medically Needy, 115, 158-162, 164-166, 168, 185, 187-189, 195, 215, 238, 250-253, 255, 266, 271, 280, 288-289, 293-294, 301, 203 Medicaid Standard, 158-159, 161-162, 164, 185-187, 189, 191-192, 194-195, 215, 217, 234, 236, 238, 250, 252, 255, 265-267, 269, 271, 280-281, 284-285, 288-289, 293- 294, 301, 303 Medicare, 126-128, 158-159, 166-168, 171-172, 212-213, 231, 239-240, 296, 302, 304 Medicare Savings Program (MSP), 166-168 Qualified Disabled and Working Individuals (QDWIs), 167 Qualified Medicare Beneficiaries (QMBs), 166-167, 172 Qualifying Individuals, (QI), 168 Specified Low-Income Medicare Beneficiaries (SLIMBs), 166-167 Minimum Monthly Maintenance Needs Allowance (MMMNA), 276, 282, 291 Native American payments, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 199 FHPlus, 273 Low Income Families (LIF), 179 Singles/Childless Couples (S/CC), 259 (MRG) 40

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MASTER INDEX JANUARY 2012 INCOME continued

Supplemental Security Income-related assistance (SSI-related assistance), 225 Net Available Monthly Income (NAMI), 448-449 New York State Department of Labor payments, See Reference, 750 Aid to Dependent Children-related assistance (ADC-related assistance), 199 FHPlus, 273 Low Income Families (LIF), 179 Singles/Childless Couples (S/CC), 260 New York State Disability Insurance, 121, 124-129, 149, 247 New York State Minimum Wage, 182, 203, 262, See Reference, 766 New York State Partnership for Long-Term Care, 136 Nursing home, 278, 285, 290 Nursing Home Transition and Diversion Waiver, 283 Office for People with Developmental Disabilities (OPWDD) Individual Support Services (ISS), 157 Other certified blind or certified disabled disregards, 221, 224.1 Otherwise available income, 275-276, 281 Definition of, See Glossary Overpayments, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 200 Low Income Families (LIF), 179 Singles/Childless Couples (S/CC), 260 Supplemental Security Income-related assistance (SSI-related assistance), 225 PACE (Program of All-Inclusive Care for the Elderly), 280-281, See Reference, 767 PASS (Plan to Achieve Self-Support), 226, 248-249, 256, 279, 287 Paternity, 140 Percentage of earned income Aid to Dependent Children-related assistance (ADC-related assistance), 200, LIF, 191 Persecution payments, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 200 Chronic care, 279, 287 FHPlus, 273 Low Income Families (LIF), 179 Singles/Childless Couples (S/CC), 260 Supplemental Security Income-related assistance (SSI-related assistance), 225 Persons in medical facilities (chronic care), See Persons in medical facilities (chronic care), 275-291; See also New York State Partnership for Long Term Care, 136, Assessment/Determination of Income Available for the Cost of Care, 275 Budgeting for Institutionalized Spouses in HCBS waivers, 283-284 Chronic Care Budgeting Methodology for Individuals, 272, 283, 285-289 Chronic Care Budgeting Methodology for Institutionalized Spouse, 278-282 Community Spouse and Family Member Allowance, 276, 282, 284, 291 Personal Needs Allowances (PNA), 280-281, 289, 290, See Reference, 767-768, 776 Plan to Achieve Self-Support (PASS), 226, 248-249, 256, 279, 287, See Reference, 751 Prescription Drug, 212, 239, 296 (MRG) 41

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MASTER INDEX JANUARY 2012 INCOME continued

Pregnancy/Pregnant, 139, 158, 161, 163-165, 171-172, 185, 187, 194, 207, 215, 217, 250, 265, 270, 282, 293-294, 301 Preventative housing service, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 200 FHPlus, 273 Low Income Families (LIF), 180 Singles/Childless Couples (S/CC), 260 Supplemental Security Income-related assistance (SSI-related assistance), 226 Program for All-Inclusive Care for the Elderly (PACE), 280-281, See Reference, 767 Public Assistance, Development of PA Standard of Need amount, See Reference, 769 Qualified Disabled and Working Individuals (QWDIs), 167 Qualifying Individuals, (QI), 168 Qualified Medicare Beneficiaries (QMBs), 166-167 Radiation Exposure Compensation Trust Fund payments, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 200 Chronic Care, 280, 287 FHPlus, 273 Low Income Families (LIF), 180 Supplemental Security Income-related assistance (SSI-related assistance), 226 Railroad Retirement, 121, 126-129, 154 Reduced (Limited) $90 Veterans' Administration pension, SSI-related, 226, 287, See Reference, 751 Refunds, 132, 175, 198, 226, 259, 273, 296, 303-304, See Reference, 751 Relative, Legally responsible relative (LRR), 127, 139, 147, 150-153, 163, 215, 219, 237, 270, 273, 282, 288, 295-297, See also Household composition, 165, 302 Relocation, Federal Relocation Assistance; Income, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 223, See Resources, SSI- related, 383, See Reference, 749 Rental Income, 144-146 Replacement of assistance already paid, SSI-related, 227, See Reference, 751 Retirement funds, 135-137 Retirement, Survivors' and Disability Insurance (RSDI), 121, 126-129, 213, 240, See Reference, 737 Retroactive benefits under the SSI Program, 227, See Reference, 751 Reverse Mortgages (RM), 121, 149 Room and/or board, 105, 118-120, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 197, 200 Low Income Families (LIF), 174, 180 Singles/Childless Couples (S/CC), 257-258, 260 Supplemental Security Income-related assistance (SSI-related assistance), 221, 227 School and employment status, 181, 201 Self-employment, 104-105, 113-117, 144, 244, 265, 276 Sick pay, 124-125 (MRG) 42

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MASTER INDEX JANUARY 2012 INCOME continued

Singles/Childless Couples (S/CC), 115, 118, 144, 149, 156, 160, 162, 172, 265-271, 278, 285, 292 Budgeting methodologies, 265-271 $90 Work Expense Disregard, 257, 263, 265, 267-269, 271 185% Maximum Income Limit, 265, 267-268, 270 100% Maximum Income Test, 268, 271 Room and board, 257-258, 260 Definition of, See Glossary Disregards, See Income under specific type, 257-264 Level, 761 SLIMBs, Specified Low-Income Medicare Beneficiaries (SLIMBs), 166-167, See References, 763 Social Security retirement benefits, 126-129, 154 Amounts, See Reference, 770-772 Specified Low-Income Medicare Beneficiaries (SLIMBs), 166-167, See References, 763 Spend down/Spenddown requirement, 164-166, 168, 172, 185, 195, 217, 244, 271, 284, 292-297, 299, 302 Definition of, See Glossary Expanded Eligibility Program, 185, 195, 271 Spousal Impoverishment, 283, 290 Minimum Monthly Maintenance Needs Allowance (MMMNA), 276-277, 281, 284, 291, See Reference, 775 SSI payments, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 200 FHPlus, 273 Low Income Families (LIF), 180 Singles/Childless Couples (S/CC), 262 Supplemental Security Income-related assistance (SSI-related assistance), 226, 228, 248 SSI-Related Disregards Student Income, 227-228, See Reference, 751, 754 State or Local Relocation Assistance payments, 132, SSI-related, 226-227 See Reference, 751 Stimulus Bill, See also American Recovery and Reconciliation Act (AARA), 122 Students, 126, 128, See Reference, 751, 754 Aid to Dependent Children-related assistance (ADC-related assistance), 201-202 FHPlus, 272 Low Income Families (LIF), 176, 180-181 Singles/Childless Couples (S/CC), 261 Supplemental Security Income-related assistance (SSI-related assistance), 227-228 See Reference, 751, 754 Supplemental Security Income-related assistance (SSI-related assistance, 106, 111, 115- 116, 125, 130, 132-133, 142, 144, 149-150, 154, 156, 158. 161. 171, 173, 180, 200, 213, 220-256, 262, 273, 276, 278, 280-283, 286, 288, 292-295, 301 (MRG) 43

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MASTER INDEX JANUARY 2012 INCOME continued

Budgeting methodologies, 220-255 Allocation, 231-236, 250-251, 253-256 Blind work expenses, 242, 247-248 Deeming, 231-232, 237-239, 250, 253-256, 384, 389-391 Determination of Eligibility, 250-255 Health insurance premiums, 224, 239-241, 251-252, 254-255 Impairment-related work expenses, 224.1, 242-246 Plan to Achieve Self-Support (PASS), 226, 248-249, 256, 279, 287 Definition of, See Glossary Disregards, See Income under specific type, 314, 321, 358, 360, 366, 382-388 See Reference, 754 Income Allocation, 231-236, 755 Minimum Monthly Maintenance Needs Allowance (MMMNA), 276-277, 281, 284, 291 Amounts, See Reference, 775 Nursing Home Transition and Diversion (NHTD) waiver, 283 Support payments, 121, 139-141, See Reference, 792 ADC-related assistance, 203, 207, 216 Chronic Care, 276 Low Income Families (LIF), 182 Singles/Childless Couples (S/CC), 262, 266, 271 SSI-related assistance, 221, 255 Taxes and taxation, 103-104, 113, 119, 131-132, 135, 144, 146, 226, 247 Self-employment tax, 115 TBI, Traumatic Brain Injury, 283 Third party insurance payments, 220, 288, 302, 304, SSI-related, 228, See Reference, 752 Title III, Federal Economic Opportunity Act, See Reference, 749 ADC-related assistance, 198 FHplus, 272 LIF, 175 S/CC, 258 Supplemental Security Income-related assistance (SSI-related assistance), 228 Trade readjustment Allowance (TRA), See Reference, 752 ADC-related assistance, 203 LIF, 182 S/CC, 262 Traumatic Brain Injury (TBI), 283 Unearned income, 103, 118, 121-157, 173, 182-183, 188, 196, 202, 204, 212, 222, 224, 228, 235, 239, 251-252, 261-264, 268, See Reference, 752 Contributions from non-legally responsible relatives and friends, 142-143, 150-153 Definition of, See Glossary, 121 Dividends and interest, 121, 130-134 Individual Retirement Account, 133, 135 Individual Support Services, 157 (MRG) 44

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MASTER INDEX JANUARY 2012 INCOME continued

In-kind Income, 142, 150-153 Lump Sum Payments, 154-155 Military Dependency Allotment, 121, 147-148 New York State Disability Insurance Benefits, 103-104, 121, 124-125, 149 Rental income, 144-146 Retirement funds, 135-137 Reverse Mortgages, 121, 149 Social Security (Retirement, Survivors, and Disability) Railroad Retirement and Veteran’s Benefits, 126-129, 213, 240 Support payments (voluntary and court-ordered), 121, 139-141, 182, 203, 207, 216, 221, 255, 262, 266, 271, 276 Windfalls, 156 Union benefits (other than pensions), 121, 138 Under age 19, 128, 158, 164-165, 217 Unemployment Insurance Benefits (UIB), 122-125, ADC-related assistance, 203, LIF, 182, S/CC, 262 United States Census, See Reference, 752 Aid to Dependent Children-related assistance (ADC-related assistance), 203 Low Income Families (LIF), 182 S/CC, 262 SSI-related assistance, 228 Veterans, SSI-related, 229, See Reference, 792 Veterans' Administration Disability benefits, 121, 126-129 Vietnam veterans, See Reference, 752 Aid to Dependent Children-related assistance (ADC-related assistance), 203 Chronic Care, 279-280, 287 FHPlus, 273 Low Income Families (LIF), 182 Singles/Childless Couples (S/CC), 262 Supplemental Security Income-related assistance (SSI-related assistance), 229 Vocational Rehabilitation Act, SSI-related, 229, See Reference, 752 Volunteer Program payments, See Reference, 752 Aid to Dependent Children-related assistance (ADC-related assistance), 204 FHPlus, 273 Low Income Families (LIF), 183 Singles/Childless Couples (S/CC), 263 Supplemental Security Income-related assistance (SSI-related assistance), 229 Volunteers in Service to America (VISTA), See Reference, 752 Aid to Dependent Children-related assistance (ADC-related assistance), 196, 203 FHPlus, 272 Low Income Families (LIF), 173, 182 Singles/Childless Couples (S/CC), 257, 262 Supplemental Security Income-related assistance (SSI-related assistance), 220, 229 Widows/Widowers, 126-127 (MRG) 45

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MASTER INDEX JANUARY 2012 INCOME continued

Windfalls, 156 Women, Infants and Children (WIC) Program, See Reference, 752 Aid to Dependent Children-related assistance (ADC-related assistance), 204 Family Health Plus, 273 Low Income Families (LIF), 183 Supplemental Security Income-related assistance (SSI-related assistance), 229 Workers' Compensation, 121, 124-125 Work expense, See Reference, 752 ADC-related assistance, 183, 187, 190, 197 LIF, 204, 208-210 MBI-WPD, 209.1 S/CC, 263, 269 SSI-related assistance, 224.1, 242, 247 Workforce Investment Act (WIA) (formerly JTPA), See Reference, 752 ADC-related, 199 FHPlus, 273 LIF, 183 S/CC, 263

Income Tax refunds, See Categorical Factors, 51, See ADC-related assistance, 198, FHPlus, 273, LIF, 175, S/CC, 259, SSI-related, 224, See Reference, 750

Individual Development Accounts, See Income, LIF disregard, 176, See Reference, 750

Individual Residential Alternative (IRA), See Other Eligibility Requirements, 642, 695

Individual Retirement Account (IRA), See Income, 133, 135, See Resources, 316, 453

Individual Support Services (ISS), See Income, Office for People with Developmental Disabilities (OPWDD), 157

Infants residing with incarcerated mothers, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 523, 541, 543-544

Infants under age one, See Categorical Factors, 52, 55

Infrequent or irregular income, See Income, 111, SSI-related, 224, See Reference, 750

In-kind income, See Income, 142, 150-153, See Reference, 750

Institutionalized spouse, See Income, 275-285, 290, 295, See Resources, 317, 393-396, 398, 406, 432-433, 439, 442, 450, See Other Eligibility Requirements, 489, 501, 554-555 Definition of, See Glossary

(MRG) 46

(master-index)(page-47)Page 47#

MASTER INDEX JANUARY 2012 Insurance, See Categorical Factors, 66, See Income, 113, 121, 146, 212, 239, 302, 304, ADC- related assistance, 198, Chronic Care, 279, FHPlus, 273, LIF, 178, MBI-WPD, 256, SSI-related assistance, 228; See Resources, 317, SSI-related assistance, 383, 388, Third party resources, 411-429, See Reference, 750 AIDS Health Insurance Program (AHIP), 54, 231, 309, 373, 378, 380, 409, 440, 580, 642, 762 Cash value of life insurance, 325-326, 328, 366, 369-370 Definition of, See Glossary Child Health Plus (CHPlus), 70 Employer Group Health, 136, 421-422, 427-429, 716, 718 Family Health Plus and FHPlus Premium Assistance Program, 64, 66 Health insurance premiums, 5, 193, 207, 212-214, 216, 224, 239-241, 251-252, 254-256, 275, 288, 416-417, 428-429, 485, 530, 548, 708, 711, 717 Liability insurance, 66, 144, 212, 239 Life insurance, 131, 133, 324-326, 365, 369-370, 383, 470, 472, 500, 585, 596, 601 Definition of, See Glossary Medicare, 25, 20, 24, 73-80, 93, 96, 126-128, 158-159, 166-168, 171-172, 212-213, 231, 239-240, 296, 302, 304, 309, 318, 378, 380, 404, 409, 414-419, 428, 435-438, 440, 465, 470, 478, 483, 507, 530, 547, 592, 676, 717 Medicare Savings Program, 54, 73-80, 158-159, 166-168, 309, 373, 378, 380, 409, 435- 437, 440, 465, 478, 483, 530, 547, 676 New York State Disability Insurance, See Income, 18, 29, 89, 91, 103-104, 121, 124-129, 149 No-Fault Insurance Law, 420 NYS Partnership for LTC, 54, 136, 309, 373, 378, 380, 401, 409, 422, 430-434, 440, 452 RSDI, 29, 89, 91, 126-129 Third Party Health Insurance (TPHI), 72, 98, 219, 302, 304, 318, 411-429, 484, 486, 530, 565-566 Unemployment Insurance Benefits, 122-125 Widow/widowers, 93

Insurance payments, See Income ADC-related assistance, 198, Chronic care, 275, 279, FHPlus, 273, LIF, 178, SSI-related assistance, 228, See Resources, SSI-related assistance, 387, See Reference, 750

Intermediate Care Facility (ICF), See Other Eligibility Requirements, 510, 540, 642, 696, 731, See also OPWDD and Waivers Definition of, See Glossary

Interest/Dividend Payment, See Income, 121, 130-134, SSI-related, 223-224.1, 226, See Reference, 749

Interest Income, See Categorical Factors, 43, See Income, 134, See Other Eligibility Requirements, 472, 483, 484.1, See Reference, 796-797

Irrevocable pre-need funeral agreements, See Resources, 365-368.1 (MRG) 47

(master-index)(page-48)Page 48#

MASTER INDEX JANUARY 2012

Irrevocable trusts, See Resources, 361, 363

IRWES, Impairment-related work expenses, See Categorical Factors, 47, See Income, 223- 224.1, 242-246, 252, 256

IV-B, See Other Eligibility Requirements, 592

IV-D, See Categorical Factors, 20, 72, See Resources, 407, 413, See Other Eligibility Requirements, 507, 554, 557, 559-568

IV-E, See Categorical Factors, 71-72, See Income, 218-219, See Other Eligibility Requirements, 504, 514, 562 Compact Care Coordinator, 514 Definition of, See Glossary KinGAP, kinship guardian assistance payments, 72, 506 Non-Title IV-E, 218-219, 504 Title IV-E, 71-72, 86, 218-219, 504, 514, 562, 574, 592

J John/Jane Doe, See Other Eligibility Requirements, 581, 599, 610

Job Corps, See Income, ADC-related assistance, 199, FHPlus, 273, LIF, 177, S/CC, 259, See Reference, 750

Job Training Partnership Act (JPTA), See Workforce Investment Act (WIA), See Income, ADC-related assistance, 204, FHPlus, 273, LIF, 183, S/CC, 263, See Reference 752

Jurisdiction, See Categorical Factors, 5, See Resources, 359-360, See Other Eligibility Requirements, 567, 583 Definition of, See Glossary

K Kinship guardian assistance program (KinGAP), See Categorical Factors, 72, See Other Eligibility Requirements, 506 Definition, See Glossary

(MRG) 48

(master-index)(page-49)Page 49#

MASTER INDEX JANUARY 2012 L Lawful Permanent Residents (LPR), See Other Eligibility Requirements, 617, 620, 624-625, 633, 638, 645-648, 657, 660, 665, 669, 671

Legally Recognized Same-Sex Marriages, See Categorical Factors, 5

Legally responsible relative (LRR), See Income, 127, 139, 147, 150-153, 163, 215, 219, 237, 270, 273, 282, 288, 295-297, See Resources, 327, 334, 384-385, 406-407, 415, See Other Eligibility Requirements, 498-501, 538, 550-571, See Reference, 794, See also Household composition, 5, 13-14, 56, 165, 302, 572-575 Definition of, 550, See Glossary Parents and children, 556-558 Absent parents, 557, 559, 561-567 Emancipated minor, 560 IV-D requirements, 561-568 Step-parents, 550, 556-557, 561, 569-571 Spouse, 553-555 Both spouses institutionalized, 555 Institutionalized spouse with a community spouse, 554-555 Institutionalized waiver participant with community spouse, 555 Living apart in the community, 554 Living together, 553

Levels, See Resources, 310, 319, 321, 323, 335, 342, 345, 378-391, 409, 433, 447, 449

Congregate Care Levels, 187-188, 267-288 Federal Poverty Income Levels, 158-159, 163-171, 185-191, 195, 215, 217, 256, 265, 268, 271, 274, 291-292, 294, See Reference, 756-759, 760-764 Expanded Levels, 52, 158-159, 163-165 Income and Resource Levels, See Reference, 760-764 Medicaid Resource Level, See Reference, 760-764, SSI-related only, 780 Medically Needy Income Levels, See Reference, 756-759 MBL Living Arrangement Chart, See Categorical Factors, 7, 24, 37, See Income, 158, 161-162, 164, 185, 189, 192, 194, 215, 238, 250, 252, 255, 266, 270, 284-285, 289, See Other Eligibility Requirements, 543, See Reference, 768 SSI Benefit Levels, 234, See Reference, 781

LIF, Low Income Families, See Categorical Factors, Low Income Families (LIF), 3-4, 6, 52, 54, 59, 67-68, 97, See Income, 162, 171, 173-195, See Resources, 309, 372, 378, 280, 408, 440, See Other Eligibility Requirements, 504, 572-575, 630, See Reference, 748- 753, 761, 796-797

LIS (Low Income Subsidy), See Categorical Factors, 75-77, See Other Eligibility Requirements, 478

Liens, See Resources, 335, 338-339, 341, 353, 360, 400-401, 403, 419, 421, 426, 430, 432- 433, See Other Eligibility Requirements, 676, 679-680, 680.5 (MRG) 49

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MASTER INDEX JANUARY 2012 Definition of, See Glossary

Life estates, See Resources, 353-354, 357, 443 Definition of, See Glossary

Life Expectancy Table for Annuities, See Reference, 785.2

Life insurance, See Income, 131, 133, See Resources, 324-326, 365, 365.1, 383, 369-370, 452, See Other Eligibility Requirements, 472, 500, 585, 596, 601, 680.6 Accelerated Life Insurance payments (Living Needs benefits), 325 Cash surrender value (CSV), 324-326 Definition of, See Glossary, 324 Endowment, 325 Face Value, 324 Individual/Group policies, 325 Limited payment, 325 Ordinary Life insurance (Whole Life), 324-326 Term insurance, 325

Limited Licensed Home Care Agency Definition of, See Glossary

Living arrangements, See Categorical Factors, 12-14, 59, 72, See Other Eligibility requirements, 505-506, 515, 517, 528, 535-544, 561, 623, 693, 695, 731-733See also Household composition, 5, 13-14, 56; See Other Eligibility Requirements, 498-501, 538, 550-571 Medical Facilities, 535, 539 Own Home, 535, 538 Public Institutions, 523, 535-537, 539, 541-544 Infants Residing with Incarcerated Mothers, 523, 543-544

Living Needs Benefits, See Resources, Life Insurance, 325

Lombardi, See LTHHCP, See Other Eligibility Requirements, 729

Long term care services, See Categorical Factors, 54, See Income 136, See Resources, 309, 325, 328, 338, 364, 367, 372-377, 401-402, 418, See Reference, 790, 796-797 Partnership for Long Term Care, See Categorical Factors, 54, See Income, 136, See Resources, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452, See Reference, 796- 797

Long Term Home Health Care Program (LTHHCP), See Resources, 452, See Other Eligibility Requirements, 702, 704-705, 729-730

Look-Back Period, See Resources, 399, 432-433, 439-440, 448-449, See Reference, 785 Definition of, See Glossary (MRG) 50

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MASTER INDEX JANUARY 2012

Low birth weight babies, See Categorical Factors, 57

Low Income Families (LIF), See Categorical Factors, 3-4, 6, 52, 54, 59, 67-68, 97, See Income, 162, 171, 173-195, See Resources, 309, 372, 378, 380, 408, 440, See Other Eligibility Requirements, 504, 572-575, 630, See Reference, 748-753, 761, 796-797 Budgeting methodologies, 173-195 $90 Work Expense Disregard, 190-192 100% Maximum Income Test, 188, 191, 194-195 185% Maximum Income Test, 187, 191 Child/incapacitated adult care cost, 190 Determination of eligibility, 194-195 Earned Income Disregard, 191-192 Definition of, See Glossary Deprivation of parental support or care, 6-8, 10, 14-23, 50, 84 Disregards, See Income under specific type, 173-192, 753 Household composition, 572-575 Level, See Reference, 761 Medicaid Standard, 158-159, 161-162, 164, 185-187, 189, 191-192, 194-195, 215, 217, 234, 236, 238, 250, 252, 255, 265-267, 269, 271, 280-281, 284-285, 288-289, 293- 294, 301, 303

Low Income Subsidy (LIS), See Categorical Factors, 75-77, See Other Eligibility Requirements, 478

LTHHCP (Long-Term Home Health Care Program), See Resources, 452, See Other Eligibility Requirements, 702, 704-705, 729-730

Luberto v Daines, See Categorical Factors, 86, See Other Eligibility Requirements, 548

Lump Sum Payments, See Income, 103, 124, 136, 154-155, See Resources, 308-310, 321- 322, 325, 355, 432, See Other Eligibility Requirements, 686 Definition of, See Glossary

M Managed Care, See Categorical Factors, 31, 43, 55-57, 64-66, 69, 85, See Resources, 374- 375, 413, 416, 418-419, See Other Eligibility Requirements, 463, 469, 509-510, 527, 529-530, 594, 678-679

Managed Care Organization (MCO), See Categorical Factors, 56, 85, See Resources, 418

Managed Long Term Care, See Other Eligibility Requirements, 470 Definition of, See Glossary (MRG) 51

(master-index)(page-52)Page 52#

MASTER INDEX JANUARY 2012

Marriage termination, See Categorical Factors 10 Divorce, See Categorical Factors, 10, 20, See Income, 126-127, 139, See Other Eligibility Requirements, 570, 578, 580, 587, 604, 716

MBI-WPD (Medicaid Buy-in for Working People with Disabilities), See Categorical Factors, 24, 28-30, 37-38, 43-51, See Income, 159, 256, 294, See Resources, 309, 316, 370, 380- 381, 391, See Other Eligibility Requirements, 465, 470, 483-485, 512, See Reference, 748-752, 764, 796-797 Definition of, See Glossary

MBL Living Arrangement Chart, See Categorical Factor, 7, 24, 37, See Income, 158, 161- 162, 164, 185, 189, 192, 194, 215, 238, 250, 252, 255, 266, 270, 284-285, 289, See Other Eligibility Requirements, 543, See Reference, 768

MCO (Managed Care Organization), See Categorical Factors, , 56, 85

MCTP (Medicaid Cancer Treatment Program), See Categorical Factors, 54, 67-69, See Resources, 309, 372, 380, 409, 440, See Other Eligibility Requirements, 465, 470, 483, 484.1 Levels, See Reference, 764, 797

Meals, See Income, Free meals, ADC-related assistance, 198, FHPlus, 272, LIF, 176, S/CC, 258, SSI-related assistance, 224, See Reference, 750

Medicaid Definition of, See Glossary

Medicaid Advantage Plans, See Resources, 415, 416-418

Medicaid Advantage Plus Plans, See Resources, 417-418

Medicaid Buy-in for Working People with Disabilities (MBI-WPD), See Categorical Factors, 24, 28-30, 37-38, 43-51, See Income, 159, 256, 294, See Resources, 309, 316, 370, 380- 381, 391, See Other Eligibility Requirements, 465, 470, 483-485, 512, See Reference, 748-752, 764, 796-797 Basic Coverage Group, 43-49 Definition of, See Glossary Disregards, 748-752 Levels, 764 Medical Improvement Group, 43.1, 45-48, 51 Substantial Gainful Activity and Transition, 48

Medicaid Cancer Treatment Program (MCTP), See Categorical Factors, 54, 67-69, See Resources, 309, 372, 380, 409, 440, See Other Eligibility Requirements, 465, 470, 483, 484.1, See Reference, 764, 796-797 (MRG) 52

(master-index)(page-53)Page 53#

MASTER INDEX JANUARY 2012

Medicaid Disability Review Team (state and local), See Categorical Factors, 29-31, 34, 36, 38, 45, 48-50, See Other Eligibility Requirements, 720

Medicaid Expanded Income Levels, 158-159, 163-165

Medicaid Extended Coverage (MEC), See Resources, 430-434

Medicaid for Medicare beneficiaries, Medicare Savings Program, See Categorical Factors, 54, 73-80, See Income, 158-159, 166-168, See Resources, 309, 373, 378, 380, 409, 435- 437, 440, See Other Eligibility Requirements, 465, 478, 483, 530, 547, 676, See Reference, 762-763, 796-797 Qualified Disabled and Working Individuals (QDWIs), 74-75, 167, 309, 380, 437, 762 Qualified Medicare Beneficiaries (QMBs), 54, 73, 75-77, 166-167, 309, 373, 378, 380, 409, 436, 440, 478, 507, 762, 796-797 Qualifying Individuals, (QI), 54, 74, 76-77, 168, 309, 373, 378, 380, 409, 437, 440, 478, 763, 796-797 Specified Low-Income Medicare Beneficiaries (SLIMBs), 54, 73, 75-77, 166-167, 309, 373, 378, 380, 409, 436, 440, 478, 763, 796-797

Medicaid Standard, See Categorical Factors, 7, 24, 37, 54, 60-61, See Income, 158-159, 161- 162, 164, 185-187, 189, 191-192, 194-195, 215, 217, 234, 236, 238, 250, 252, 255, 265- 267, 269, 271, 280-281, 284-285, 288-289, 293-294, 301, 303, See Other Eligibility Requirements, 543, 681, 709

Medicaid Resource Level, See Resources, 310, 319, 321, 323, 335, 342, 345, 378-391, 409, 433, 447, 449

Levels, See Reference, 756-759, 760-764, SSI-Related only, 780

Medical facility rule, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 520

Medical Improvement Group, See Categorical Factors, Medicaid Buy-in Program for Working People with Disabilities, 43.1, 45-48, 50-51

Medical institutions, See Other Eligibility Requirements, 466, 532-533, 535-536, 539, 679, 680.1, 683 Definition of, See Glossary

Medical parole, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 522

Medical support, See Categorical Factors, 20, See Resources, 407, 415, See Other Eligibility Requirements, 466, 532-533, 535-536, 539, 678.1 Definition of, See Glossary

(MRG) 53

(master-index)(page-54)Page 54#

MASTER INDEX JANUARY 2012 Medically needy, See Categorical Factors, 7, 24, 28, 35, 37, 54, 58, 86, 96, See Income, 115, 158-162, 164-166, 168, 185, 187-189, 195, 215, 238, 250-253, 255, 266, 271, 280, 288- 289, 293-294, 301, 203, See Resources, 428, 450, See Other Eligibility Requirements, 491, 543, 576, 630, 721, 726, 732 Definition, See Glossary Income Levels, See Reference, 756-759

Medicare, See Categorical Factors, 25, 20, 54, 73-80, 93, 96, See Income, 126-128, 158-159, 166-168, 171-172, 212-213, 231, 239-240, 296, 302, 304, See Resources, 309, 318, 373, 378, 380, 404, 409, 414-419, 428, 435-438, 440, See Other Eligibility Requirements, 465, 470, 478, 483, 507, 530, 547, 592, 717 Definition of, See Glossary

Medicare Advantage Plans (Medicare Part C), See Resources, 416-417

Medicare Advantage Special Needs Plans (SNP), See Resources, 418

Medicare Buy-in, See Categorical Factors, 80, See Resources, 417, See Reference, 765

Medicare Managed Care Plan, See Resources, 417

Medicare Improvement for Patients and Providers Act of 2008 (MIPPA), See Categorical Factors, 74

Medicare Part A and B Premiums, See Categorical Factors, 73-74, 76, 93, See Resources, 414-416, 436-437, See Other Eligibility Requirements, 680.8 Amounts, See Reference, 762, 765

Medicare Part D, See Categorical Factors, 75, See Resources, 415-417, 428 Low Income Subsidy Application, See Resources, 415-417, See Other Eligibility Requirements, 478

Medicare Savings Program (MSP), See Categorical Factors, 54, 73-77, See Income, 158-159, 166-168, See Resources, 309, 373, 378, 380, 409, 435-437, 440, See Other Eligibility Requirements, 465, 478, 481.1, 483, 530, 547, 549.3, 680.8, See Reference, 762-763, 796-797 Definition of, See Glossary Qualified Disabled and Working Individuals (QDWIs), 74-75, 167, 309, 380, 437, 762 Qualified Medicare Beneficiaries (QMBs), 54, 73, 75-77, 166-167, 309, 373, 378, 380, 409, 436, 440, 478, 507, 762, 796-797 Qualifying Individuals (QI), 54, 74, 76-77, 168, 309, 373, 378, 380, 409, 437, 440, 448, 478, 763, 796-797 Specified Low-Income Medicare Beneficiaries (SLIMBs), 54, 73, 75-77, 166-167, 309, 373, 378, 380, 409, 436, 440, 478, 763, 796-797

Mehler, See Income, 219, See Reference, 794 (MRG) 54

(master-index)(page-55)Page 55#

MASTER INDEX JANUARY 2012

Military Dependency Allotment, See Income, 121, 147-148

Military dependent’s identification card, See Other Eligibility Requirements, 579, 587, 604

Minimum/Maximum Community Spouse Resource Allowance, See Resources, 316, 392, 394-396, 408, 447, 450 Allowances, See Reference, 779

Minimum Wage, See Income, 182, 203, 262 Federal Minimum Wage Amount, See Categorical Factors, 46-47, See Reference, 766 New York State, 182, 203, 262 Minimum Wage Amount, See Reference, 766

Minimum Monthly Maintenance Needs Allowance (MMMNA), See Income, 276, 282, 291, See Resources, 396, 430-431, See Other Eligibility Requirements, 554, See Reference, 775 Definition of, See Glossary

Modification Petition Definition of, See Glossary

Money Judgment, See Other Eligibility Requirements, 499 Definition of, See Glossary

Mortgages/Mortgages and contracts of sale, See Income, 116, 119, 144-145, 228, See Resources, 335, 338, 341, 343, 355-357, 401, 403, 443, 447, 451, See Other Eligibility Requirements, 503, 685.1 Definition of, See Glossary Reverse Mortgages, See Income, 121, 149, See Resources, 402

Moves, See Other Eligibility Requirements Homeless, 521 In-district, 526-527 Out-of-district, 519, 523, 526-527

Mutual Funds, See Income, 130, 133, See Resources, 308, 311, 317, 327-328, 333, See Other Requirements, 680.4

N NAMI, Net Available Monthly Income, See Income, 161-162, 300-301, See Resources, 448- 449, See Other Eligibility Requirements, 485.1 (MRG) 55

(master-index)(page-56)Page 56#

MASTER INDEX JANUARY 2012

National Breast and Cervical Cancer Early Detection Program (NBCCEDP), See Categorical Factors, 67

Native American payments, See Income, ADC-related assistance, 199, FHPlus, 273, LIF, 179, S/CC, 259, SSI-related assistance, 225; See Resources, SSI-related assistance, 383, See Reference, 750

Native Americans, See Other Eligibility Requirements, Citizenship and immigration status, 579, 587, 591, 595, 604-607, 614 Definition of, See Glossary State and federal charges, 687-689 American Indian born in Canada, 605-607, 614, Definition, See Glossary Living on reservation, 687-689 Non-citizen member of a federally-recognized tribe, 605, 614

Newborns, See Categorical Factors, 53, 55-57, See Other Eligibility Requirements, 522, 589, 592-593, 697, 700

New York Health Options, See Other Eligibility Requirements, 484

New York State Department of Health, See Categorical Factors, 26, 36, 67, 69

New York State Department of Labor payments, See Income, ADC-related assistance, 199, FHPlus, 273, LIF, 179, S/CC, 260, See Reference, 750

New York State Disability Insurance, See Categorical Factors, 18, 29, 89, 91, See Income, 103-104, 121, 124-129, 149

New York State Medicaid Newborn System, See Categorical Factors, 53

New York State Minimum Wage, See Income, 182, 203, 262, See Reference, 766

New York State Partnership for Long Term Care, See Categorical Factors, 54, See Income 136, See Resources, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452 Definition of, See Glossary Dollar for Dollar Asset Protection (DDAP), 402, 430-434, 452, 680, 680.3,685.1 Medicaid Extended Coverage (MEC), 430-434 Qualified Partnership Policyholder (QPP), 401-402, 430-434, 679-680, 680.3, 685.1 Total Asset Protection (TAP), 54, 309, 373, 378, 380, 401, 409, 430-431, 440, 452, 680, 680.3, 685.1

NHTD, Nursing Home Transition and Diversion Waiver, See Income, 283, See Resources, 377, 452, See Other Eligibility Requirements, 722-724, 727

Non-Assignable Annuity See Resources, 454 (MRG) 56

(master-index)(page-57)Page 57#

MASTER INDEX JANUARY 2012 Definition of, See Glossary

Non-Citizen U.S. National, See Other Eligibility Requirements, Citizenship

Definition of, See Glossary

Non-Custodial Parent, See Other Eligibility Requirements, 676, 678 Definition of, See Glossary

Non-Immigrants admitted on a temporary basis, See Other Eligibility Requirements, Citizenship and immigration status, 591, 666-668, 672-673

Definition of, See Glossary

Non-probate assets, See Other Eligibility Requirements, 676, 677, 680.1, 680.8-680.9, 683

Nursing facility, See Resources, 309, 319, 338, 357, 373-375, 377, 401-402, 404, 433, 438- 446, 448-449, See Other Eligibility Requirements, 466, 470-471, 474, 485-485.1, 489, 506, 510, 517, 539, 545, 581, 586, 597, 602, 678, 680.2, 685, 687, 701-706, 720, 727, 729, See Reference, 785, 788, 790 Citizenship and Immigration Status, 586, 597, 602, 673 Definition of, See Glossary Presumptive Eligibility, 702-706

Nursing home care Definition of, See Glossary

Nursing Home Transition and Diversion (NHTD) waiver, See Income, 283, See Resources, 377, 452, See Other Eligibility Requirements, 722-724, 727

O OMH, Office of Mental Health (OMH), See Resources, 452, See Other Eligibility Requirements, 506, 517-518, 520, 522, 528, 535-536, 546,,549.1- 549.2, 549.4, 642,685, 687-694 District of Fiscal Responsibility, 517-518, 520, 522 Living Arrangements, 535-536 State and federal charges, 687-694

Community residences (CR), 511, 522, 535, 541, 642, 690, 693, 695, 731

Family-based treatment (FBT), 642, 694

Overburden, Chapter 621, 691, 695-696

Psychiatric Center (PC), 525, 642, 690-693

Residential Care Center for Adults (RCCA), 535, 694

Residential Treatment Facility (RTF), 693

State Operated Community Residence (SOCR), 693, 695 Teaching Family Home (TFH), 642, 694 (MRG) 57

(master-index)(page-58)Page 58#

MASTER INDEX JANUARY 2012

Voluntary Operated Family Care (VOFC), 693, 695

Office for People with Developmental Disabilities (OPWDD), formerly OMRDD, See Resources, 452, See Other Eligibility Requirements, 506, 511, 517-518, 520, 522, 528, 549.4, 642, 687-695, 720, 731-733 District of Fiscal Responsibility, 517-518, 520, 522 Home and Community Based Services waiver, 731-733 Individual Support Services (ISS), See Income 157 State and federal charges, 587, 691, 695

Community residences (CR), 642, 695

Family Care (FC), 642, 695 Individual Residential Alternative (IRA), 642, 695

Intermediate Care Facilities (ICF), 642, 696

Overburden, Chapter 621, 691, 695-696

OPWDD Certified Schools for Mentally Retarded, 642, 696

Small residential units (SRU), 642, 696

State Operated Community Residence (SOCR), 642, 695

State Operated Individual Residential Alternatives (SOIRA), 695 Voluntary Operated Family Care (VOFC), 693, 695 Voluntary Operated Individual Residential Alternative (VOIRA), 695

OMH, See Office of Mental Health

OPWDD, See Office for People with Developmental Disabilities, formerly Office for Mentally Retarded and Developmentally Disabled

OPWDD Certified Schools for Mentally Retarded, See Other Eligibility Requirements, 642, 696

Order, See Other Eligibility Requirements, 498-499, 563-564, 566, 676, 678, 682 Definition of, See Glossary

Order of Filiation Definition of, See Glossary

Ordinary Life Insurance (Whole Life), See Resources, Life Insurance, 324-325

Other certified blind or certified disabled disregards, See Income, 221, 224.1

Other Eligibility Requirements, 457-733 Adoption subsidy, 573-574 Application, certification and renewal, 461-485 Facilitated Enrollers, 463-464.1, 468, 474, 594, 711-712 Family Planning Benefit Program (FPBP), 468, 472, 476-477, 481-483, 506 New application, 465-475 Reapplication, 479-480 (MRG) 58

(master-index)(page-59)Page 59#

MASTER INDEX JANUARY 2012 Recertification/renewal, 461-486, 494, 496, 504, 565, 567, 715 OTHER ELIGIBILITY REQUIREMENTS continued

Authorization, 461, 464, 468, 481, 483, 488, 504-506, 524, 530, 547, 562, 713, 723, 729 Assistance to persons who change residency, 524-530 Breast and Cervical Cancer, Medicaid Cancer Treatment Program (MCTP), 465, 470, 483, 484.1 Bridges to Health (B2H), 725-726 Card issuance, 506-507 Care at Home Waiver, 720-721 Chaffee children, 481, 526, 573 Child Health Plus (CHPlus), 464-465, 477, 491, 563, 575, 608, 639-640, 661, 669-671, 675, 712, 777 Child Support, 559-561, 564, 566-567, 708, 711, 732 Citizen, 578, 583-584, 592-605, 607, 614, 632, 638, 661, 664, 669 Definition of, See Glossary Citizenship and immigration status, 589-675 AIDS, 589, 624 Aliessa v Novello, 641 Citizens, 578, 583-584, 592-605, 607, 614, 632, 638, 661, 664, 669 Domestic violence, 521, 621, 623-624, 628, See Reference, 792 Domestic Violence Liaison (DVL), 619, 623-624, 628 Native Americans, 579, 587, 591, 595, 604-607, 614 American Indian born in Canada, 605-607, 614, Definition, See Glossary Living on reservation, 687-689 Non-citizen member of a federally-recognized tribe, 605, 614 Non-Immigrants admitted on a temporary basis, 591, 666-668, 672-673 Permanent Residence under Color of Law (PRUCOL) aliens, 589, 591, 608, 641-658, 662-664, 669-671

Documentation Guide, 659-661 Qualifieds, 611-640, See Reference, 791 Amerasian immigrants, 611-612, 616, 624, 629, 631-632, 791 Asylees, 614, 629, 631, 791 Battered qualified aliens, 611, 613, 618-628, 791 Conditional entrants, 617 Cuban and Haitian entrants, 611-612, 615, 629, 631-632, 644, 659, 687-688, 791 Definition of, See Glossary Lawful permanent residents, 617, 620, 624-625, 633, 638, 645-648, 657, 660, 665, 669, 671 Parolees, 522, 548, 615, 617 Persons granted indefinite stays of deportation, 643-645, 656, 659 Persons on active duty in the U.S. Armed Forces, 611-612, 616, 634-635, 715 Persons under Order of Supervision, 643-644, 656, 659 Refugees, 530, 540, 611-612, 614, 617, 629-633, 636-639, 644, 659, 665, 671, 687-688 Refugee Medical Assistance (RMA), 629-633, 791 Special Non-Immigrant, 591, 669-671 (MRG) 59

(master-index)(page-60)Page 60#

MASTER INDEX JANUARY 2012 Temporary Non-Immigrant, 591, 666-668, 672-673 OTHER ELIGIBILITY REQUIREMENTS continued

Temporary Protected Status (TPS), 591, 643, 647-648, 658, 661-664 U.S. Armed Forces active duty and veterans, 611-612, 616, 634-635, 715 Veterans of the U.S. Armed Forces, 611-612, 616, 634-635, 715 Victims of Trafficking, 591, 611-612, 617, 629, 632-633, 636-640, 665, 671, See Reference, 791 Undocumented/illegal alien, 589, 591, 672-675, 697 Emergency Medical Condition, 581, 589, 591, 599, 609-610, 638, 666-668, 672-674 Visa Statuses, 591, 621, 631, 665, 670 Claims, See Liens, 680.5, 680.7-680.8, 683-685 COBRA, 547, 716-718, See Reference, 762 Colorectal and Prostate Cancer, Medicaid Cancer Treatment Program (MCTP), 465, 483, 484.1 Common Benefit Identification Card (CBIC) Issuance, 495.3-495.7, 506-507, 713 Community Residences (CRs), 731 Computer Matching, 719 Confinement and Pregnancy Related Expenses, 681-682 Consumer Directed Personal Assistance Program (CDPAP), 723 Copayments, 478, 509-511, 563, 676, 717 Decision and notification, 486-495 Acceptance, 488-489 Denial, 490-491 Discontinuance or reduction, 493-495 Timely notice, 495 Fair hearing rights, 472, 474, 487, 490, 494, 517, 523, 677, 681 Notice of intent, 462, 486, 493-494 Withdrawal of application, 486, 492

Deferred Enforced Departure (DED), 647, 659, 661, 664 Deficit Reduction Act (DRA), 578, 592 Department of Correctional Services (DOCS), 545-546, 548 Department of Homeland Security, 579, 583, 641, 650, 654, 662 District of Fiscal Responsibility, 475, 514-525, 528, 536, 539, 543-544 Dollar for Dollar Asset Protection (DDAP), 680, 680.3, 685 Domestic Violence, 521, 621, 623-624, 628, See Reference, 792 Domestic Violence Liaison (DVL), 619, 623-624, 628 Electronic Medicaid Eligibility Verification System (EMEVS), 508 Emergency Medical Condition, 581, 589, 591, 599, 609-610, 638, 666-668, 672-674 Chemotherapy, 673 Organ transplant, 672 Radiation therapy, 673 Facilitated enroller (FE), 463-464.1, 468, 474, 594, 711-712 Family Care (FC), 535, 642, 691, 693-695, 725, 731, See Reference, 771 Family Court Act (FCA), 535, 563 (MRG) 60

(master-index)(page-61)Page 61#

MASTER INDEX JANUARY 2012 Family Health Plus (FHPlus), 463, 465, 470, 472, 475-477, 483, 496, 506-507, 509-511, 524, 526, 529-530, 545, 608, 638, 650, 662-663, 669, 676-679, 699 OTHER ELIGIBILITY REQUIREMENTS continued

Family member, 461, 549, 573, 611, 613, 616, 629, 631, 635, 656, 707, 715 Family Planning Benefit Program (FPBP), 465, 468, 472, 476-477, 481-483, 506, 509, 511 Financial Maintenance, 496-497 Foster Care, 481, 504, 506-507, 514, 526, 535, 538, 543, 560, 574, 592, 725 Good Cause, 477, 561-562, 564,-568, 623, 709 Guardian/guardianship, 468, 499, 502, 506, 522, 578, 580, 586-587, 602, 713, 721-722, 728 Health Insurance, 472, 484, 486, 5333000, 547, 553, 561, 563, 566, 585, 596, 601, 702, 716-717 Home and Community-Based Services (HCBS) Waiver, 506, 511, 550, 555-558, 678, 694, 696, 720-721, 725-728, 731-733 Homeless, 519, 521, 528, 535, 541, 581, 598-599, 623 Household Composition, 572-577 ADC-related, 572-575 LIF, 572-575 Pregnant women, 572-575 S/CC, 577 SSI-related, 576 Identity, 471, 473, 485, 578-589, 592, 605, 609-610, 713 Immediate medical need, 506-507, 666, 672, 714 Immigration, 589-675 Incarcerated Individuals, 522, 543-549 Discontinuation, 546-547 Infants Residing with Incarcerated Mothers, 523, 543-544 Mail-in renewal returned to district with out-of-county address, 548 Maintaining Medicaid Eligibility for Incarcerated Individuals, 544-549

Reinstatement, 547 Releasee Residing with Family Member, 549 Released to Community With Parole Supervison, 548

Released to Community without Supervision, 547-548 Suspension of Medicaid, 544-546

Permanent absence, 546 Temporary Absence, 546 Individual Taxpayer Identification Number (ITIN), 699 Infants residing with incarcerated mothers, 523, 543-544 Institutionalized, 465, 489, 501, 510, 524, 554-555, 581, 676-678, 680-685 Institutionalized spouse, 489, 501, 554-555 Intermediate Care Facility (ICF), 510, 540, 696, 731 John/Jane Doe, 581, 599, 610 Lawful permanent residents, See Citizenship and Immigration status, 617, 620, 624-625, 633, 638, 645-648, 657, 660, 665, 669, 671 (MRG) 61

(master-index)(page-62)Page 62#

MASTER INDEX JANUARY 2012 Legally Responsible Relative (LRR), 498-501, 538, 550-571, See also Household composition, 572-577 OTHER ELIGIBILITY REQUIREMENTS continued

Definition of, See Glossary, 550 Parents and children, 556-558 Absent parents, 557, 559, 561-567 Emancipated minor, 560 IV-D requirements, 561-568 Step-parents, 550, 556-557, 561, 569-571 Spouse, 553-555 Both spouses institutionalized, 555 Institutionalized spouse with a community spouse, 554-555 Institutionalized waiver participant with community spouse, 555 Living apart in the community, 554 Living together, 553 Liens, 676, 679-680, 680.5, 680.7-680.8, 683-685 Definition of, See Glossary Living arrangements, 505-506, 515, 517, 528, 535-544, 561, 623, 693, 695, 731-733, See Household composition, 575-577 Living in own home, 535, 538 Medical facilities, 535, 539 Public institutions, 525, 535-537, 539, 541-544 Infants Living with Incarcerated Mothers, 523, 543-544 Low Income Families (LIF), 504, 630, See Household composition, 572-575 Low Income Subsidy (LIS), 478 LTHHCP, Long Term Home Health Care Program, 702, 704-705, 729-730 Managed Care, 463, 469, 509-510, 527, 529-530, 594, 678-679 Medicaid Buy-in for Working People with Disabilities, 465, 470, 483-484, 512 Medicaid Eligibility for Incarcerated Individuals, 544-549 Medical facility rule, See District of Fiscal Responsibility (DFR), 520 Medically Needy, 428, 450 Medical parole, See District of Fiscal Responsibility (DFR), 522 Medical support, 466, 532-533, 535-536, 539, 678.1 Medicare, 465, 470, 478, 483, 507, 530, 547, 592, 676, 717 Medicare Part A and B, 680.8 Medicare Part D Low Income Subsidy Application, 478 Medicare Savings Program, 465, 478, 483, 530, 547, 676 Native Americans, See Citizenship and immigration status, 579, 587, 591, 595, 604-607, 614; See State and federal charges, American Indian born in Canada, 605, 607, 614, Definition, See Glossary Living on reservation, 687-689 Non-citizen member of a federally-recognized tribe, 605, 614 Newborns, 522, 589, 592-593, 697, 700 Non-custodial parent, 676, 678 Non-Immigrants admitted on a temporary basis, See Citizenship and immigration status, (MRG) 62

(master-index)(page-63)Page 63#

MASTER INDEX JANUARY 2012 591, 666-668, 672-673

OTHER ELIGIBILITY REQUIREMENTS continued

Nursing facility, 466, 470-471, 474, 483, 484.1-485.1, 489, 506, 510, 517, 539, 545, 581, 586, 597, 602, 678, 687, 701-706, 720, 727, 729 Nursing Facility, Hospice or Home Health Services, 702-706 Nursing Home Transition and Diversion Waiver, 722-724, 727 Office of Mental Health (OMH), 506, 517-518, 520, 522, 528, 535-536, 546, 642, 685, 687-694 Office of Mental Health (OMH)/Office of Mental Retardation (OMR) Chapter 621 Eligibles, 690, 694, 696 OPWDD, 506, 511, 517-518, 520, 522, 528, 642, 687-695, 720, 731-733 Other Visa Statutes, 665 Overburden, 690, 694, 696 Ownership and availability, 498-503 PACE, 722 Parolees, See Citizenship and immigration status, 522, 548, 615, 617, See also Maintaining Medicaid Eligibility for Incarcerated Individuals, 548 Paternity, 557, 559-562, 564-567, 573, 681-682 Permanent Residence under Color of Law (PRUCOL) aliens, See Citizenship and immigration status, 589, 591, 608, 641-658, 662-664, 669-671 Definition of, See Glossary Documentation Guide, 659-661 PERS, Personal Emergency Response System, 723, 729 Personal Injury Settlement, 679 Persons granted indefinite stays of deportation, See Citizenship and immigration status, 643, 645, 656, 659 Persons on active duty in the U.S. Armed Forces, See Citizenship and immigration status, 611-612, 616, 634-635, 715 Persons under Order of Supervision, See Citizenship and immigration status, 643-644, 656, 659 Pregnancy/Pregnant, 468, 474, 486, 491, 510, 523, 526, 550, 552, 556-559, 561-562, 568-569, 571-575, 589, 600-603, 607, 614-618, 623, 627-629, 635, 639-640, 656-658, 664, 671-672, 675, 678, 680-682, 697, 699, 701, 707-709, 710, 712 Pre-Natal Care providers, 473, 701, 707-708, See Reference, 760 Prescription drugs, 509-511 Presumptive eligibility, 468, 473, 523, 526, 701-713 Definition of, 701 Nursing facility, hospice or home health care services, 701-706 Pregnant women, 523, 526, 701, 707-709 Qualified Entity, 594, 701, 710-713 Under age 19, 701, 710-713 PRUCOL, Permanent Residence Under Color of Law, 589, 591, 608, 641-658, 662-664, 669-671 Public institutions, 525, 535-537, 539, 541-544 (MRG) 63

(master-index)(page-64)Page 64#

MASTER INDEX JANUARY 2012 Qualified Aliens, See Citizenship and Immigration status, 611-640, See Reference, 791 Amerasian immigrants, 611-612, 616, 624, 629, 631-632, 791 OTHER ELIGIBILITY REQUIREMENTS continued

Asylees, 614, 629, 631, 791 Battered qualified aliens, 611, 613, 618-628, 791 Conditional entrants, 617 Cuban and Haitian entrants, 611-612, 615, 629, 631-632, 644, 659, 687-688, 791 Definition of, See Glossary Lawful permanent residents, 617, 620, 624-625, 633, 638, 645-648, 657, 660, 665, 669, 671 Parolees, 522, 548, 615, 617 Persons granted indefinite stays of deportation, 643-645, 656, 659 Persons on active duty in the U.S. Armed Forces, 611-612, 616, 634-635, 715 Persons under Order of Supervision, 643-644, 656, 659 Refugees, 530, 540, 611-612, 614, 617, 629-633, 636-639, 644, 659, 665, 671, 687- 688 Refugee Medical Assistance (RMA), 629-633, 791 Special Non-Immigrant, 591, 669-671 Temporary Non-Immigrant, 591, 666-668, 672-673 Temporary Protected Status (TPS), 591, 643, 647-648, 658, 661-664 U.S. Armed Forces active duty and veterans, 611-612, 616, 634-635, 715 Veterans of the U.S. Armed Forces, 611-612, 616, 634-635, 715 Victims of Trafficking, 591, 611-612, 617, 629, 632-633, 636-640, 665, 671, See Reference, 791 Qualified Entity, 594, 701, 710-713 Qualified Medicare Beneficiary, QMB, 478, 507 Qualified Partnership Policyholder (QPP), 679-680, 680.3, 685 Real property, 678.1, 680.1-680.4, 680.6-680.7, 683-684, 685.1 Recertification/Renewal, 461-486, 494, 496, 504, 565, 567, 715 Recipient Restriction Program (RRP), 508 Electronic Medicaid Eligibility Verification System (EMEVS), 508 Recoveries, 676-686 Confinement and Pregnancy Related Expenses, 681-682 Estate recoveries, 680, 680.1-680.9 Liens, 676, 679-680, 680.5, 680.7-680.8, 683-685 Voluntary repayments, 677, 680, 686 Regional Resource Development Centers (RRDC), 722-727 Resources, 462, 469, 471-472, 483-485, 497-503, 520-521, 538, 550-559, 562, 569-570, 572, 576, 676, 678-680, 684, ¸707-708, 711, 717, 720-721, 724-726, 732 Retroactive Eligibility Period, 471-472, 475, 495.1-495.8, 502, 504, 507, 675, 712, 732 Satisfactory Immigration Status, 578, 589, 591, 593, 609-619 SAVE, Systematic Alien Verification to Entitlements, 625, 649 Singles/Childless Couples (S/CC), 466, 475, 541, 554, 572, 577, 629-630, 694, 696, 698- 699, 706 Social Security Act (MRG) 64

(master-index)(page-65)Page 65#

MASTER INDEX JANUARY 2012 Section 1115, 570-571, 607, 694, 696 Section 1915 (c), 550, 556-557, 569, 720, 729 OTHER ELIGIBILITY REQUIREMENTS continued

Title IV Section D (IV-D), 507, 554, 557, 559-568 Title IV-E, 504, 514, 562 Social Security enumeration, 697-700 Social Security Number (SSN) application, 698 Special Non-Immigrant, See Citizenship and immigration status, 591, 669-671 Definition of, See Glossary Spenddown, 472, 475, 484.1-485, 486, 491, 493, 495.3, 520, 684 Spouses, 316-318, 326, 337, 339, 354, 357, 361-362, 366, 369, 371, 382, 389, 393-396, 398-399, 402, 405-408, 421, 427, 432-433, 435, 439, 441-443, 445-447, 450-452, See Legally Responsible Relatives (LRR), 553-555 Definition of, See Glossary, 550 SSI/SSI-related, See Supplemental Security Income-related assistance (SSI-related assistance), 461-462, 471-472, 483-486, 491, 494, 497-502, 504, 506-507, 513-514, 517-518, 525, 541, 554, 561, 572, 574, 576, 592, 678, 684, 686, 707, 710-711, 717, 719-721, 726 State and federal charges, 687-696 Native Americans, 687-689 Overburden, 690, 694, 696 OMH, 693-694 OMH/OPWDD Chapter 621, 687, 691-694 OPWDD, 691, 695-696 State Residence and Responsibility for Assistance, 513-535 Systematic Alien Verification to Entitlements (SAVE), 635, 649 Tax Relief and Health Care Act of 2006, 592 TBI, Traumatic Brain Injury, 511, 727-728 Temporary absence from legal residence, See District of Fiscal Responsibility (DFR), 518- 519, 546, See Reference, 792 Temporary Non-Immigrant, See Citizenship and immigration status, 591, 666-668, 672- 674 Definition of, See Glossary Temporary Protected Status (TPS), See Citizenship and immigration status, 591, 643, 647- 648, 658, 661-664 Definition of, See Glossary Third Party Health Insurance (TPHI), 484, 486, 530, 565-566 Total Asset Protection (TAP) 680, 680.3, 685 Transition rule, See State residence and district responsibility for assistance, District of Fiscal Responsibility (DFR), 519, 525 Transitional Medicaid (TMA), 562, 630 Traumatic Brain Injury (TBI), 511, 727-728 Under age 21, 477, 491, 506, 510, 522, 526, 535-536, 540, 543, 550, 554, 556, 559, 561, 564-566, 569, 573, 575, 577, 594, 645, 680.2-680.3,680.6- 680.7, 685, See Reference, 788, 793 (MRG) 65

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MASTER INDEX JANUARY 2012 Undocumented/illegal alien, See Citizenship and immigration status, 589, 591, 672-675, 697 OTHER ELIGIBILITY REQUIREMENTS continued

Emergency Medical Condition, 581, 589, 591, 599, 609-610, 638, 666-668, 672-674 Chemotherapy, 673 Organ transplant, 672 Radiation therapy, 673 U.S. Armed Forces active duty and veterans, See Citizenship and immigration status 611- 612, 616, 634-635, 715 Veterans' Affairs referral, 715 Veterans of the U.S. Armed Forces, See Citizenship and immigration status, 455.1, 611- 612, 616, 634-635, 715 Voluntary departure, See Citizenship and immigration status, 643, 645-647, 650, 656-657, 659, 661-662 Voluntary repayments, 677, 680, 686 Voter registration card, See Identity, 580, 587, 604 Waivers, 506, 511, 525, 550, 555-559, 569-571, 687, 720-733 Bridges to Health (B2H), 725-726 Care at Home, 720-721 Nursing Home Transition and Diversion, 722-724, 727 OPWDD, 731-733 Traumatic Brain Injury (TBI), 511, 727-728

Other Visa Statuses, 665

Otherwise Available Income, See Income, 275-276, 281, See Other Eligibility Requirements, 554 Definition of, See Glossary

Overburden, See Other Eligibility Requirements, 690, 694, 696

Overpayments, See Income, ADC-related assistance, 200, LIF, 179, S/CC, 260, SSI-related assistance, 225, See Reference, 751

Ownership and Availability, See Other Eligibility Requirements, 498-503

P PACE (Program of All-Inclusive Care for the Elderly), See Income, 280-281, See Other Eligibility, 722 Definition of, See Glossary Personal Needs Allowance (PNA), See Reference, 767

(MRG) 66

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MASTER INDEX JANUARY 2012 Paid Medical Bills, See Other Eligibility Requirements, 495.2-495.5

Parent Locator Service, See Other Eligibility Requirements, 561 Definition of, See Glossary

Parents, See Categorical Factors, Aid to Dependent Children (ADC), 7-23; Singles/Childless Couples (S/CC), 61 Continued absence, 6, 8, 15, 20-22 Definition of, See Glossary Death of, 15, 17, 95 Deprivation of parental support, 6-8, 10, 14-23, 50, 84 FNP Parent, 3-4, 54, 58, 171-172, 185, 187, 194, 207, 215, 309, 373, 378, 380, 408, 440 Incapacity, 18-19, 59 Parents living with dependent children under age 21, 3, 12, 54, 59-60, 67-68 Step-Parent, 10, 58-60 Definition of, See Glossary Un/under employed two parent household, 8, 15, 23, 59

PA Standard of Need, See Reference, 761, 769, See Glossary

Parolees, See Other Eligibility Requirements, Citizenship and immigration status, 522, 548, 615, 617, also Maintaining Medicaid Eligibility for Incarcerated Individuals, 544-549, See Reference, 793

Part D, Medicare Part D, See Categorical Factors, 75, See Resources, 415-417, 428, See Other Eligibility Requirements, 478

Partnership for Long Term Care, See Categorical Factors, 54, See Income, 136, See Resources, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452 Dollar for Dollar, 402, 430-434, 452, 680, 680.3, 685 Total Asset Protection, See Categorical Factors, 54, See Resources, 309, 373, 378, 380, 401, 409, 430-431, 440, 452, See Other Eligibility Requirements, 680, 680.3, 685, See Reference, 796-797

PASS (Plan to Achieve Self-Support), See Income, 226, 248-249, 256, 279, 287, See Resources, Personal Property, 348-349, Supplemental Security Income-related assistance (SSI-related assistance), 384, See Reference, 751

Passport, US, See Categorical Factors, 26, 53, See Other Eligibility Requirements, 579, 583, 594-595, 600, 606-607, 614-627, 629, 625, 628, 631, 633, 646, 657, 660, 668

Paternity, See Categorical Factors, 10, 20, See Income, 140, See Other Eligibility Requirements, 557, 559-562, 564-567, 573, 681-682 Definition, See Glossary

Paternity Hearing (MRG) 67

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MASTER INDEX JANUARY 2012 Definition, See Glossary

Paternity Petition Definition, See Glossary

Payer of last resort, See Resources, 411

Pay-in, See Income, Excess Income, 295, 298, 303-304, See Resources, 374, See Other Eligibility Requirements, 488, 491

Pension plans of an ineligible or non-applying legally responsible relative. See Resources, SSI-related assistance, 384

Percentage of earned income, See Income, ADC-related assistance, 200, LIF, 191

Perinatal, See Categorical Factors, 56, See Income, 164-165, See Other Eligibility Requirements, 545, See Reference, 789

Permanent absence status, See Categorical Factors, 72, See Income, 172, 278, 283, 285, See Resources, 318, 398-399 Definition of, See Glossary

Permanent Residence under Color of Law (PRUCOL), See Categorical Factors, 31, See Other Eligibility Requirements, Citizenship and Immigration status, 589, 591, 608, 641- 658, 662-664, 669-671 Definition of, See Glossary Documentation Guide, 659-661

PERS, Personal Emergency Response System, See Other Eligibility Requirements, 723, 729 Definition of, See Glossary

Persecution payments, See Income, ADC-related assistance, 200, Chronic Care, 279, 287, FHPlus, 273, LIF, 179, S/CC, 260, SSI-related assistance, 225; See Resources, SSI- related assistance, 384, See Reference, 751

Personal Care Services Definition of, See Glossary

Personal Emergency Response System (PERS), See Other Eligibility Requirements, 723, 729 Definition of, See Glossary

Personal Incidental Allowance (PIA), See Income, Personal Needs Allowance (PNA), 280- 281, 288, 290, See Resources, 310, 318-320, See Reference, 767-768, 776

Personal Injury Settlement, See Other Eligibility Requirements, 679

(MRG) 68

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MASTER INDEX JANUARY 2012 Personal Needs Allowances (PNA), See Income, Persons in medical facilities (chronic care), 280-281, 288, 290, See Resources, 310, 318-320 Allowances, See Reference, 767-768, 776

Personal property, See Income, 144, 173, 196, 221, 257, See Resources, 346-350, 358, See Other Eligibility Requirements, 679, 680.2 Automobiles and other vehicles, 348-350, 382 Essential personal property, 346-347, 382, 384

Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, See Categorical Factors, 84, See Other Eligibility Requirements, 612

Persons granted indefinite stays of deportation, See Other Eligibility Requirements, Citizenship and immigration status, 643-645, 656, 659

Persons in medical facilities (chronic care), See Income, 275-291, See also New York State Partnership for Long Term Care, 136, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452 Assessment/determination of income available for the cost of care, 275 Chronic care budgeting methodologies for individuals, 172, 283, 285-289 Chronic care budgeting methodology for institutionalized spouses, 278-282 Community spouse and family member allowances, 276, 282, 284, 291 Family Member Allowance (FMA), 276, 282, 284, 291 Allowances, See Reference, 773 Minimum Monthly Maintenance Needs Allowance (MMMNA), See Income, 276-277, 281, 284, 291, See Resources, 396, 430-431, See Other Eligibility Requirements, 554, See Reference, 775

Persons on active duty in the U.S. Armed Forces, See Other Eligibility Requirements, Citizenship and immigration status, 611-612, 616, 634-635, 715

Persons under Order of Supervision, See Other Eligibility Requirements, Citizenship and immigration status, 643-644, 656, 659

Petition, See Other Eligibility Requirements, 502, 563, 609, 618, 621, 624-625, 628, 645, 656, 658-659, 661, 664-665, 669, 671 Definition, See Glossary

Petitioner Definition, See Glossary

Pickle Amendment (formerly Section 503)/Eligibles, See Categorical Factors, 80, 86, Extensions/Continuations, 91-92, 96 Reduction Factors for Calculating Medicaid Eligibility under the Pickle Amendment, See Reference, 742-744

(MRG) 69

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MASTER INDEX JANUARY 2012 Plan to Achieve Self-Support (PASS), See Income, SSI-related, 226, 248-249, 256, 279, 287, See Resources; Personal Property, 348-349, Supplemental Security Income-related assistance (SSI-related assistance), 384, See Reference, 751

PNA, See Income Personal Needs Allowance (PNA), 280-281, 289, 290, See Resources, Personal Needs Allowance (PNA) accounts, 310, 318-320 Allowances, See Reference, 767-768, 776

Post-retroactive period, See Other Eligibility Requirements, 495.3, 495.6

Pre-Add Allowance, See Income, Public Assistance Standard of Need (PA Standard of Need), Public Assistance Basic Allowance (Pre-Add), See Reference, 769 Definition, See Glossary

Pregnancy/Pregnant, See Categorical Factors, 6, 18, 54-57, 63, 64, 67, 82-83, 86-87, See Income, 139, 158, 161, 163-165, 171-172, 185, 187, 194, 207, 215, 217, 250, 265, 270, 282, 293-294, 301, See Resources, 309, 373, 378, 380, 409, 423, 440, See Other Eligibility Requirements, 468, 474, 486, 491, 495.4, 510, 523, 526, 550, 552, 556-559, 561-562, 568-569, 571-575, 678, 680-682, 697, 699, 701, 707-709, 710, 712, See Reference, 712, 796-797 Application Requirements, 796 Citizenship and Immigration, 589, 600-603, 607, 614-618, 623, 627-629, 635, 639-640, 656-658, 664, 671-672, 675 Covered Services, See Reference, 789 Levels, See Reference, 760 Presumptive Eligibility, 707-709 Renewal/Recertification Documentation Requirements, 797 Retroactive Eligibility period, 495.4

Premium Assistance Program, See Categorical Factors, FHPlus, 64-66, See Resources, 411, See Reference, 738-741

Premium payments, See Categorical Factors, 5, 73-76, See Income, 168, 212-213, 240, See Resources, 324-325, 416, 428, 437, See Other Eligibility Requirements, 512, 530, 546, 718, See Reference, 762, 764

Pre-Natal Care providers, See Categorical Factors, 56, See Other Eligibility Requirements, 473, 701, 707-708, See Reference, 760

Pre Need Funeral Agreements, See Resources, 365-369, 371, 373, 409, 447, SSI-related disregards, 382, 385

Pre-retroactive period, See Reference, 777.1

Prescription drugs, See Categorical Factors, 64, 74, See Income, 212, 239, 296, See Resources, 415-417, 428, See Other Eligibility Requirements, 509-511, See Reference, (MRG) 70

(master-index)(page-71)Page 71#

MASTER INDEX JANUARY 2012 787-788

Presumptive eligibility, See Categorical Factors, 57, See Other Eligibility Requirements, 468, 473, 523, 526, 701-713 Assistance to persons who change residency, 526 Definition of, See Glossary, 701 Nursing facility, hospice or home health care services, 701-706 Pregnant women, 523, 526, 701-707, 709, Levels, See Reference, 760 Qualified Entity, 594, 701, 710-713 Under age 19, 701, 710-713

Presumption of paternity Definition, See Glossary

Preventative housing service, See Income, ADC-related assistance, 200, FHPlus, 273, LIF, 180, S/CC, 260, SSI-related assistance, 226; See Resources, SSI-related assistance, 385, See Reference, 751

Principal wage earner, See Categorical Factors, Employment, 16, 23

Private duty nursing Definition of, See Glossary

Private proprietary home for adults Definition of, See Glossary

Probability of Paternity Definition, See Glossary

Probate assets, See Other Eligibility Requirements, 680.3, 680.8, 685.1

Program for All-Inclusive Care for the Elderly (PACE), See Income, 280-281, See Other Eligibility Requirements, 722 Definition of, See Glossary Personal Needs Allowance (PNA), See Reference, 767

Promissory Notes, See Income, 132, See Resources, 303, 333-334, 357, 443

Property, See Income, 144, 173, 196, 221, 256, See Resources, 335-3450, 358, 382, 382, See Other Eligibility Requirements, 679 Business, 328, 342-343, 346, 350-352, 383, 385 Personal, 144, 173, 196, 221, 257, 346-350, 358, 382, 384, 679 Automobiles and other vehicles, 346, 348-350, 382 Essential, 346-350 Real, 335-345 Contiguous/Non-contiguous property, 336-338, 340-341, 383 (MRG) 71

(master-index)(page-72)Page 72#

MASTER INDEX JANUARY 2012 Definition of, See Glossary Homestead, See Resources, 335-342, 345, 353, 357, 383, 400, 402, 441-442, See Other Eligibility Requirements, 680.2, 684

PRUCOL (Permanent Residence under Color of Law Aliens), See Categorical Factors, 31, See Other Eligibility Requirements, Citizenship and immigration status, 589, 591, 608, 641-658, 662-664, 669-671 Definition of, See Glossary Documentation Guide, 659-661

PRWORA (Personal Responsibility and Work Opportunity Reconciliation Act) of 1996, See Categorical Factors, 84, See Other Eligibility Requirements, 612

Psychiatric Center (PC), See Resources, 416, See Other Eligibility Requirements, 525, 549.1- 549.4, 642, 690-693

Public home, See Other Eligibility Requirements, 536, 539, 541, See Reference, 768 Definition of, See Glossary

Public institution, See Other Eligibility Requirements, 523, 535-537, 539, 541-544 Definition of, See Glossary

Putative father, See Other Eligibility Requirements, 564 Definition, See Glossary

Q Qualified Entity, See Other Eligibility Requirements, 594, 701, 710-713

Qualifieds, See Other Eligibility Requirements, 611-640, See Reference, 791 Amerasian immigrants, 611-612, 616, 624, 629, 631-632, 791 Asylees, 614, 629, 631, 791 Battered qualified aliens, 611, 613, 618-628, 791 Conditional entrants, 617 Cuban and Haitian entrants, 611-612, 615, 629, 631-632, 644, 659, 687-688, 791 Definition of, See Glossary Lawful permanent residents, 617, 620, 624-625, 633, 638, 645-648, 657, 660, 665, 669, 671 Parolees, 522, 548, 615, 617 Persons granted indefinite stays of deportation, 643-645, 656, 659 Persons on active duty in the U.S. Armed Forces, 611-612, 616, 634-635, 715 Persons under Order of Supervision, 643-644, 656, 659 Refugees, 530, 540, 611-612, 614, 617, 629-633, 636-639, 644, 659, 665, 671, 687- 688 (MRG) 72

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MASTER INDEX JANUARY 2012 Refugee Medical Assistance (RMA), 629-633, 791 Special Non-Immigrant, 591, 669-671 Temporary Non-Immigrant, 451, 453, 455.31, 455.37d, 456.1-456.2591, 666-668, 672- 674 Temporary Protected Status (TPS), 591, 643, 647-648, 658, 661-664 U.S. Armed Forces active duty and veterans, 611-612, 616, 634-635, 715 Veterans of the U.S. Armed Forces, 611-612, 616, 634-635, 715 Victims of Trafficking, 591, 611-612, 617, 629, 632-633, 636-640, 665, 671, See Reference, 791

Qualified Disabled and Working Individual (QDWI), See Categorical Factors, 74-75, See Income, 167, See Resources, 309, 380, 437

Levels, See Reference, 762

Qualified Individual (QI), See Categorical Factors, 54, 74, 76-77, See Income, 168, See Resources, 309, 373, 378, 380, 409, 437, 440, See Other Eligibility Requirements, 478

Levels, See Reference, 763, 796-797

Qualified Medicare Beneficiary (QMB), See Categorical Factors, 54, 73, 75-77, See Income, 166-167, See Resources, 309, 373, 378, 380, 409, 436, 440, See Other Eligibility Requirements, 478, 507, See Reference, 762, 796-797

Qualified Partnership Policyholder (QPP), See Resources, 410-402, 430-434, See Other Eligibility Requirements, 679-680, 680.3, 685.1

Qualified State Savings Program (Section 529), See Resources, 315

Qualifieds, See Other Eligibility Requirements, Citizenship and Immigration status, 611-640

Definition of, See Glossary

R Radiation Exposure Compensation Trust Fund payments, See Income, ADC-related assistance, 200, Chronic Care, 280, 287, FHPlus, 273, LIF, 180, SSI-related assistance, 226; See Resources, SSI-related assistance, 385, See Reference, 751

Railroad Retirement, See Categorical Factors, 25, 30, 50, See Income, 121, 126-129, 154

RCCA, Residential Care Center for Adults, See Other Eligibility Requirements, 535, 694

Real property, See Resources, 335-345, See Other Eligibility Requirements, 678.1, 680.1- 680.4, 680.6-680.7, 683-684, 685.1 Contiguous/non-contiguous property, 336-338, 340-341, 383 Definition of, See Glossary (MRG) 73

(master-index)(page-74)Page 74#

MASTER INDEX JANUARY 2012 Homestead, 335-342, 345, 353, 357, 383, 400, 402, 441-442 Income-producing, 342-344 Producing Personal Goods/Services, 345

Real property sales, See Resources, SSI-related assistance, 388

Recertification/Renewal, See Categorical Factors, 43, See Resources, 375, See Other Eligibility Requirements, 461-486, 494, 496, 504, 565, 567, 715

Recipient Definition, See Glossary

Recipient Restriction Program (RRP), See Other Eligibility Requirements, 508

Recoveries, See Other Eligibility Requirements, 676-686 Confinement and Pregnancy-Related Expenses, 681-682 Liens, 676, 679-680, 680.5, 680.7-680.8, 683-685 Estate, 680 Estate Recoveries, 680.1-680.9 Non-probate assets, 676, 677, 680.1, 680.8-680.9, 683 Voluntary Repayment, 77, 680, 686

Reduced (Limited) $90 Veterans' Administration pension, See Income, SSI-related, 226, 287, See Reference, 751

Reference/Desk Aids, 734-795 249E, 737 AHIP (AIDS Health Insurance Program), 762, 796-797 Allocation, Income, 755 Annuities, 785.2 Application requirements, 796 Birth Verification Indicator (BVI), 795 Boarder or roomer (Lodger) income, 751, 768 Breast and Cervical Cancer Treatment Program levels, 764, 796-797 Burial funds, 748 Child Health Plus, CHPlus, 777 Children Under age 1 income and resource levels, 760 Children Between age 1 and 5 income and resource levels, 760 Children Between age 1 and 18 income and resource level, 761 Children Between age 6 and 18 income and resource levels, 761 Children Under Age 21 Application requirements, 796 Income and resource levels, 761 Renewal/recertification documentation requirements, 797 Citizenship, 791, 795 COBRA Continuation income and resource levels, 762 (MRG) 74

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MASTER INDEX JANUARY 2012 Coinsurance, 788 Community-based Long term care (LTC), 790 REFERENCE/DESK AIDS continued

Colorectal and Prostate Cancer, 764 Community care, 796-797 Community spouse, 773 Congregate Care Levels, 768-770 Co-payment, amounts, 787 Covered services, 788 Covered services for pregnant women, 789 Disregards, 748-754 Earned Income Disregard (EID), 753 SSI Disregards Student Income, 751, 754 District of Fiscal Responsibility (DFR), 792-794 Adult care facilities, 793 Assisted Living, 793 Children under age 21, 788 Domestic violence, 792 Emergency temporary housing, 792 Guardian, 793 Incarcerated, 793 Parole, 793 Temporary absence, 792 Where found, 793 Excess Income, 777.1 Family Health Plus (FHPlus) income and resource level, 763 Family Health Plus Resource Level, 781 Family Health Plus Premium Assistance Program (FHP/PAP), 738-741 Family Member Allowance (FMA), 773 Family Planning Benefit Program (FPBP) Application requirements, 796 Income and resource levels, 748-752, 764 Renewal/recertification documentation requirements, 797 Federal Minimum Wage, 766 Federal Poverty Levels, 756-759 Federal Benefit SSI Rate (FBR), 755 FMA (Family Member Allowance), 773 Garden Produce or livestock, 750 GI Bill deduction, 750 Graduate Education Grants or Scholarships, 751 Home Energy, Public Assistance Standard of Need, 769 Household size, 794 Income Allocation, 755 Income: Community and Institutionalized, 774 Income Disregards, 748-751 (MRG) 75

(master-index)(page-76)Page 76#

MASTER INDEX JANUARY 2012 Income and Resource Test, 760-764 LIF income and resource Level, 761 REFERENCE/DESK AIDS continued

Life expectancy table, 785.2 Look-back period, 785 Long-term care services, 785, 796-797 Mandatory services, 788 MBI-WPD income and resource level, 748-752, 764, 796-797 MBL Living Arrangement Chart, 768 MCTP (Medicaid Cancer Treatment Program), 764, 796-797 MMMNA (Minimum Monthly Maintenance Needs Allowance), 775 Medicaid Buy-in for Working People with Disabilities (WBI-WPD) Application requirements, 796 Income and resource levels, 748-752, 764 Renewal/recertification documentation requirements, 797 Resource levels, 780 Medicaid Cancer Treatment Program (MCTP) Application requirements, 796 Income and resource levels, 764 Renewal/recertification documentation requirements, 797 Medicaid Covered Services, 788 Medically Needy income levels, 756-759 Medicare Part A and Part B Premium amounts, 762, 765 Minimum/Maximum Community Spouse Allowance, 779 Minimum Monthly Maintenance Needs Allowance (MMMNA), 775 Minimum Wage, 766 Federal Minimum Wage, 766 New York State Minimum Wage, 766 New York State Minimum Wage, 766 Non-SSI child, 755 Nursing facility, 785, 788, 790 PACE PNA, 767 Personal Needs Allowance (PNA), 767-768, 776 PACE PNA, 767 Perinatal, Covered services for pregnant women, 789 Pickle Amendment, Reduction Factors for Calculating Medicaid Eligibility, 742-744 Pre-Add Allowance (PA Basic Allowance) PA Standard of Need, 769 Pregnant women Application requirements, 796 Covered services for pregnant women, 789 Income and resource levels, 760 Renewal/recertification documentation requirements, 797 Prescription Drug, 787-788 Presumptive Eligibility for Pregnant Women income and resource levels, 760 Public Assistance Standard of Need, 769 (MRG) 76

(master-index)(page-77)Page 77#

MASTER INDEX JANUARY 2012 Qualified Disabled and Working Individual (QDWI) income and resource level, 763 Qualified Individual (QI) REFERENCE/DESK AIDS continued

Application requirements, 796 Income and resource levels, 763 Renewal/recertification documentation requirements, 797 Qualified Medicare Beneficiary (QMB) Application requirements, 796 Income and resource levels, 762 Renewal/recertification documentation requirements, 797 Reduction Factors for Calculating Medicaid Eligibility Under the Pickle Amendment, 742- 744 Refugee Medical Assistance (RMA), Eligibility periods, State/Federal Charge, Codes and Alien/Citizenship Indicator Codes, 791 Regional Rates for Transfer of Assets, 783-784 Renewal documentation requirements, 797 RSDI Factor, 737 RSDI Increases, 737 S/CC Application requirements, 796 Income and resource levels, 761 Renewal/recertification documentation requirements, 797 SGA (Substantial Gainful Activity) amounts, 745 Section 249E, 737 Single/Childless Couples (S/CC) Application requirements, 796 Income and resource levels, 761 Renewal/recertification documentation requirements, 797 SLIMB (Specified Low-Income Medicare Beneficiary) Application requirements, 796 Income and resource levels, 763 Renewal/recertification documentation requirements, 797 Specified Low-Income Medicare Beneficiary (SLIMB) Application requirements, 796 Income and resource levels, 763 Renewal/recertification documentation requirements, 797 Spousal Impoverishment, 773-776 Family Member Allowance (FMA), 773 Income: Community and Institutionalized, 774 Minimum Monthly Maintenance Needs Allowance (MMNA), 775 Social Security Benefit amounts, 770-772 SSI Benefit Levels, 755, 770-772 SSI-related assistance resource levels, 758 SSI-related only Medicaid Resource Level, 780 SSI Resource Levels, 781 (MRG) 77

(master-index)(page-78)Page 78#

MASTER INDEX JANUARY 2012 Student Income Disregard, 751, 754 Substantial Gainful Activity (SGA) amounts, 745 Trial Work Period (TWP) amounts, 746 REFERENCE/DESK AIDS continued

Trust funds, 785.1 Under age 21, Application requirements, 796 Income and resource levels, 761 Renewal/recertification documentation requirements, 797

Refugee Assistance Program (RAP), See Categorical Factors, Extensions/Continuations, 85

Refugee Cash Assistance (RCA) Definition, See Glossary

Refugee Medical Assistance (RMA), See Other Eligibility Requirements, 629-633, See Reference, 791 Definition, See Glossary

Refugee Social Services Program (RSSP) Definition, See Glossary

Refugees, See Other Eligibility Requirements, Citizenship and Immigration status, 530, 540, 611-612, 614, 617, 629-633, 636-639, 644, 659, 665, 671, 687-688

Refunds, See Income, 132, 175, 198, 226, 259, 273, 296, 303-304

Regional Resource Development Centers (RRDC), See Other Eligibility Requirements, 722- 727

Rehabilitation, See Categorical Factors, 34, 36

Reimbursement of paid and unpaid medical bills, See Other Eligibility Requirements, 472, 495.2-495.8, See Reference, 777.1 Agency Delay, 472.1, 495.3-495.5, 495.7 Agency Error, 472.1, 495.4-495.5, 495.7 Post-retroactive period, 495.3, 495.6, See Reference, 777.1 Pre-retroactive period, See Reference, 777.1

Relative, See Income, Legally Responsible Relative (LRR), 127, 139, 147, 150-153, 163, 215, 219, 237, 270, 273, 282, 288, 295-297, See Resources, 327, 334, 384-385, 406- 407, 415, See Other Eligibility Requirements, 4989-501, 538, 550-571; See also Household composition, 572-577

Relative Petition, See Other Eligibility Requirements, PRUCOL, 645, 656-657 (MRG) 78

(master-index)(page-79)Page 79#

MASTER INDEX JANUARY 2012

Releasee, See Other Eligibility Requirements, Maintaining Medicaid Eligibility for Incarcerated Individuals, 549

Relocation, See Income, Federal Relocation Assistance, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 223, See Resources, SSI- related assistance, 383, See Reference, 749

Relocation Referral Form, See Other Eligibility Requirements, 528, 530

Remainder beneficiary, See Resources, 433, 452-453, See Other Eligibility Requirements, 680.6

Renewal, See Recertification/Renewal

Rentals, See Income, 113, 116, 121, 144-146, 277, See Resources, Real property, 343-344, 354, See Other Eligibility Requirements, 623

Reparation, See Income, 179, 200, 225-226, 260, 273, 275, 279, 287, See Resources, 384, See Other Eligibility Requirements, 680.2, 685

Replacement of assistance already paid, See Income, SSI-related, 227, See Reference, 751

Residence/residency, See Categorical Factors, 43, 72, 86, See Income, 145, 177-178, 219, See Resources, 337, 407, 416, See Other Eligibility Requirements, 472, 477, 483-484, 485-485.1, 491, 513-535, 538, 541, 548, 588, 593, 598, 603, 605, 611, 613, 617, 620, 622-625, 633, 635, 638, 642, 645-648, 657, 659-660, 665, 669, 671, 691, 693, 695, 713, 725, 731, 733, See Reference, 796-797 Lawful Permanent Residents (LPR), See Other Eligibility Requirements, 617, 620, 624- 625, 633, 638, 645-648, 657, 660, 665, 669, 671

Residence for Survivors of Violence Programs (RSVP) Definition, See Glossary

Residential Care Center for Adults (RCCA), See Other Eligibility Requirements, 535, 694, Residence for adults Definition, See Glossary

Residential Health Care Facility (RHCF), Definition of, See Glossary

Residential Treatment Facility (RTF), See Other Eligibility Requirements, 693 Definition of, See Glossary

Resource Definition of, See Glossary (MRG) 79

(master-index)(page-80)Page 80#

MASTER INDEX JANUARY 2012

Resource level Definition of, See Glossary, 378

Resources, See Categorical Factors, 5, 24-25, 28, 32, 37, 43-45, 49, 54, 86, 91, 96, See Income, 103, 130, 132-134, 149, 156, 167-168, 179, 182, 199, 203, 224-225, 231-232, 250, 259, 262, 281, 288, 295, See Resources, 305-456 (see below), See Other Eligibility Requirements, 462, 469, 471-472, 481, 483-485.1, 497-503, 520-521, 538, 550-559, 562, 569-570, 572, 576, 676, 678-680, 680.3, 684, 685.1¸707-708, 711, 717, 720-721, 724-726, 732 ADC-related, 309-310, 372, 378, 380-381, 399, 408, 440 Agent Orange Settlement Fund, See Resources, Vietnam veterans, 385 Aid and Attendance, Retroactive Veterans benefits Supplemental Security Income-related assistance (SSI-related assistance), 387 AIDS Health Insurance Program (AHIP), See Resources, 309, 373, 379-380, 409, 440 ALP, Assisted Living Program, 377, 416, See Reference, 793 Assessment/Determination, 392-397 Assignment and Subrogation, 425-426 Automobiles and other vehicles, 346, 348-350 Supplemental Security Income-related assistance (SSI-related assistance), 382 Availability, 308, 311, 326-327, 364, 373 Bearer Bonds, coupon bonds, 332 Blind, 337, 339, 381, 384, 402, 406-407, 442, 446 Blood Plasma settlements Supplemental Security Income-related assistance (SSI-related assistance), 382 Bonds, 308, 311, 317, 327-333 Breast and Cervical Cancer, (Medicaid Cancer Treatment Program, MCTP), 309, 372, 380, 409, 440 Budgeting for legally responsible relatives (LRR), 327, 334, 384-385, 406-407, 415 Budgeting methodologies, Windfalls, 309, 323, 420 Business property, 328, 342-343, 346, 350-352, 383, 385 Burial funds, 365-366, 369-371, 382, 477 Burial Spaces, 365-366, 368, 371, 382, 477 Supplemental Security Income-related assistance (SSI-related assistance), 382 Care at Home (CAH) waiver, 377, 407, 452 Cash payments for medical services or social services Supplemental Security Income-related assistance (SSI-related assistance), 386 Cash surrender value (CSV), 324-326 CHAMPUS (Civilian Health and Medical Plan for Uniformed Services), See Resources, Third party resources, 419 Child Health Plus, 410 Child's savings account, 312 Supplemental Security Income-related assistance (SSI-related assistance), 385 Chronic Care Budgeting, 399 COBRA, 309, 380-381, 427 (MRG) 80

(master-index)(page-81)Page 81#

MASTER INDEX JANUARY 2012 Coinsurance, 416-417, 435-436 Community Spouse Resource Allowance, 316, 392, 394-396, 408, 447, 450 Contiguous Property and Non-Contiguous Property, 336-338, 340-341, 383 RESOURCES continued

Continuing Care Retirement Community Contracts, 404-405 Copayments, 413-419 Countable resources, 310, 312, 315-216, 319, 321-323, 326-327, 332, 335, 337-338, 342, 345-346, 348, 353-355, 369, 379, 381-382, 387, 389-394, 399, 402, 406-409, 428, 447, 452,, See Reference, 779 Definition of, See Glossary Coupon bonds (bearer bonds), 332 Deductibles, 311, 315-316, 413, 415-419, 435-436 Definition of, See Glossary, 308 Disabled, 381, 399, 441-442 Disaster Relief and Emergency Assistance Supplemental Security Income-related assistance (SSI-related assistance), 382-383 Disregards, See specific type, MBI-WPD, 391, SSI-related, 314, 321, 358, 360, 366, 382- 388 Documentation, 372-377 Dollar for Dollar Partnership policies/Dollar for Dollar Asset Protection (DDAP), 402, 430-434, 452 Earned Income Tax Credit (EITC) payments, Time Limited Resource Disregards Supplemental Security Income-related assistance (SSI-related assistance), 387 Energy Employees Occupational Illness Compensation (EEOICP), SSI-Related Disregards, 383 Equity value of a trade or business, SSI-related assistance, 383 Essential Personal Property, 346-350 Supplemental Security Income-related assistance (SSI-related assistance), 382, 384 Excess Income, 309, 372, 374, 378, 380, 408, 410, 427, 435, 440 Excess (surplus) resources, 310, 341, 403, 407-410, 433 Definition of, See Glossary Family member, 337, 366, 371, 382-383, 407, 419, 428 Family Planning Benefit Program (FPBP), 423 Family Health Plus (FHPlus), 309-310, 372, 378, 380-381, 408, 440, Federal Relocation Assistance Supplemental Security Income-related assistance (SSI-related assistance), 383 Financial institution accounts, 308-313, 451 In Trust For (ITF), 311 Funeral agreements, pre-need, irrevocable Supplemental Security Income-related assistance (SSI-related assistance), 382, 385 Good Cause, 387, 415, 422-424, Definition of, See Glossary Guardian, 311, 359-360, Definition of, See Glossary Health Insurance, 410-411, 413-415, 420, 423, 425, 427-429 Home and Community Based Waiver (HCBS), 375, 416, 440, 452 (MRG) 81

(master-index)(page-82)Page 82#

MASTER INDEX JANUARY 2012 Homestead, Definition of, See Glossary, 335-342, 345, 353, 357, 383, 400, 402, 441-442, See also Real property Institutionalized spouse, 317, 393-396, 398, 406, 432-433, 439, 442, 450 Definition of, See Glossary RESOURCES continued

Insurance, 317, SSI-related, 383, 388 Employer Group Health, 421-422, 427-429 Life insurance, 324-326, 365, 369-370, 452 Cash value, 325-326, 328, 366, 369-370 No-Fault Insurance Law, 420 Third party resources, 318, 411-429 Insurance payments Supplemental Security Income-related assistance (SSI-related assistance), 387 Irrevocable trusts, 361, 363 Legally Responsible Relatives, 327, 334, 384-385, 406-407, 415 Levels, 378-391, See Reference, 756-759, 760-764 Definition of, See Glossary, 378 MBI-WPD, 309, 370, 380-381, 391 Medicaid Resource Level, 310, 319, 321, 323, 335, 342, 345, 378-391, 409, 433, 447, 449, SSI-related only, 780 Liens, 335, 338-339, 341, 353, 360, 400-401, 403, 419, 421, 426, 430, 432-433 Life estates, 353-354, 357, 443 Life insurance, 324-326, 365, 369-370, 383, 452 Accelerated Life Insurance payments (Living Needs benefits), 325 Cash surrender value (CSV), 324-326 Definition of, See Glossary, 324 Endowment, 325 Face Value, 324 Individual/Group policies, 325 Limited payment, 325 Ordinary Life insurance (Whole Life), 324-326 Term insurance, 325 Living Needs Benefits, 325 Long term care services, 309, 325, 328, 338, 364, 367, 372-377, 401-402, 418 Long Term Home Health Care Program (LTHHCP), 452 Look-Back period, 399, 432-433, 439-440, 448-449 Low Income Families (LIF), 309, 372, 378, 380, 408, 440 Lump sum payments, 308-310, 321-322, 325, 355, 432, MBI-WPD (Medicaid Buy-in for Working People with Disabilities), 309, 316, 370, 380- 381, 391 Medicaid Cancer Treatment Program (MCTP), 309, 372, 380, 409, 440 Medicaid Extended Coverage (MEC), 430-434 Medicaid Resource Level, 310, 319, 321, 323, 335, 342, 345, 378-391, 409, 433, 447, 449

Levels, SSI-related only, See Reference, 780 Medically Needy, 491, 543, 576, 630, 721, 726, 732 (MRG) 82

(master-index)(page-83)Page 83#

MASTER INDEX JANUARY 2012 Medical support, 407, 415 Medicare, 309, 318, 378, 380, 404, 409, 414-419, 428, 435-438, 440

Definition of, See Glossary

Part D, 415-417, 428 RESOURCES continued

Medicare Managed Care Plan, 417 Medicare Savings Program, 309, 373, 378, 380, 409, 435-437, 440 Minimum/Maximum Community Spouse Allowance, 316, 392, 394-396, 408, 447, 450

Allowances, 779 MMMNA (Minimum Monthly Maintenance Needs Allowance), 396, 430-431

Allowances, 775 Mortgages/Mortgages and contracts of sale, 335, 338, 341, 343, 355-357, 401, 403, 443, 447, 451 Mutual funds, 308, 311, 317, 327-328, 333 NAMI (Net Available Monthly Income), 448-449 Native American payments Supplemental Security Income-related assistance (SSI-related assistance), 383 New York Partnership for Long Term Care, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452 Nursing facility, 309, 319, 338, 357, 373-375, 377, 401-402, 404, 433, 438-446, 448-449 Nursing Home Transition and Diversion Waiver, NHTD, 377, 452 OMH, 452 OPWDD, 452 Ordinary Life Insurance (Whole Life), 324-325 Part-D, Medicare Part D, 415-417, 428 Partnership for Long Term Care, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452 PASS (Plan to Achieve Self-Support), 348-349, 384, See Reference, 751 Pay-in, 374 Pension plans of an ineligible or non-applying legally responsible relative Supplemental Security Income-related assistance (SSI-related assistance), 384 Persecution payments Supplemental Security Income-related assistance (SSI-related assistance), 384 Personal Needs Allowance (PNA) accounts, 310, 318-320 Personal property, 346-350, 358 Persons in medical facilities (chronic care), 275-291 Assessment/Determination of income available for the cost of care, 275 Budgeting for Institutionalized Spouses in HCBS Waivers, 282-284 Chronic care budgeting methodologies for individuals, 272, 283, 285-289 Chronic care budgeting methodologies for institutionalized spouses, 278-282, 285 Community spouse and family member allowance, 276, 282, 284, 291 Minimum Monthly Maintenance Needs Allowance (MMMNA), 276-277, 281, 284, 291 Personal Needs Allowance (PNA) for Persons Transferred or Discharged, 291 Plan to Achieve Self-Support (PASS), 348-349, 384, See Reference, 751 Pregnancy/Pregnant, 309, 373, 378, 380, 409, 423, 440 (MRG) 83

(master-index)(page-84)Page 84#

MASTER INDEX JANUARY 2012 Pre-need funeral agreements, 365-369, 371, 373, 409, 447 SSI-related assistance, 382, 385 Prescription Drug, 415-417, 428 Preventative housing service RESOURCES continued

Supplemental Security Income-related assistance (SSI-related assistance), 385 Promissory Notes, 308, 333-334, 357, 443 Property, 346-350, 358, 382, 384 Business, 328, 342-343, 346, 350-352, 383, 385 Personal, 346-350, 358 Automobiles and other vehicles, 348-350, 382 Essential personal property, 346-347, 382, 384 Real, 335-345 Contiguous/Non-contiguous property, 336-338, 340-341, 383 Definition of, See Glossary Homestead, 335-342, 345, 353, 357, 383, 400, 402, 441-442 Income producing, 342-344 Producing Personal Goods/Services, 345 QDWI (Qualified Disabled and Working Individual), 309, 380, 437, See Reference, 762 QI (Qualified Individual), 309, 373, 378, 380, 409, 437, 440, 478, See Reference, 763, 796-797 QMB (Qualified Medicare Beneficiary), 309, 373, 378, 380, 409, 436, 440, See Reference, 762 Qualified Partnership Policyholder (QPP), 401-402, 430-434 Qualified State Savings Program (Section 529), 315 Radiation Exposure Compensation Trust Fund payments, 385 Real property, 335-345 Contiguous/non-contiguous property, 336-338, 340-341, 383 Definition of, See Glossary Homestead, 335-342, 345, 353, 357, 383, 400, 402, 441-442 Income producing, 342-344 Producing Personal Goods/Services, 345 Real property sales Supplemental Security Income-related assistance (SSI-related assistance), 388 RFI, 310 Relocation, SSI-related assistance, 388 Remainder beneficiary, 433, 452-453 Resource Test (Income and Resource Test), See Reference, 760-764 Retirement funds, 316-317, 391 Reverse Mortgage, 402 Revocable trusts, 362 Securities, 327-333 Single/Childless Couples (S/CC), 309, 372, 378, 380, 399, 408, 427, 429, 440 Budgeting Methodologies, 265-271 $90 Work Expense Disregard, 257, 263, 265, 267-269, 271 (MRG) 84

(master-index)(page-85)Page 85#

MASTER INDEX JANUARY 2012 185% Maximum Income Limit, 265, 267-268, 270 100% Maximum Income Test, 268, 271 Room and board, 257-258, 260 Definition of, See Glossary RESOURCES continued

Disregards, See Income under specific type, 257-264 SLIMB, Specified Low Income Medicare Beneficiary, 478, 763 Spenddown, 309-310, 372, 374, 378, 380, 401, 408, 415-418, 428, 431, 433, 435-436, 440, 448 SSI-related assistance, 308-309, 312, 314-316, 319, 321, 323-324, 326-327, 329, 331-332, 334-335, 337-343, 345-355, 357, 359, 361-362, 364-376, 378-392, 400-410, 430, 437, 439, 441-453, 455, SSI Disregards, 314, 321, 358, 360, 366, 382-388 Deeming, 384, 389-391 Time-related disregards, 387-388 State or Local Relocation Assistance payments Supplemental Security Income-related assistance (SSI-related assistance), 388 State Victims Assistance funds Supplemental Security Income-related assistance (SSI-related assistance), 388 Stocks, bonds, securities, 308, 311, 327-333 Students/Student Loans, 315 Supplemental Security Income-related assistance (SSI-related assistance), 385 Substantial Home Equity, 401-403 Supplemental Security Income-related assistance (SSI-related assistance), 308-309, 312, 314-316, 319, 321, 323-324, 326-327, 329, 331-332, 334-335, 337-343, 345-355, 357, 359, 361-362, 364-376, 378-392, 400-410, 430, 437, 439, 441-453, 455,Supplemental Needs Trust (SNT), 359, 362-364 TBI, Traumatic Brain Injury, 377, 452 Third Party Health Insurance (TPHI), 484, 486, 530, 565-566 Third Party Resources, 318, 411-429 Assignment and subrogation, 425-426 Civilian Health and Medical Plan for Uniformed Services (CHAMPUS), 419 Coinsurance, 416 Definition of, See Glossary, 411 Enrollment in Employer Group Health insurance, 427-429 Good Cause Not to Bill, 477, 561-562, 564,-568, 623, 709 Medicare, 530 Medicare Savings Program, 530, 676 New York State Partnership for Long-Term Care, 309, 373, 378, 380, 301, 409, 422, 430-434, 440, 452 Third Party Resource Unit (TPRU), 413 Veterans Nursing Home Per Diem, 438 Wrap-around policies, 413 Total Asset Partnership policies/Total Asset Protection, 309, 373, 378, 380, 401, 409, 430- 431, 440, 452 (MRG) 85

(master-index)(page-86)Page 86#

MASTER INDEX JANUARY 2012 Transfer of assets, 312, 354, 358-359, 362, 365, 433, 439-456 Annuities, 452-454 Definition, See Glossary Penalty period, 359, 433, 439, 441, 447-451 RESOURCES continued

Regional rates, 352-354, 433, 447-450, See Reference, 783-784 Uncompensated value, 353-354, 438, 447-450 Traumatic Brain Injury (TBI), 377, 452 Trust funds, See Income, 224, See Resources, 358-364, 411 Definition of, See Glossary, 358 Exception Trusts, 359-361, 363 Irrevocable Trust, 361, 363 Revocable Trust, 362 Supplemental Needs Trust (SNT), 359, 362-363 Testamentary Trust, 363 Third Party Trust, 363 Undue hardship, 395, 402, 446, 449 Under age 19, 309, 373, 378-380, 409, 440 Unearned income, 311, 314, 327, 331-332, 355, 385 Uniform Gifts to Minors Act (UGMA)/Uniform Transfer to Minors Act (UTMA), 314 Veterans Nursing Home Per Diem, 385 Vietnam veterans Supplemental Security Income-related assistance (SSI-related assistance), 385 Windfalls, 309, 323, 420 Workers’ Compensation, 419-420 Wrap-around policies, 413 Zero coupon bonds, 327, 331-332

Respondent, Definition, See Glossary

Retirement funds, See Resources, 316-317, 391

Retirement, Survivors' and Disability Insurance (RSDI), See Categorical Factors, 18-19, 29- 30, 35-37, 89-92, See Income, 121, 126-129, 132, 213, 240, See Other Eligibility Requirements, 499, 719, See Reference, 737

Retroactive benefits under the SSI Program, See Income, SSI-related, 227, See Reference, 751

Retroactive eligibility period, See Categorical Factors, 6-7, 58-59, 61, 63, 75, See Income, 106, 122, 297 299, 308, See Resources, 374, 409, See Other Eligibility Requirements, 471-472, 475, 495.1-495.8, 502, 504, 507, 675, 712, 732 Reimbursement of paid and unpaid medical bills, 297-298, 495.2-495.8, See Reference, 777.1 (MRG) 86

(master-index)(page-87)Page 87#

MASTER INDEX JANUARY 2012 Agency Delay, 472.1, 495.3-495.5, 495.7 Agency Error, 472.1, 495.4-495.5, 495.7 Post-retroactive period, 495.3, 495.6, See Reference, 777.1 Pre-retroactive period, 297, See Reference, 777.1

Reverse Mortgage, See Income, 121, 149, See Resources, 402

Review Team, See Categorical Factors, 29-31, 34, 36, 38, 45, 48-50

Revocable pre-need funeral agreements, See Resources, 366.1

Revocable trusts, See Resources, 362, See Other Eligibility Requirements, 680.5

RFI, See Income, 107, 123, 134, See Resources, 310, See Other Eligibility Requirements, 472, 484-484.2, 699

Room and/or Board, See Income, 105, 118-120, ADC-related, 197, 200, LIF, 174, 180, S/CC, 257-258, 260, SSI-related, 221, 227, See Reference, 751, 768

Rosenberg (PA case closing), See Categorical Factors, Extensions/Continuations, Separate Medicaid determinations, 86-87

RRDC (Regional Resource Development Centers), See Other Eligibility Requirements, 722- 727

RRP (Recipient Restriction Program), See Other Eligibility Requirements, 508

RSDI, See Categorical Factors, 18-19, 29-30, 35-37, 89-92, See Income, Retirement, Survivors' and Disability Insurance (RSDI), 121, 126-129, 213, 240, See Other Eligibility Requirements, 499, 719, See Reference, 737

RTF, Residential Treatment Facility, See Other Eligibility Requirements, 693

S Safety Net Assistance (SNA), See Categorical Factors, 87, See Other Eligibility Requirements, 574 Definition, See Glossary

Same-sex marriages, See Categorical Factors, 5

Satisfactory Immigration Status, See Other Eligibility Requirements, 578, 589, 591, 593, 609-619, See Reference, 791

Definition of, See Glossary (MRG) 87

(master-index)(page-88)Page 88#

MASTER INDEX JANUARY 2012

e-notification, 609 PRUCOL, 589, 591, 608, 641-658, 662-664, 669-671

Qualified Aliens, 611-640

Battered Qualified aliens, 611, 613, 618-628, 791

U.S. Armed Forces Active Duty and Veterans, 611-612, 616, 634-635, 715 Victims of Human Trafficking, 591, 611-612, 617, 629, 632-633, 636-640, 665, 671

Temporary Protected Status, 591, 643, 647-648, 658, 661-664

SAVE, Systematic Alien Verification to Entitlements, See Other Eligibility Requirements, Citizenship and Immigration Status, PRUCOL, 625, 649

S/CC, Singles/Childless Couples, See Categorical Factors, 4, 31, 54, 61, 87, See Income, 115, 118, 144, 149, 156, 160, 162, 172, 265-271, 278, 285, 292, See Resources, 309, 372, 378, 380, 399, 408, 427, 429, 440, See Other Eligibility Requirements, 466, 475, 541, 554, 572, 577, 629-630, 694, 696, 698-699, 706, See Reference, Application requirements, 796, Income and resource levels, 761, Renewal/recertification documentation requirements, 797

School and employment status, See Income, 181, 201

SDX (State Data Exchange), See Other Eligibility Requirements, 482, 485.1, 491, 513-514, 518, 546, 580

Section 503, See Categories/Categorical Factors, Extensions/Continuations, Pickle Amendment, 80, 86, 91-92, 96, See Reference, 742-744

Securities, See Resources, 327-333, See Other Eligibility Requirements, 680.3

Self-employment, See Income, 104-105, 113-117, 144, 244, 265, 276

Separate health care coverage determinations, See Categorical Factors, 87-88

Separate Medicaid determinations (financial/eligibility), See Categorical Factors, Extensions/Continuations, 71-72, 86-88

Shelter for the homeless, See Other Eligibility Requirements, Homeless shelter, 541, 623, See Reference, 768

Sick pay, See Income, 124-125

Significant financial distress, See Income, 277 Definition of, See Glossary

Singles/Childless Couples (S/CC), See Categorical Factors, 4, 31, 54, 61, 87, See Income 115, 118, 144, 149, 156, 160, 162, 172, 265-271, 278, 285, 292, See Resources, 309, (MRG) 88

(master-index)(page-89)Page 89#

MASTER INDEX JANUARY 2012 372, 378, 380, 399, 408, 427, 429, 440, See Other Eligibility Requirements, 466, 475, 541, 554, 572, 577, 629-630, 694, 696, 698-699, 706 Application requirements, 796 Budgeting methodologies, 265-271 $90 Work Expense Disregard, 257, 263, 265, 267-269, 271 185% Maximum Income Limit, 265, 267-268, 270 100% Maximum Income Test, 268, 271 Room and board, 257-258, 260 Definition of, See Glossary Disregards, See Income under specific type, 257-264 Household composition, 577 Income and resource levels, 761 Renewal/recertification documentation requirements, 797

SLIMBs, See Categorical Factors, Medicaid for Medicare Beneficiaries, Specified Low- Income Medicare Beneficiaries (SLIMBs), 54, 73, 75-77, See Income, 166-167, See Resources, 309, 373, 378, 380, 409, 436, 440, See Other Eligibility Requirements, 478 See Reference, Application requirements, 796, Income and resource levels, 763 Renewal/recertification documentation requirements, 797

Small business income, See Income, 105, 113-117

Small Residential Units (SRU), See Other Eligibility Requirements, 642, 696

Social Security Act, See Categorical Factors 62, 70, 80-82, 93, 96, See Resources, 360, 414, 452, See Other Eligibility Requirements, 514, 550, 556-557, 561, 569-571, 687, 694, 696 Amendments of 1983, 93 Section 202 (Widows/Widowers), 93-94 Section 1115, 4, 57-571, 687, 694, 696 Section 1619 (a), 82 Section 1619 (B), 49-50, 80, 96 Section 1903 (a) (5), 62 Section 1915 (c), 550, 556-557, 569, 720, 722, 725, 729 Section 1917(d)(4)(C), 360 Title II, 93, 175, 183, 198, 204, 223, 227, 229, 258, 263, 383, 414 Title IV-D, 20, 72, 407, 413, 507, 554, 557, 559-568 Title IV-E (Foster Care), 71-72, 85-86, 218-219, 504, 514, 562, 574, 592 Definition of, See Glossary Title XIX Definition of, See Glossary Title XXI, See Child Health Plus (CHPlus), 70

Social Security benefits, See Categorical Factors, 28, 36-37, 50, 89, 95, See Income, 126-129, 154, See Other Eligibility Requirements, 685 Amounts, See Reference, 770-772 (MRG) 89

(master-index)(page-90)Page 90#

MASTER INDEX JANUARY 2012

Social Security enumeration, See Other Eligibility Requirements, 697-700

Social Security Number (SSN) application, See Other Eligibility Requirements, 698

SOFC (State Operated Family Care), See Other Eligibility Requirements, 642, 693

SOPC (State Operated Psychiatric Center), See Other Eligibility Requirements, 549.1

SOIRA (State Operated Individual Residential Alternatives), See Other Eligibility Requirements, 642, 695

SOLQ (State On-Line Query), See Other Eligibility Requirements, 580

Special Non-Immigrant, See Other Eligibility Requirements, 591, 669-671

Specified relative, See Relationship to specified relative or caretaker

Specified Low-Income Medicare Beneficiaries (SLIMBs), See Categorical Factors, 54, 73, 75-77, See Income, 166-167, See Resources, 309, 373, 378, 380, 409, 436, 440, See Other Eligibility Requirements, 478 See Reference, Application requirements, 796, Income and resource levels, 763, Renewal/recertification documentation requirements, 797

Spend down/Spenddown requirement, See Categorical Factors, 31, 48, 54, 58-59, 75, 85-86, 91, 96, See Income, 164-166, 168, 172, 185, 195, 217, 244, 271, 284, 292-297, 299, 302, See Resources, 309-310, 366, 372, 374, 378, 380, 401, 408, 415-418, 428, 431, 433, 435-436, 440, 448, See Other Eligibility Requirements, 472, 475, 484.1, 485, 486, 491, 493, 495.3, 520, 684 Definition of, See Glossary Expanded Eligibility Program, 185, 195, 272

Spouse, See Other Eligibility Requirements, See Legally Responsible Relatives (LRR), 553- 555 Definition of, See Glossary, 550

Spousal Impoverishment, See Income, 283, 290, See Resources, 430 Family Member Allowance (FMA), See Reference, 773 Income: Community and Institutionalized, See Reference, 774 Minimum Monthly Maintenance Needs Allowance (MMMNA), See Reference, 775 Personal Needs Allowance (PNA), See Reference, 776

SSI 1619b, See Categorical Factors, 50, 96

SSI Disregards, See Income, 220-230, See Reference, 751, See Resources for specific type, 314, 321, 358, 360, 366, 382-388 (MRG) 90

(master-index)(page-91)Page 91#

MASTER INDEX JANUARY 2012 Student Income amount, See Reference, 754

SSI payments, See Reference, 751 Aid to Dependent Children-related assistance (ADC-related assistance), 200 FHPlus, 273 Low Income Families (LIF), 180 Singles/Childless Couples (S/CC), 262 Supplemental Security Income-related assistance (SSI-related assistance), 226, 228, 248

SSI/SSI-related assistance, See Categorical Factors, Supplemental Security Income-related assistance (SSI-related assistance), 3-5, 26, 28-30, 35-37, 49, 80, 82, 84, 87-89, 91-93, 95-97, See Income, 106, 111, 115-116, 125, 130, 132-133, 142, 144, 149-150, 154, 156, 158. 161. 171, 173, 180, 200, 213, 220-256, 262, 273, 276, 278, 280-283, 286, 288, 292-295, 301, See Resources, 308-309, 312, 314-316, 319, 321, 323-324, 326-327, 329, 331-332, 334-335, 337-343, 345-355, 357, 359, 361-362, 364-376, 378-392, 400-410, 430, 437, 439, 441-453, 455, See Other Eligibility Requirements, 461-462, 471-472, 481, 482-486, 491, 494, 495.2, 497-502, 504, 506-507, 513-514, 517-518, 525, 541, 554, 561, 572, 574, 576, 592, 678, 680.2, 685, 686, 707, 710-711, 717, 719-721, 726 Application requirements, 796 Definition, See Glossary Income and resource Levels, See Reference, 761 Renewal/recertification documentation requirements, 797

State and federal charges, 687-696 Native Americans, 687-689 Overburden, 690, 694, 696 OMH, 693-694 OMH/OPWDD Chapter 621, 687, 691-694 OPWDD, 695-696

State Children's Health Insurance Program, See Categorical Factors, Child Health Plus (CHPlus), 70

State Disability Review Teams, See Categorical Factors, 29-30, 45, 48-49

State Income Standards Definition, See Glossary

State or Local Relocation Assistance payments, See Income, 132, SSI-related, 226-227; See Resources, 388, See Reference, 751

State Operated Family Care (SOFC), See Other Eligibility Requirements, 642, 693, 695

State Operated Individual Residential Alternatives (SOIRA), See Other Eligibility Requirements, 642, 695 (MRG) 91

(master-index)(page-92)Page 92#

MASTER INDEX JANUARY 2012

State Operated Psychiatric Center (SOPC), See Other Eligibility Requirements, 549.1

State Parent Locator Service (SPLS) Definition, See Glossary

State residence and district responsibility for assistance, See Other Eligibility Requirements, 513-535 Assistance to persons temporarily absent, 531-532 Assistance to persons temporarily in the state, 533-534 Assistance to Persons Who Change Residency, 524-530 District of Fiscal Responsibility (DFR), 475, 514-525, 528, 536, 539, 543-544, See Reference, 792-794 Adult care facility, 511, 518, 521, See Reference, 793 Children eligible for continuous Medicaid coverage, 504-505, 523, 527 District placement rule, 520 Domestic violence, 521, 621, 623-624, 628, 792 Homeless rule, 521 Infants residing with incarcerated mothers, 523, 543-544 Medical facility rule, 520 Medical parole, 522 Temporary absence from legal residence, 518-519, 546, See Reference, 792 Transition rule, 519, 525 Under age 21, 477, 491, 506, 510, 522, 526, 535-536, 540, 543, 550, 554, 556, 559, 561, 564-566, 569, 573, 575, 577, 594, 645, 680.2-680.3, 680.6-680.7, 685, 788, 793, See Levels, 761 Where-found rule, 515-519, 522, 793

State Victims Assistance funds, See Resources, Time-limited SSI-related disregards, 388

Statute of Limitations Definition, See Glossary

Stay in medical facility, See Categorical Factors, 83, See Income, 299-302 Definition, See Glossary

Stenson (SSI case closing), See Categorical Factors, Extensions/Continuations, Separate Medicaid determinations, 86-88

Step parent, See Categorical Factors, 10, 58-60, See Legally Responsible Relative (LRR), 550, 556-557, 561, 569-571, See Other Eligibility Requirements, 498-501, 538, 550- 571 Definition, See Glossary

Stimulus Bill, See also American Recovery and Reconciliation Act (AARA), See Income, 122 (MRG) 92

(master-index)(page-93)Page 93#

MASTER INDEX JANUARY 2012

Stocks, Bonds, Securities, See Resources, 308, 311, 327-333, See Other Eligibility Requirements, 680.4

Students, See Income, 116, 128, ADC-related assistance, 201-202, FHPlus, 272, LIF, 176, 180-181, S/CC, 261, SSI-related assistance, 227-228, See Reference, 751, See Resources, SSI-related assistance, 385, See Other Eligibility Requirements, 502, 589, 629, 666, 668, 711 Disregard Amount (Student Loan), See Reference, 754

Subsidized employment, See Categorical Factors, 42 Definition, See Glossary

Substance abuse, See Categorical Factors Addiction, drug or alcohol, 18, 35, See Other Eligibility Requirements, 511, 519, 522

Substantial Gainful Activity (SGA), See Categorical Factors, 29, 34, 38-39, 41-42, 48, 80, 82 Amount, See Reference, 745

Substantial Home Equity, See Resources, 401-403, See Reference, 782

Summons Definition, See Glossary

Supplant Definition, See Glossary

Supplemental Needs Trust (SNT), See Resources, 296, 299-299.1, 359, 362-364, See Other Eligibility Requirements, 679, See Reference, 785.1

Supplemental Security Income (SSI)/ Supplemental Security Income-related assistance (SSI- related assistance), See Categorical Factors, 3-5, 26, 28-30, 35-37, 49, 80, 82, 84, 87- 89, 91-93, 95-97, See Income, 106, 111, 115-116, 125, 130, 132-133, 142, 144, 149- 150, 154, 156, 158. 161. 171, 173, 180, 200, 213, 220-256, 262, 273, 276, 278, 280- 283, 286, 288, 292-295, 301, See Resources, 308-309, 312, 314-316, 319, 321, 323- 324, 326-327, 329, 331-332, 334-335, 337-343, 345-355, 357, 359, 361-362, 364-376, 378-392, 400-410, 430, 437, 439, 441-453, 455, See Other Eligibility Requirements, 461-462, 471-472, 483-486, 491, 494, 497-502, 504, 506-507, 513-514, 517-518, 525, 541, 554, 561, 572, 574, 576, 592, 678, 684, 686, 707, 710-711, 717, 719-721, 726 Aid to the Aged, Blind or Disabled (AABD), 81, 89-90 Allocation 231-236 65 and over, 24-26 Blindness, 27-28 Budgeting, 171 Budgeting methodologies, 220-254 Allocation, 231-236 (MRG) 93

(master-index)(page-94)Page 94#

MASTER INDEX JANUARY 2012 Blind work expenses, 242, 247-248 Cash benefit levels, 126, 237 Deeming, 231-232, 237-239, 250, 253-256, 384, 389-391 Health insurance premiums, 224, 239-241, 251-252, 254-255 Impairment-related work expenses, 224.1, 242-246 Plan to Achieve Self-Support (PASS), 226, 248-249, 256, 279, 287 Trial work period, 40-41, 49, See Reference, 746 Deeming, 384, 389-391 Definition of, See Glossary Disability, 29-37 Disregards, See Income under specific type, 220-230, See Resources under specific type, 314, 321, 358, 360, 366, 382-388, See Reference, 751, 754 Household composition, 576 Income Allocation, 231-236, See Reference, 755 Minimum Monthly Maintenance Needs Allowance (MMMNA), 276-277, 281, 284, 291, See Reference, 775 Net Available Monthly Income (NAMI), 448-449 SSI Payments, 180, 200, 262, 273 Resources, Deeming, 384, 389-391 Levels, See Reference, 761 Trial Work Period, 40-41, 49 Amounts, See Reference, 746

Supplemental Security Income (SSI) Definition of, See Glossary

Support collection unit Definition, See Glossary

Support hearing Definition, See Glossary

Support obligation Definition, See Glossary

Support order Definition, See Glossary

Support payments, See Categorical Factors, 121, 139-141, See Income, ADC-related assistance, 203, 207, 216, Chronic Care, 276, LIF, 182, S/CC, 262, 266, 271, SSI- related assistance, 221, 255, See Reference, 792

Support petition Definition, See Glossary

(MRG) 94

(master-index)(page-95)Page 95#

MASTER INDEX JANUARY 2012 Systematic Alien Verification to Entitlements (SAVE), See Other Eligibility Requirements, Citizenship and Immigration Status, PRUCOL, 635, 649

T Tax Relief and Health Care Act of 2006, See Other Eligibility Requirements, 592

Taxes and taxation, See Income, 103-104, 113, 119, 131-132, 135, 144, 146, 226, 247 Self-employment tax, 115

TBI, Traumatic Brain Injury, See Categorical Factor, 86, 91-92, See Income, 283, See Resources, 377, 452, See Other Eligibility Requirements, 511, 727-728

Teaching Family Home (TFH), See Other Eligibility Requirements, 642, 694

Temporary absence from legal residence, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 518-519, 546, See also Maintaining Medicaid for Incarcerated Individuals, 546, See Reference, 792 Definition, See Glossary

Temporary Assistance (TA), See Categorical Factors, 87, See Resources, 376, See Other Eligibility Requirements, 495.1, 495.5, 461-462, 465, 481, 486, 493-494, 504, 524, 711 Definition, See Glossary

Temporary Assistance for Needy Families (TANF) Definition, See Glossary

Temporary Non-Immigrant, See Other Eligibility Requirements, Citizenship and immigration status, 591, 666-668, 672-674 Definition of, See Glossary

Temporary Protected Status (TPS), See Other Eligibility Requirements, Citizenship and immigration status, 591, 643, 647-648, 658, 661-664 Definition of, See Glossary

Testamentary trusts, See Resources, 363

Third Party Health Insurance (TPHI), See Categorical Factors, 43, 72, 98, See Income, 219, 302, 304, See Resources, Third Party Resources, 318, 411-429, See Other Eligibility Requirements, 484, 486, 530, 565-566, See Reference, 796-797

Third party insurance payments, See Income, 220, 288, 302, 304, SSI-related, 228, See Reference, 752

(MRG) 95

(master-index)(page-96)Page 96#

MASTER INDEX JANUARY 2012 Third Party Resources, 411-429 Assignment and subrogation, 425-426 Civilian Health and Medical Plan for Uniformed Services (CHAMPUS), 419 Coinsurance, 416 Definition of, See Glossary, 411 Enrollment in Employer Group Health insurance, 427-429 Good Cause Not to Bill, 477, 561-562, 564,-568, 623, 709 Medicare, 530 Medicaid Advantage Plans, 415, 416-418 Medicaid Advantage Plus Plans, 417-418 Medicare Advantage Special Needs Plans (SNP), 418 Medicare Savings Program, 530, 676 New York State Partnership for Long-Term Care, 309, 373, 378, 380, 301, 409, 422, 430- 434, 440, 452 Part A and Part B, 676, See Reference, 762, 765 Part D, 415-417, 428 Third Party Resource Unit (TPRU), 413 Veterans Nursing Home Per Diem, 385 Wrap-around policies, 413

Third Party Resource Unit (TPRU), See Resources, Third Party Resources, 413

Timely notice, See Resources, 451, See Other Eligibility Requirements, 495, 520

Tips, 108-109

Title III, Federal Economic Opportunity Act, See Income, ADC-related assistance, 198, FHPlus, 272, LIF, 175, S/CC, 258, SSI-related assistance, 228, See Reference, 749

Title IV-E, See Categorical Factors, 71-72, 85, See Income, 218-219, See Other Eligibility Requirements, 504, 514, 562, 574, 592 Definition, See Glossary

Title XIX Definition, See Glossary

TMA (Transitional Medicaid), See Categorical Factors, Extensions/Continuations, 86, 97- 98.1, See Income, 209, See Other Eligibility Requirements, 562, 630

Total Asset Partnership policies/Total Asset Protection (TAP), See Categorical Factors, 54, See Resources, 309, 373, 378, 380, 401, 409, 430-431, 440, 452, See Other Eligibility Requirements, 680, 680.3, 685

TPHI (Third Party Health Insurance), See Categorical Factors, Insurance, 43, 72, 98, See Income, 219, 302, 304, See Resources, Third party resources, 411-429, See Other Eligibility Requirements, 484, 486, 530, 565-566, See Reference, 796-797 (MRG) 96

(master-index)(page-97)Page 97#

MASTER INDEX JANUARY 2012

TPRU (Third Party Resource Unit), See Resources, 413

TPS (Temporary Protected Status), See Other Eligibility Requirements, Citizenship and immigration status, 591, 643, 647-648, 658, 661-664 Definition of, See Glossary

Trade Readjustment Allowance (TRA), See Income, ADC-related, 203, LIF, 182, S/CC, 262, See Reference, 752

Transfer of assets, See Resources, 312, 254, 258-259, 362, 365, 433, 439-456, See Other Eligibility Requirements, 485.1, 497, 678-678.1, See Reference, 783-784, 785.1 Annuities, 452-454, 785.1 Penalty period, 359, 433, 439, 441, 447-451 Regional rates, 455-456, See Reference, 783-784 Uncompensated value, 353-354, 433, 447-450 Definition of, See Glossary

Transition rule, See Other Eligibility Requirements, District of Fiscal Responsibility (DFR), 519, 525

Transitional Medicaid (TMA), See Categorical Factors, 86, 97-98.1, See Income, 209, See Other Eligibility Requirements, 562, 630

Traumatic Brain Injury (TBI), See Categorical Factor, 86, 91-92, See Income, 283, See Resources, 377, 452, See Other Eligibility Requirements, 511, 727-728

Trial work period, See Categorical Factors, 40-41, 49 Amounts, See Reference, 746

Trust funds, See Categorical Factors, 43, See Income, 224, See Resources, 358-364, 411, See Other Eligibility Requirements, 680.1, 680.5, See Reference, 785.1 Definition of, See Glossary, 358 Exception Trusts, 358-361, 363, 680.5 Irrevocable Trust, 361-362, 680.5 Pooled Trust, 680.5 Revocable Trust, 362, 680.5 Supplemental Needs Trust (SNT), 359, 363-363, 478a Testamentary Trust, 363 Third Party Trust, 363

U (MRG) 97

(master-index)(page-98)Page 98#

MASTER INDEX JANUARY 2012 UGMA/UTMA (Uniform Gifts to Minors Act /Uniform Transfers to Minors Act), See Resources, 314

Uncompensated value, See Resources, 353-354, 433, 447-450 Definition, See Glossary

Under age 19, See Categorical Factors, 54, See Income, 128, 158, 164-165, 217, See Resources, 309, 373, 378-380, 409, 440, See Other Eligibility Requirements, 495. 4, 468, 474, 486, 491, 504, 520, 701, 710-713

Under age 21, See Categorical Factors, 6, 52-54, 60, 62, 87, 97, See Income, 104, 158-160, 163, 171-172, 180, 185, 187, 194, 201, 207, 215, 217, 250, 261, 265, 282, 293,-294, 301, See Resources, 309, 372-372, 378, 380, 408, 440, See Other Eligibility Requirements, 477, 491, 506, 510, 522, 526, 535-536, 540, 543, 550, 554, 556, 559, 561, 564-566, 569, 573, 575, 577, 594, 645, 690.2-680.3, 680.6-680.7, 685, See Reference, 788, 793, 796-797

Undergraduate, See Income, ADC-related assistance, 202, FHPlus, 272, LIF, 181, S/CC, 261, SSI-related assistance, 228, See Other Eligibility Requirements, 502 Definition, See Glossary

Undocumented immigrant/illegal alien, See Other Eligibility Requirements, Citizenship and Immigration status, 589, 591, 672-675, 697 Definition of, See Glossary Emergency Medical Condition, 581, 589, 591, 599, 609-610, 638, 666-668, 672-674 Chemotherapy, 673 Organ transplant, 672 Radiation Therapy, 673

Undue Hardship, See Resources, 395, 402, 446, 449, See Other Eligibility Requirements, 680.6-680.8

Unearned income, See Income, 103, 118, 121-157, 173, 182-183, 188, 196, 202, 204, 212, 222, 224, 228, 235, 239, 251-252, 261-264, 268, See Resources, 311, 314, 327, 331- 332, 355, 385, See Other Eligibility Requirements, 512, 567, See Reference, 752 Contributions from non-legally responsible relatives and friends, 142-143, 150-153, See Reference, 793 Definition of, See Glossary, 121 Dividends and interest, 133 Individual Retirement Account, 133, 135 Military Dependency Allotment, 121, 147-148 Rental income, 144-146 Retirement funds, 135-137 Support payments (voluntary and court-ordered), 121, 139-141, 182, 203, 207, 216, 221, 255, 262, 266, 271, 276

(MRG) 98

(master-index)(page-99)Page 99#

MASTER INDEX JANUARY 2012 Union benefits (other than pensions), See Income, 121, 138

Unemployment, See Income, 122-125

Unemployment Insurance Benefits (UIB), See Income, 122-125, ADC-related assistance, 203, LIF, 182, S/CC, 262, See Other Eligibility Requirements, 484, 498, 717, 719

Un/under employed two parent household, 8, 15, 23, 59

Uniform Gifts to Minors Act (UGMA)/Uniform Transfers to Minors Act (UTMA), See Resources, 314

United States Census, See Categorical Factors, 26, 53, See Income, ADC-related assistance, 203, LIF, 182, S/CC, 262, SSI-related assistance, 228, See Other Eligibility Requirements, 585, 596, 602, See Reference, 752

United States Citizen, See Citizenship

Definition of, See Glossary

United States Citizenship and Immigration Services (USCIS), See Other Eligibility Requirements, 609, 613-614, 618-619, 624-626, 628, 631-632, 637, 641, 644-646, 648- 649, 651-652, 654, 656-666, 668-671, 675

Definition of, See Glossary

Unpaid medical bills, See Other Eligibility Requirements, 495.6-495.8

U.S. Armed Forces active duty and veterans, See Other Eligibility Requirements, Citizenship and immigration status 611-612, 616, 634-635, 715

USCIS (United States Citizenship and Immigration Services), See Other Eligibility Requirements, 609, 613-614, 618-619, 624-626, 628, 631-632, 637, 641, 644-646, 648- 649, 651-652, 654, 656-666, 668-671, 675

V VAWA (Violence Against Women Act), See Other Eligibility Requirements, 624

Veteran, See Other Eligibility Requirements, 591, 611-612, 616, 634-635, 680.2, 685, 687, 715

Definition of, See Glossary Disregards, See Income, SSI-related, 229, See Reference, 792

Veterans' Administration Disability benefits, See Categorical Factors, 17-18, 30, 35, See Income, 121, 126-129 (MRG) 99

(master-index)(page-100)Page 100#

MASTER INDEX JANUARY 2012

Veterans Affairs referral, See Other Eligibility Requirements, 715

Veterans’ benefits, See Categorical Factors, 18, 35, See Income, 121, 126-129, See Resources, 387, See Other Eligibility Requirements, 715

Veterans of the U.S. Armed Forces, See Other Eligibility Requirements, Citizenship and Immigration status, 611-612, 616, 634-635, 715

Veterans Nursing Home Per Diem, See Resources, 438

Victims of Trafficking, See Other Eligibility Requirements, Citizenship and Immigration status, 591, 611-612, 617, 629, 632-633, 636-640, 665, 671, See Reference, 791

Certified (Federal Office of Refugee Resettlement), 616, 630, 632, 637, 639-640

Confirmed (State), 638-639 Definition of, See Glossary

Vietnam veterans, See Income, ADC-related assistance, 203, Chronic Care, 279-280, 287, FHPlus, 273, LIF, 182, S/CC, 262, SSI-related assistance, 229, See Resources, SSI- related assistance, 385, See Reference, 752

Violence Against Women Act (VAWA), See Other Eligibility Requirements, 624

Visa Statuses, See Other Eligibility Requirements, Citizenship and immigration status, 591, 621, 631, 665, 670

VISTA (Volunteers in Service to America), See Income, ADC-related, 196, 203, FHPLus, 272, LIF, 173, 182, S/CC, 257, 262, SSI-related, 220, 229, See Reference, 752

Vital Records, See Categorical Factors, 26, See Other Eligibility Requirements, 530, 593

Vocational Rehabilitation Act, See Income, SSI-related, 229, See Reference, 752

VOFC (Voluntary Operated Family Care), See Other Eligibility Requirements, 642, 693, 695

Voluntary acknowledgment of paternity Definition of, See Glossary

Voluntary departure, See Other Eligibility Requirements, Citizenship and immigration status, 643, 645-647, 650, 656-657, 659, 661-662

Voluntary Operated Family Care (VOFC), See Other Eligibility Requirements, 642, 693, 695

Voluntary Operated Individual Residential Alternatives (VOIRA), See Other Eligibility Requirements, 642, 695

(MRG) 100

(master-index)(page-101)Page 101#

MASTER INDEX JANUARY 2012 Voluntary repayments, See Other Eligibility Requirements, Recoveries, 677, 680, 686

Volunteer Program Payments, See Income, ADC-related assistance, 204, FHPlus, 273, LIF, 183, S/CC, 263, SSI-related assistance, 229, See Reference, 752

Volunteers in Service to America (VISTA), See Income ADC-related assistance, 196, 203 FHPlus272, LIF, 173, 182, S/CC, 257, 262, SSI-related assistance, 220, 229, See Reference, 752

Voter registration card, See Other Eligibility Requirements, 580, 587, 604

W Wages, Salaries and Contractual Income, 106-107

Wage subsidy Definition, See Glossary

Wage verification, See Income, 105, See Other Eligibility Requirements, 484

Wage withholding Definition, See Glossary

Waivers, See Categorical Factors, 4, 31, See Income, 278-279, 281, 283-285, See Resources, 318, 320, 375, 377, 396, 398, 407, 440, 448, 452, See Other Eligibility Requirements, 506, 511, 550, 555-558, 562, 569-571, 720-733 1115, See Categorical Factors, 4, 31 Bridges to Health (B2H), See Other Eligibility Requirements, 725-726 Care at Home, See Resources, 377, 407, 452, See Other Eligibility Requirements, 720-721 HCBS, See Income, 278-279, 281-285, See Resources, 318, 375, 377, 398, 407, 416, 440, 452, See Other Eligibility Requirements, 506, 511, 550, 556-558, 562, 569-571, 694, 696, 720-721, 725-728, 731-733 Definition, See Glossary LTHHCP, See Resources, 452, See Other Eligibility Requirements, 702, 704-705, 729-730 Nursing Home Transition and Diversion Waiver, NHTD, See Income, 283, See Resources, 377, 452, See Other Eligibility Requirements, 722-724, 727 OMH, See Resources, 452 OPWDD, See Resources, 452, See Other Eligibility Requirements, 731-733 Traumatic Brain Injury (TBI), See Categorical Factors, 86, 97-98, See Income, 283, See Resources, 377, 452, See Other Eligibility Requirements, 511, 727-728

Waiver Service Provider (WSP), See Other Eligibility Requirements, 725

Where found rule, See Other Eligibility Requirements, District of Fiscal Responsibility (MRG) 101

(master-index)(page-102)Page 102#

MASTER INDEX JANUARY 2012 (MRG) 102 (DFR), 515-519, 522, See Reference, 793

Widows/Widowers, See Categorical Factors Extensions/Continuations, 93-94; See Income, 126-127, See Resources, 421, See Other Eligibility Requirements, 624

Windfalls, See Income, 156, See Resources, 309, 323, 420 Definition of, See Glossary

Women, Infants and Children (WIC) Program, See Income, ADC-related assistance, 204, FHPlus, 273, LIF, 183, SSI-related assistance, 229, See Reference, 752

Workers' Compensation, See Categorical Factors, 18-19, 20, 35, 66, See Income, 121, 124- 125, See Resources, 419-420, See Other Eligibility Requirements, 680.2, 685

Work expense, See ADC-related assistance, 183, 187, 190, 197, LIF, 204, 208-210, MBI- WPD, 256, S/CC, 263, 269, SSI-related assistance, 224.1, 242, 247, See Reference, 752

Workforce Investment Act (WIA) (formerly JTPA), See Income, ADC-related, 199, FHPlus, 273, LIF, 183, S/CC, 263, See Reference, 752

Wrap-around policies, See Resources, 413

Z Zero coupon bonds, See Income, 131, See Resources, 327, 331-332

(other-eligibility-requirements)New York Medicaid Reference Guide: Other Eligibility Requirements#

(other-eligibility-requirements)(page-1)Page 1#

UPDATED: JUNE 2011

457

TABLE OF CONTENTS

OTHER ELIGIBILITY REQUIREMENTS

APPLICATION, CERTIFICATION AND RENEWAL ...................................................... .461

FACILITATED ENROLLERS…………………………………….…………………463

NEW APPLICATION ........................................................................................ 465

FAMILY PLANNING BENEFIT PROGRAM APPLICATION…………………... 476

MEDICARE D LOW INCOME SUBSIDY APPLICATION……………………... 478

REAPPLICATION ............................................................................................ .479

RENEWAL…………………….…………..……………………………………..…...481

DECISION AND NOTIFICATION……………………………………………………..…….. 486

ACCEPTANCE……………………………………………………………………....488

DENIAL…………………………………………………………………………….....490

WITHDRAWAL OF APPLICATION……………………………………………… 492

DISCONTINUANCE OR REDUCTION……………………………………………493

TIMELY NOTICE………………………………………………………………495

RETROACTIVE ELIGIBILITY PERIOD……………………………………………………..495.1

PAYMENT OF PAID MEDICAL BILLS ……………………………………………495.2

PAYMENT OF UNPAID MEDICAL BILLS ……………………………………….495.6

FINANCIAL MAINTENANCE…………………………………………………………………496

OWNERSHIP AND AVAILABILITY…………………………………………………………..498

AUTHORIZATION……………………………………………………………………………..504

CARD ISSUANCE .......................................................................... …………………… 506

RECIPIENT RESTRICTION PROGRAM (RRP) ..................................................... …..508

CO-PAY ......................................................................................................................... 509

(MRG)

(other-eligibility-requirements)(page-2)Page 2#

UPDATED: JANUARY 2012

458

MEDICAID BUY-IN PROGRAM FOR WORKING PEOPLE WITH DISABILITIES PREMIUM PAYMENTS………… 512

STATE RESIDENCE AND RESPONSIBILITY FOR ASSISTANCE…………………513

DISTRICT OF FISCAL RESPONSIBILITY (DFR)……………………….…..515

ASSISTANCE TO PERSONS WHO CHANGE RESIDENCY……………...524

ASSISTANCE TO PERSONS TEMPORARILY ABSENT……………….….531

ASSISTANCE TO PERSONS TEMPORARILY IN THE STATE…………...533

LIVING ARRANGEMENTS……………………………………………………………….535

LIVING IN OWN HOME………………………………………………………...538

MEDICAL FACILITIES………………………………………………………….539

PUBLIC INSTITUTIONS………………………………………………………..541

INFANTS RESIDING WITH INCARCERATED MOTHERS………………..543

MAINTAINING MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS…..545

MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIUALS ADMITTED TO TO A PSYCHIATRIC CENTER…………………………………………………….549.1

LEGALLY RESPONSIBLE RELATIVES (LRRs)……………………………………….550

SPOUSE…………………………………………………………………………553

PARENTS AND CHILDREN…………………………………………………..556

ABSENT PARENTS……………………………………………………………559

EMANCIPATED MINOR………………………………………………………560

IV-D REQUIREMENTS………………………………………………………..561

STEP-PARENTS……………………………………………………………….569

HOUSEHOLD COMPOSITION…………………………………………………………572

LOW INCOME FAMILIES (LIF), ADC-RELATED, PREGNANT WOMEN AND CHILDREN)………………………………….…………573

SSI-RELATED…………………………………………………………………576

(MRG)

(other-eligibility-requirements)(page-10)Page 10#

UPDATED: JANUARY 2012

465

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

Description: An application for Medicaid, Family Health Plus, Child Health Plus, the Family Planning Benefit Program, Medicare Savings Program, the Medicaid Cancer Treatment Program: Breast, Cervical, Colorectal, and Prostate Cancer Treatment Programs, and/or Medicaid Buy-In Program for Working People With Disabilities (MBI-WPD) is a written, dated form prescribed by the State. The applicant, his/her authorized representative or, when the applicant is incompetent or incapacitated, by someone acting on behalf of the A/R must sign it.

Policy: An applicant requesting Medicaid, Family Health Plus, the Family Planning Benefit Program, Medicare Savings Program, Medicaid Cancer Treatment Program: Breast, Cervical, Colorectal and Prostate Cancer Treatment Programs and/or Medicaid Buy-In Program for Working People With Disabilities may make application by dropping off an application to an LDSS or by mailing the application to the local district, facilitated enroller or other designated entity.

NOTE: Access NY Health Care applications and Supplement A can be printed from the internet at:

http://www.health.state.ny.us/nysdoh/fhplus/application.htm.

However, such applications may not be completed or submitted online.

Applicants may request assistance in understanding the Medicaid program or completing an application.

As of June 11, 2010, ALL applicants applying for Medicaid only, including applicants seeking coverage of long-term care services or nursing home care will make application for benefits on the Access NY Health Care application (DOH-4220). However, if an LDSS receives the LDSS-2921 application for a Medicaid-only applicant, they must accept the application and cannot require that the DOH-4220 or the DOH-4495A also be completed. The LDSS-2921 should continue to be used when an individual is applying for Medicaid and another program, such as Temporary Assistance, Child Care Assistance and/or Food Stamps. Individuals who are applying for the Family Planning Benefit Program (FPBP) should use the DOH-4282, Family Planning Benefit Program Application Form. The DOH-4286 (Instructions for the Family Planning Benefit Program Application) provides guidance for completing the DOH-4282. These forms may be accessed on the DOH website, at the LDSS, or at FPBP providers. Individuals who are applying for the Medicare Savings Program (MSP) should use the DOH-4328.

(MRG)

(other-eligibility-requirements)(page-11)Page 11#

UPDATED: JANUARY 2012

466

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

NOTE: For individuals applying on the DOH-4220, county specific absent parent forms must no longer be used.

The ACCESS NY Supplement A, DOH-4495A, must be completed if anyone who is applying is age 65 or older, certified blind or certified disabled (of any age), not certified disabled but chronically ill or institutionalized and applying for coverage of nursing home care, including care in a hospital that is equivalent to nursing home care. Supplement A must be signed and dated by the applicant and/or his/her representative and if appropriate, the applicant’s spouse. An S/CC or ADC-Related applicant who requires temporary nursing home care is not required to complete Supplement A. However, if such S/CC or ADC-Related applicant has a community spouse and such spouse is in a medical institution and/or nursing facility and is likely to remain in the facility for at least 30 consecutive days, Supplement A must be completed.

NOTE: Effective April 1, 2010, an LDSS can no longer require that an application interview take place.

References: SSL Sect. 366

366-a

Chapter 58 of the Laws of 2009

Dept. Reg. 360-2.2

360-2.3

360-2.4

360-6.2

ADMs 11 OHIP/ADM-1 10 OHIP/ADM-4

04 OMM/ADM-6

04 OMM/ADM-5

03 OMM/ADM-4

01 OMM/ADM-6

97 OMM/ADM-2

95 ADM-17

93 ADM-29

93 ADM-3

91 ADM-28

90 ADM-9

88 ADM-31

(MRG)

(other-eligibility-requirements)(page-12)Page 12#

UPDATED: JANUARY 2012

467

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

INFs 10 OHIP/INF-1

GISs 08 MA/003

07 MA/027

07 MA/026

96 MA/015

INFs 10 OHIP/INF-1

GISs 08 MA/003

07 MA/027

07 MA/026

96 MA/015

Interpretation: An application may be made by the applicant, his/her authorized representative or, when the applicant is incompetent or incapacitated, by someone acting responsibly for him/her. The applicant or someone acting responsibly on the applicant's behalf must sign the application in ink. When both a husband and wife are applying, both spouses are required to sign the “State-prescribed form”. If only one spouse is applying, the non-applying spouse cannot be required to sign the application even though information concerning his/her financial circumstances is necessary to determine eligibility for the applying spouse.

(MRG)

(other-eligibility-requirements)(page-13)Page 13#

UPDATED: JUNE 2010

468

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

NOTE: If the applicant’s representative signs the application, the LDSS must obtain a separate authorization from the applicant or a copy of legal guardianship. The applicant can identify the role of this person to: apply for and/or renew Medicaid, discuss his/her Medicaid application or case, and/or get copies of notices and agency correspondence. This authorization continues until it is revoked by the recipient; a reauthorization is not required at renewal. However, if the applicant is incompetent or incapacitated, a copy of the legal guardianship papers is not required, nor is a separate document authorizing the representative. In these situations, the LDSS is authorized to discuss the application/case and send notices and related correspondence to the responsible individual in addition to the applicant.

The date of application is the date that a signed “State-prescribed” application form, or a State-approved equivalent form or process is received by the LDSS. The application date for individuals who apply at outreach sites or facilitated enrollers is the date on which the application is started. For children under age 19 and pregnant women applying through the presumptive eligibility process, the application date is the date of the screening.

NOTE: An application is considered to be filed with the LDSS when an applicant submits a signed and dated application that includes his/her name and address. The LDSS may need more information to make a Medicaid eligibility determination, but the application date is protected.

A district cannot refuse an individual the right to apply. The applicant may be accompanied and assisted in the application process, if s/he wishes, by a person of his/her choice. The applicant may receive application assistance by an LDSS staff member, an FE, or designated staff at outreach sites such as family planning providers, providers who determine presumptive eligibility and hospitals with out-stationed workers. If requested, application assistance must be provided by the LDSS in person either as a walk-in or by appointment, over the telephone or in writing. Local departments of social services must work with the applicant or his/her representative to obtain any information missing from the application, including necessary documentation.

(See OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL FACILITATED ENROLLERS)

Effective April 1, 2010, an in-person application interview with the applicant or his/her representative must not be required. Applicants for presumptive eligibility (PE) and family planning benefit program (FPBP) must be screened in person when they present at a facility for covered services by a PE provider. (MRG)

(other-eligibility-requirements)(page-14)Page 14#

UPDATED: JANUARY 2012

469

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

The applicant must be provided material describing the program and informing the applicant or representative of: (1) the eligibility requirements for Medicaid including the different Medicaid coverage options for persons who have a resource test; (2) the responsibility of the applicant to report all facts necessary for a proper determination of eligibility; (3) the joint responsibility of the district and the applicant to explore all facts concerning eligibility and the applicant's responsibility for securing, wherever possible, records or documents supporting his/her statements; (4) the types of verification needed; (5) the fact that any investigation essential to determine eligibility will be made; (6) the fact that the A/R may be reimbursed for paid Medicaid covered medical care and services received during the three months prior to the month of application and up until the actual date of application, if otherwise eligible; (7) the fact that after the date of application the A/R must use providers who accept Medicaid and who are Medicaid approved; and (8) the applicant's responsibility to immediately notify the district of all changes in his/her circumstances. This material/information is found in: LDSS-4148A, “What You Should Know About Your Rights and Responsibilities”; LDSS-4148B, “What You Should Know About Social Services Programs” (including OHIP- 0054 and as appropriate Informational Notice to Institutionalized Individuals with Real Property); LDSS-4148C, “What You Should Know if You Have an Emergency”, also known as Books 1, 2 and 3. Local social services districts may either include this information with the application package that is either mailed or handed to the applicant(s), or the LDSS may send the booklets to the applicant(s) after they receive an application. However, the LDSS may not wait until eligibility is determined to send the information. If an LDSS chooses to provide the booklets in the application package, and the LDSS receives an application printed from the internet, the information must be sent to the applicant.

NOTE: As a condition of eligibility, certain referrals to other LDSS units such as referrals to the Child Support Enforcement Unit (CSEU) are necessary. Although there is no face-to-face interview requirement, such required referrals have not been waived or eliminated.

As a result of mandatory managed care, most applicants for Medicaid must choose a managed care plan. Although choosing a Medicaid managed care plan is not a condition of eligibility, failure to do so will result in the applicant being assigned to one, also known as auto- assignment. (MRG)

(other-eligibility-requirements)(page-15)Page 15#

UPDATED: JUNE 2011

470

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

Because FHPlus is a managed care-only product, new applicants MUST select a managed care plan AND complete a managed care enrollment form as a condition of eligibility unless the A/R resides in a district that has only ONE Family Health Plus Plan. It is strongly recommended that A/Rs complete Section K of the DOH-4220 Access NY Health Care Application or Section 19 of the LDSS-2921 or the Medicaid Managed Care and Family Health Plus enrollment form whenever possible to enable the A/R to provide primary Care provider or health center choice information. If the person fails to do so, the enrollment must be entered in accordance with procedures outlined in 01 OMM/ADM 6 Section IV. C. 3. In districts that have more than ONE Family Health Plus Plan, an application is not complete unless a plan has been selected.

Prior to making a plan selection, all Medicaid and FHPlus applicants must be informed about the managed care program, available plans in the county and optional benefits. This is known as managed care “education”. Managed care education may be conducted by mail, in person, by telephone or through FEs. Applicants may be referred to managed care workers or enrollment counselors at the time they choose to come into the LDSS to conduct business such as copying documents, requesting application assistance or to bring in required documentation. Districts must provide managed care education packets that include county specific information and a managed care contact for more detailed information.

MBI-WPD recipients with income below 150% of the federal poverty level may enroll in managed care. MBI-WPD recipients with income at or above 150% of the federal poverty level cannot be enrolled in managed care.

Persons in receipt of Medicare, regardless of their categorical status or income level cannot be enrolled in Medicaid managed care with some exceptions including Managed Long Term Care and Medicare Advantage Plans. Applications for the Medicaid Cancer Treatment Program are received and processed by State DOH/OHIP staff. (See CATEGORICAL FACTORS MEDICAID CANCER TREATMENT PROGRAM (MCTP))

SSI-related Medicaid applicants have the option of applying for:

1. Community Coverage without Long-Term Care which includes all Medicaid covered services except nursing facility services and (MRG)

(other-eligibility-requirements)(page-16)Page 16#

UPDATED: JUNE 2011

471

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

community based long-term care services. SSI-related Medicaid applicants who are not seeking coverage of long-term care services may attest to the amount of their resources rather than provide proof. (See RESOURCES DOCUMENTATION REQUIREMENTS) 2. Community Coverage with Community-Based Long-Term Care which includes all Medicaid covered care and services except nursing facility services. (See RESOURCES DOCUMENTATION REQUIREMENTS) SSI-related Medicaid applicants electing to apply for this coverage must provide proof of their current resources. 3. Medicaid coverage of all covered care and services which includes nursing facility services. SSI-related Medicaid applicants electing to apply for this coverage must provide documentation of resources for the past 60 months in accordance with transfer of resource policies. (See RESOURCES TRANSFER OF ASSETS )

Local districts must inform SSI-related Medicaid applicants of the available coverage options and may require the applicant to sign a “Request for Medicaid Coverage” or an approved local equivalent, indicating the coverage choice an applicant made.

It is important that the applicant understand the eligibility determination process, including the effect that the documentation of resources options have on the services the SSI-related individual may receive. The applicant must also understand that it is his/her responsibility to keep the district informed of any change in his/her income and/or resources and the need for a service which s/he does not have coverage.

If a recipient has active community coverage (with or without long term care) and subsequently is admitted to a nursing facility, Supplement A must be completed and resource and trust documentation submitted for the appropriate time period(s).

If an SSI-related recipient who attested to his/her resources subsequently requests coverage for long-term care services, the date of the request shall be treated as the date of the new application for purposes of establishing the effective date and the three-month retroactive period for increased coverage. Districts must send the recipient a “Long-Term Care Change in Need Resource Checklist” and inform the recipient of the additional documentation that is needed to determine eligibility for long-term care.

(MRG)

(other-eligibility-requirements)(page-17)Page 17#

UPDATED: JUNE 2011

472

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

The applicant is advised of his/her right to have an agency conference or to request a fair hearing, as appropriate. The applicant is also notified of other services for which s/he may be eligible.

Verification: All factors relating to the eligibility determination are verified. These include, but are not limited to: identity; citizenship or alien status; family composition; residence; age; income from all sources; all resources of SSI-related applicants including savings and life insurance; and medical, accident and/or health insurance.

However, Medicaid and Family Health Plus applicants whose eligibility is determined without regard to resources may attest to the amount of interest income generated by resources.

Interest income is estimated by establishing the average interest rate(s) and applying them to the resource information obtained from RFI or other third party sources. If upon review, the district finds an inconsistency between the information reported by the individual and the estimate calculated by the district, and the interest income information obtained by the district makes the individual ineligible for Medicaid or FHPlus, documentation of the interest income must be obtained from the individual. For individuals who qualify for Medicaid with a spenddown, the difference in the amount of interest income reported by the recipient must be greater than $1.00 per month before requiring further follow-up.

The LDSS must contact the applicant to get additional information that is required to make an eligibility determination. Options for obtaining information include: calling the applicant to get information over the phone and notating and initialing it on the application and recording a note in the case record as to the date of the telephone conversation with the Applicant; if information is missing from the various sections of the application a photocopy of the incomplete pages may be mailed to the applicant to complete and return to the agency.

If the applicant is unable to provide the district with acceptable proof of (MRG)

(other-eligibility-requirements)(page-18)Page 18#

UPDATED: JUNE 2011

472.1

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

his/her eligibility, collateral sources are used to secure verification. By signing the application, the applicant agrees to an investigation confirming any information s/he provided. However, it may be necessary, due to district procedures or requirements of outside agencies, to have a separate consent form signed by the applicant before collateral sources are contacted and information verified.

NOTE: If an SSI-related Medicaid applicant attests to his/her resources, the local social services district may continue to independently verify the accuracy of the information provided by the applicant. However, the Medicaid eligibility determination cannot be delayed pending this verification.

If the applicant claims paid or unpaid medical bills for the three-month period prior to the month of application, eligibility for that period must also be established. This three-month period is retroactive from the month in which the person applied. There is no three-month retroactive period for Family Health Plus or the Family Planning Benefit Program (FPBP). When an applicant eligible for Family Health Plus or FPBP has medical bills within the three months prior to application, the bills can only be paid if there is an agency error or delay or the A/R is financially eligible for Medicaid during the three- month retroactive period and has met his/her spenddown.

NOTE: A person does not have to be living to have unpaid medical expenses covered by Medicaid. A representative may apply on behalf of the deceased person. Medical expenses may be paid for a deceased person, provided the person was eligible at the time the medical service was rendered. (MRG)

(other-eligibility-requirements)(page-19)Page 19#

UPDATED: JUNE 2011

473

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

When providing application assistance to an applicant who has brought his/her application to the local department of social services, the LDSS may offer to screen the application, but may not require that the application be screened. If during the screening the LDSS finds that the case will be ineligible/denied based on income, the district must continue to process the application, request income documentation and render a decision with proper notice.

Documentation: Sufficient to establish an audit trail:

Photocopies may be used. A primary source for eligibility documentation is any previous case record.

When citing documents, the date, issuing authority, file number and such pertinent data as necessary to determine authenticity must be recorded in the applicant's file.

Applicants must show original or certified copies of documents that document identity and citizenship. These documents may be presented at the LDSS to an FE, designated staff at an outreach site including deputized workers, or to designated staff at an entity in the community with which the LDSS has established a Memorandum of Understanding (MOU) for purposes of verifying that original documents have been seen. (It is not necessary for the LDSS to enter into a separate agreement from those that currently exist with entities such as community based organizations (CBOs) or plan FEs, family planning providers, presumptive eligibility qualified entities or Article 28 prenatal care providers.) Such community organizations will not validate the authenticity of the documents, nor will they determine if the identity and/or citizenship documentation requirement has been satisfied.

Local departments of social services must allow applicants at least 10 days to provide requested documentation. If an applicant is requested to provide documentation necessary to make an eligibility determination and does not do so within the required time period and does not ask for more time or assistance in obtaining documentation, his/her application may be denied.

(MRG)

(other-eligibility-requirements)(page-20)Page 20#

UPDATED: JANUARY 2011

474

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

NOTE: If an applicant seeking Medicaid coverage of nursing facility services does not meet a request for documentation deadline and the applicant is eligible for Medicaid coverage, QMB, SLIMB, or QI the case must be opened for the coverage for which the applicant is eligible.

If an application is submitted and all necessary information is included, an application must not be denied due to the failure to provide information that is inconsequential. For example: An application must not be denied if supporting documentation of a water expense or childcare expense is not submitted if the applicant can be determined eligible without this deduction.

The determination of eligibility is made promptly, generally within 45 days of the date of application. Determinations for persons eligible under the poverty-based programs (pregnant women and children under age 19) are completed within 30 days. Determinations of eligibility based on a disability are completed within 90 days. Under certain circumstances additional time may be required, such as when there is a delay on the part of the applicant, an examining physician or because of an administrative or other emergency that could not be controlled by the district.

NOTE: If the district is waiting for essential information, the reason for the delay is noted in the record. The applicant is notified by letter of the reason for the delay in his/her eligibility determination. Although the DOH-4220 asks the applicant to list a Client Identification Number (CIN) or an identification number from a plan card, if this information is not provided, the LDSS must not deny the application or request the information from the applicant.

Disposition: The eligibility worker reviews the application for completeness and accuracy. The LDSS must contact the applicant to obtain additional information that is needed to make an eligibility determination. If the application is being made through a facilitated enroller, the facilitated enroller does not forward the application to the district until the application is complete. (See OTHER ELIGIBLITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL FACILITATED ENROLLERS) When the applicant fails or refuses to provide information essential to the eligibility determination, s/he is informed in writing that his/her application is denied, the reasons for the denial and his/her right to a fair hearing.

NOTE: If a community applicant who is age 65 or older, certified blind (MRG)

(other-eligibility-requirements)(page-21)Page 21#

UPDATED: JANUARY 2011

475

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

or certified disabled, or not certified disabled is found eligible for Medicaid or FHPlus based on ADC-Related budgeting, eligibility cannot be denied based on the applicant’s failure to complete Supplement A. If an S/CC applicant is chronically ill and he/she failed to comply with a disability review or did not complete Supplement A, the applicant cannot be denied coverage if otherwise eligible for Medicaid under an S/CC budget or FHPlus.

If the LDSS believes that the applicant is the fiscal responsibility of another district, the LDSS where the individual is applying may take a “courtesy application” and forward it to the district of fiscal responsibility. The agreed upon district of fiscal responsibility shall obtain any information missing from the application.

NOTE: The date the first district received the application is protected as the date of application.

(See OTHER ELIGIBILITY REQUIREMENTS DISTRICT OF FISCAL RESPONSIBILITY (DFR))

Exception: When an applicant claims to have a disability or when it appears that an applicant may meet the criteria for disability, the district has 90 days from the date of application to make a determination of eligibility. This 90-day period is not used as a waiting period before granting assistance, if the applicant is eligible under a different category. Coverage is authorized as soon as eligibility is established. A note is made in the record as a reminder to re-budget the recipient, adjust any spenddown amounts and claim FP coverage for the retroactive period when the A/R is certified disabled. When it is necessary to hold a potential disability case beyond the 90-day period, this is not a basis for denying Medicaid to an otherwise eligible applicant or for terminating assistance.

(MRG)

(other-eligibility-requirements)(page-22)Page 22#

UPDATED: JANUARY 2012

476

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

FAMILY PLANNING BENEFIT PROGRAM (FPBP) APPLICATION

Policy: Local social services districts must determine FPBP eligibility for persons of childbearing age who are determined ineligible for Medicaid, and Family Health Plus. When a family or individual applies for Medicaid/ Family Health Plus and is determined ineligible, FPBP eligibility is determined for all applicants of child-bearing age. Children must be referred to CHPlus.

Persons can apply for the FPBP using the DOH-4282 and DOH 4286, FPBP application and instructions. When the application is for the Family Planning Benefit Program (FPBP) only, family planning providers and local county health departments can assist in the application process if the provider has a memorandum of understanding (MOU) with the district/SDOH. In addition, all Article 28 providers and others designated by the State Department of Health who have been trained must provide application assistance. Districts are encouraged to work with these entities to enter into MOUs, so that the application process can be facilitated. All applications taken by these family planning providers who have an MOU with the district will be forwarded to the local district for final eligibility determinations.

FPBP applicants must be informed, by the person who provides application assistance, of the benefits available under Medicaid, and Family Health Plus and of their right to apply for Medicaid and Family Health Plus. When the applicant’s reported income is at or below the Medicaid or Family Health Plus income standards, the individual/family is encouraged to apply for these programs and the application requirements are explained. After this discussion, if the applicant chooses to apply for the FPBP only, the applicant completes the Family Planning Benefit Program application (DOH-4282) and signs the “Declination of Medicaid and Family Health Plus Eligibility Determinations” statement on the back of the application. The applicant is advised that s/he may apply for Medicaid or Family Health Plus at any time in the future.

References: SSL

366(1) (a) (11)

ADMs

10 OHIP/ADM-4

03 OMM/ADM-2

02 OMM/ADM-7

INFs

10 OHIP/INF-1

(MRG)

(other-eligibility-requirements)(page-23)Page 23#

UPDATED: JUNE 2010

477

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

FAMILY PLANNING BENEFIT PROGRAM (FPBP) APPLICATION

Interpretation: Persons under the age of 21 who want to apply for family planning services only, are living with their parents, and do not have their parents' financial information complete the “Family Planning Benefit Program” application. This application is available at the LDSS, on the Internet, on the DOH website, and at an FPBP provider who has an MOU. (See INCOME FAMILY PLANNING BENEFIT PROGRAM (FPBP) BUDGETING METHODOLOGY for budgeting guidelines.) Adults who choose not to apply for Medicaid and Family Health Plus also use the Family Planning Benefit Program application.

When the applicant requests confidentiality, the applicant is instructed to write “confidential” in the margin and circle the mailing address, if different from the applicant’s residence address. However, if the application contains a different mailing address, and/or the “Yes” box is checked in answer to the question, “Do you need these services kept confidential?”, the application is treated as confidential, regardless of whether the applicant circled the mailing address or wrote “confidential” in the margin. Regular procedures regarding good cause claims must be followed.

Minors receiving Child Health Plus who have confidentiality concerns about using their Child Health Plus coverage for family planning services are allowed to enroll in FPBP, if otherwise eligible.

Medicaid and Family Health Plus recipients are not eligible for FPBP. These health care programs include family planning services.

Individuals who apply for Medicaid or Family Health Plus and are determined ineligible, have their eligibility determined for FPBP. Individuals who are financially eligible for FPBP, but who choose not to participate in FPBP, must be sent the appropriate notice to the confidential mailing address the A/R has provided if confidentiality has been requested.

(MRG)

(other-eligibility-requirements)(page-100)Page 100#

UPDATED: AUGUST 1999

541

OTHER ELIGIBILITY REQUIREMENTS LIVING ARRANGEMENTS

PUBLIC INSTITUTIONS

Description: A public institution is a non-medical facility that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. Public institutions do not include a community residence serving 16 or less residents; or a child care institution serving 25 or less residents. Policy: Medicaid cannot be provided to residents of non-medical public institutions, except when the public institution is:

• a shelter for homeless adults operated by a social services district, regardless of size;

• a correctional facility nursery. An infant/child residing in a correctional facility nursery while the mother is serving a prison term may receive Medicaid (See OTHER ELIGIBILITY REQUIREMENTS PUBLIC INSTITUTIONS INFANTS RESIDING WITH INCARCERATED MOTHERS);

• a public emergency shelter for homeless adults. Persons residing in a public emergency shelter for homeless adults may be eligible for Medicaid when the A/R is: in receipt of or eligible for S/CC; over the age of 18 and otherwise eligible; or SSI-related. However, an SSI-related A/R may be claimed FP for only six (6) months during a nine (9) month stay within 12 consecutive months. When the six months of federal participation expires, the SSI-related A/R may be claimed FNP. Persons residing in a family shelter are not subject to such categorical restrictions; or,

• a public home operated by a county. Residents of a county- operated public home may be eligible for Medicaid, without federal reimbursement.

References: SSL Sect.

365 366

Dept. Reg.

360-3.4(a)(1)

491.1-4 500.2 500.1

(MRG)

(other-eligibility-requirements)(page-101)Page 101#

UPDATED: AUGUST 1999

542

OTHER ELIGIBILITY REQUIREMENTS LIVING ARRANGEMENTS

PUBLIC INSTITUTIONS

ADMs

95 ADM-04 94 ADM-20 88 ADM-50 86 ADM-23 81 ADM-10 79 ADM-87

Interpretation: Except as listed above, Medicaid is not available to residents of non- medical public institutions.

In any month an otherwise eligible Medicaid recipient enters or leaves a public institution (in which Medicaid is not available), Medicaid may be authorized for only that portion of the month the individual is residing in the community (except as listed above).

(MRG)

(other-eligibility-requirements)(page-102)Page 102#

UPDATED: JUNE 2010

543

OTHER ELIGIBILITY REQUIREMENTS LIVING ARRANGEMENTS PUBLIC INSTITUTIONS

INFANTS RESIDING WITH INCARCERATED MOTHERS

Description: Certain correctional facilities operate nurseries for infants born to inmates. Children, born to women serving prison sentences, may live in the nursery for up to eighteen (18) months. This includes a standard twelve (12) month stay plus a possible 6 month extension if there is a reasonable probability that the mother will be released within the 18 months. In the event that the mother is not released within the allotted time, the child is placed in foster care or with relatives.

Policy: Infants and children residing in correctional facilities (where their mothers are incarcerated) are not considered "inmates" of a public institution and therefore may be eligible for Medicaid.

The child is an individual under age 21 and fulfills the requirements of one of the categories. (See CATEGORICAL FACTORS UNDER AGE 21) The child is budgeted as a household of one, residing in the community. After allowing appropriate disregards, the child's income is compared to the Medically Needy Income Level or Medicaid Standard (and MBL Living Arrangement Chart as appropriate), whichever is most beneficial.

The district in which the mother resided at the time of her sentencing is the district of fiscal responsibility for the child. The district of fiscal responsibility designates a person to review the application. The designated person may be a district employee or the district's Commissioner may enter into a Memorandum of Understanding (MOU) with the Superintendent of the facility, designating a correctional facility employee.

The mother of the child or the mother's representative must complete an application (See OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL) and submit it to the designated person at the correctional facility. The designated person reviews the application and forwards the application packet to the district of fiscal responsibility. The district of fiscal responsibility processes the application and determines the child's Medicaid eligibility.

The date of application is the date that a signed State-prescribed application form, a State-approved equivalent form or process is (MRG)

(other-eligibility-requirements)(page-103)Page 103#

UPDATED: JUNE 2010

544

OTHER ELIGIBILITY REQUIREMENTS LIVING ARRANGEMENTS PUBLIC INSTITUTIONS

INFANTS RESIDING WITH INCARCERATED MOTHERS

received by the designated person. Eligibility may be established for up to three (3) months prior to the month of application. (See OTHER ELIGIBILITY REQUIREMENTS AUTHORIZATION)

However, Medicaid cannot be authorized for the period prior to the child's birth.

References: SSL Sect. 65

366

Dept. Regs. 369.1 & .2

360-2.2

ADMs OMM/ADM 97-1

95 ADM-04

Interpretation: Completed applications are forwarded to the district of fiscal responsibility by the designated person at the correctional facility.

The child's eligibility is determined as if s/he resided in the community, as a household of one.

(MRG)

(other-eligibility-requirements)(page-104)Page 104#

UPDATED: JANUARY 2012

545

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS

Description: Medicaid coverage must be suspended for recipients incarcerated in a New York State Department of Correctional Services or local correctional facility and reinstated at the time of release from such facility.

Policy: An inmate of a State Department of Correctional Services or local correctional facility that was in receipt of Medicaid immediately prior to incarceration shall have eligibility maintained during incarceration. In addition, Medicaid coverage must be reinstated upon release from the correctional facility.

References: SSL Sect.

366 (1-a)

Dept. Regs. 360-3.4 (a) (1) 360-3.4 (c)

ADMs

08 OHIP/ADM03

LCMs

08 OHIP/LCM-1

GISs

11 MA/20

11 MA/010

09 MA/010

Interpretation: Suspension of Medicaid:

Medicaid must be suspended for Case Type 20 (MA) recipients and single individuals in a Case Type 22 who are expected to be incarcerated for at least 30 days and who at the time of incarceration have one of the following Coverage Codes: 01 (Full), 02 (Outpatient), 06 (Provisional), 10 (Anciliary Coverage Due to Prohibitive Transfer), 11 (Legal Alien), 15 (Perinatal), 18 (Family Planning Services Only), 19 (Community Coverage With Community-Based Long-Term Care), 20 (Community Coverage Without Long-Term Care), 22 (Outpatient Coverage Without Long-Term Care), 21 (Outpatient Coverage With Community-Based Long-Term Care), 23 (Outpatient Coverage With No Nursing Facility Services), 24 (Community Coverage Without Long- Term Care, Legal Alien During Five-year Ban, NYC only), and 30 (Pre- paid Capitation Plan). Also, Family Health Plus (FHPlus) coverage will be suspended for Case Type 24 (FHPlus) recipients who at the time of incarceration have Coverage Code

(MRG)

(other-eligibility-requirements)(page-105)Page 105#

UPDATED: JANUARY 2012

546

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS

06 (Provisional, not yet enrolled, Upstate only), Coverage Code 20 (Community Coverage Without Long-Term Care) or 34 (FHPlus).

NOTE: Districts are advised to call their local district liaison for further instructions when an individual with Coverage Code 10 or 23 becomes incarcerated.

In situations where the incarcerated individual was part of a multi- person household, a determination of the remaining household’s ongoing eligibility must be performed utilizing the following guidelines:

• Permanent Absence- When a recipient is incarcerated in a New York State Department of Correctional Services (DOCS) facility, the individual shall be considered permanently absent from the household. • Temporary Absence- When a recipient is incarcerated in a local correctional facility (jail), the individual shall be considered temporarily absent unless the district has information that the absence will be permanent.

NOTE: Medicaid will be suspended for Case Type 22 recipients (MA- SSI) by the State utilizing information from the New York State Department of Corrections and Community Supervision and the New York State Division of Criminal Justice Services.

Incarcerated individuals whose Medicaid or FHPlus has been suspended and who are subsequently released to a New York State local correctional facility, an Office of Mental Health (OMH) facility or Office of Children and Family Services (OCFS), formerly known as the Division for Youth (DFY), facility or other agency must have their eligibility for Medicaid continued in suspend status.

Discontinuation of Medicaid:

1. At incarceration MA Coverage must be discontinued for recipients with Coverage Code 07 (Emergency Services Only). 2. In addition, individuals with Coverage Code 31 or 36 (Active for Guarantee Coverage Only) must have their managed care guarantee coverage discontinued with appropriate notice. 3. At incarceration, Medicaid coverage and the premium payment must be discontinued for Case Type 20 and single Case Type 22 recipients

(MRG)

(other-eligibility-requirements)(page-106)Page 106#

UPDATED: NOVEMBER 2009

547

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS

who are expected to be incarcerated at least 90 days who at incarceration have Coverage Code 09 (Medicare Savings Program) or Coverage Code 17 (COBRA, AHIP and third-party health insurance), because Medicaid payment of these premiums is not cost effective. However, Case Type 20 (MA) recipients with Coverage Code 09 who are participating in the spenddown program must have their case suspended and their premium payment discontinued.

NOTE: It may not be appropriate to discontinue health insurance premium payments if the policy covers other household members.

Medicaid and FHPlus must be discontinued with appropriate notice for recipients who are incarcerated out-of-state or in a federal penitentiary within New York State.

Incarcerated individuals who are released to the federal government, other state law enforcement, immigration or who are deceased must have their Medicaid discontinued with appropriate notice.

Re-Instatement of Medicaid

Upon notification from DOCS or a Local Correctional Facility that an individual whose Medicaid or FHPlus authorization had been placed in suspend status, and is being released to Parole or has completed his/her sentence without community supervision, Medicaid coverage must be re-instated in the district where the releasee had coverage immediately prior to incarceration. Coverage will begin on the first day of the release month and continue for the following four months.

Released to the Community Without Supervision

If a formerly incarcerated recipient who has been released to the community without supervision contacts the LDSS with a change of address, the LDSS must update the recipient’s address on WMS to ensure that the renewal packet will be mailed to the correct address. If the new address is in another district, the case must not be transferred to the new district until the five-month reinstatement period has expired, the renewal process has been (MRG)

(other-eligibility-requirements)(page-107)Page 107#

UPDATED: NOVEMBER 2009

548

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS

completed and a determination of ongoing eligibility is made pursuant to 08 OHIP/LCM-1,”Continued Medicaid Eligibility for Recipients Who Change Residency (Luberto v. Daines)”.

The LDSS where the former inmate had coverage immediately prior to the incarceration must issue the mail-in renewal packet to the former inmate at the address on WMS. For recipients who have been released from a New York State Department of Correctional Services (NYS DOCS) facility to the community without supervision, the address listed on WMS will be a NYS DOCS facility. If the recipient has not contacted the LDSS with an updated address, the mail-in renewal packet must be mailed to the former inmate at NYS DOCS facility address found on WMS.

Released to the Community With Parole Supervision

The address of parolees released from a NYS DOCS facility will automatically be posted to WMS as that of his/her parole officer. If a parolee informs the LDSS of a change of address, the LDSS may record the address change in the case record but must not update the recipient’s address on WMS or transfer the case (if there is an out of county move) until the five-month reinstatement period has expired, the renewal process has been completed and the recipient is determined to be eligible.

The LDSS where the former inmate had coverage immediately prior to the incarceration must issue the mail-in renewal packet to the former inmate at the address of his/her Parole Officer listed on WMS. Such Parole Officer will provide the mail-in renewal packet to the parolee as soon as possible.

Mail-In Renewal Returned to District With Out-of County Address

In cases where the mail-in renewal is returned to the district with an out-of-county address, the district must determine ongoing eligibility for the former inmate, and if eligible, the district will authorize coverage for the usual 12 month period. Once coverage has been authorized, the district may transfer the case to the new district of residence pursuant to procedures outlined in 08 OHIP/LCM-1.

If the district determines the individual is ineligible for Medicaid or FHPlus as a result of the renewal the coverage shall be discontinued with appropriate notice.

(MRG)

(other-eligibility-requirements)(page-108)Page 108#

UPDATED: NOVEMBER 2009

549

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS

Releasee Residing with Family Members

In situations where the releasee is residing with family members, his/her ongoing eligibility shall be redetermined at renewal, after the five month reinstatement period, as a member of the household. If the releasee is a member of a currently eligible Medicaid/FHP household, eligibility for the other household member(s) shall also be reviewed.

(MRG)

(other-eligibility-requirements)(page-109)Page 109#

UPDATED: JANUARY 2012

549.1

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIDUALS ADMITTED TO A PSYCHIATRIC CENTER

Description: Generally, Medicaid coverage must be suspended for recipients age 21-64 admitted to a psychiatric center and reinstated at the time of release from such facility.

Policy: When a district is notified that a Medicaid recipient age 21-64 is a resident of a psychiatric center, the district must suspend Medicaid coverage, barring certain exceptions. Upon notification of discharge from the psychiatric center, Medicaid coverage must be reinstated in the district of fiscal responsibility immediately prior to admission.

NOTE: Districts will be notified of admissions and discharges from State Operated Psychiatric Centers by the State Department of Health in conjunction with the Office of Mental Health (OMH). However, should a district become aware that an individual age 21-64 has entered a private (non-state operated) psychiatric hospital, Medicaid coverage must also be suspended and re-instated.

References: SSL Sect.

365.2 (a) & (b)

366 (1) (c) & (d)

Dept. Regs. 360-3.4 (a) (2)

ADMs

11 OHIP/ADM-3

INFs

89 INF-43

Interpretation: Suspension of Medicaid:

On a monthly basis DOH will run a file provided by OMH to identify individuals age 21-64 who have been in a State psychiatric center for at least 30 days and have an active Medicaid/FHPlus case.

Medicaid must be suspended for Case Type 20 (MA) recipients with one of the following Coverage Codes: 01 (Full), 02 (Outpatient), 06 (Provisional), 10 (All Services Except Nursing Facility Services), 11 (Legal Alien), 15 (Perinatal), 18 (Family Planning Services Only), 19 (Community Coverage With Community-Based Long-Term Care), 20 (Community Coverage Without Long-Term Care), 22 (Outpatient Coverage Without Long-Term Care), 21 (Outpatient Coverage With Community-Based Long-Term Care), 23 (Outpatient Coverage With No Nursing Facility Services), 24 (Community Coverage Without Long- Term Care, Legal Alien During Five-year Ban, NYC only), and 30 (Pre- paid Capitation Plan). Also, Family Health Plus (FHPlus) coverage will (MRG)

(other-eligibility-requirements)(page-110)Page 110#

UPDATED: JANUARY 2012

549.2

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIDUALS ADMITTED TO A PSYCHIATRIC CENTER

be suspended for Case Type 24 (FHPlus) recipients who at the time of admission have Coverage Code 06 (Provisional, not yet enrolled, Upstate only), Coverage Code 20 (Community Coverage Without Long-Term Care) or 34 (FHPlus).

In situations where the individual was part of a multi-person household, a determination of the remaining household’s ongoing eligibility must be performed. The psychiatric center resident shall remain in the household count unless the district receives notification from OMH that the resident’s stay is other than temporary.

Medicare Part A and /or B premium payments and payments for third- party health insurance coverage must be discontinued and the Buy-In closed. If the individual is enrolled in a managed care plan, he/she must be dis-enrolled. NOTE: It may not be appropriate to discontinue payment of third-party health insurance premiums which cover other Medicaid/FHPlus household recipients.

Medicaid coverage will not be suspended for Temporary Assistance (TA)/Medicaid recipients if the individual continues to receive TA benefits based on the individual’s temporary admission to a psychiatric center. For these individuals, Medicaid coverage will continue. Also, Supplemental Security Income (SSI) beneficiaries will continue to receive Medicaid coverage based on the receipt of SSI.

Exceptions to Suspension:

1. Medicaid Coverage must be discontinued for recipients with Coverage Code 07 (Emergency Services Only). 2. Individuals with Coverage Code 31 or 36 (Active for Guarantee Coverage Only) must have their managed care guarantee coverage discontinued with appropriate notice. 3. Individuals authorized for Medicare Savings Program (coverage code 09) must have their coverage discontinued. 4. Individuals with coverage code 17, Health Insurance Continuation Only- COBRA, AHIP must have their coverage discontinued. NOTE: If the COBRA/AHIP policy covers other eligible household members, it may not be appropriate to discontinue payment of health insurance premiums.

(MRG)

(other-eligibility-requirements)(page-111)Page 111#

UPDATED: JANUARY 2012

549.3

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIDUALS ADMITTED TO A PSYCHIATRIC CENTER

5. Case Type 20 (MA) recipients with Coverage Code 09 who are participating in the spenddown program must have their case suspended and their premium payment discontinued. Recipients who have been authorized for MSP-only must have their MSP Buy-in span end-dated in eMedNY.

Re-Instatement of Medicaid

Upon notification from DOH/OMH that an individual whose Medicaid or FHPlus authorization had been placed in suspend status is being discharged from the psychiatric center such individual must have their Medicaid coverage reinstated with the coverage they had immediately prior to their admission to the psychiatric center. Medicaid coverage must be reinstated for five months (the month of discharge, plus four months) with appropriate notice at the individual’s current address.

In situations where the releasee is residing with family members who are not in receipt of Medicaid or FHPlus, his/her ongoing eligibility shall be redetermined at renewal as a member of the household, after the five month reinstatement period. If the releasee is a member of a currently eligible Medicaid/FHP household, eligibility for the other household member(s) must be reviewed at renewal.

Exceptions to Re-Instatement

1. Medicaid eligibility must be redetermined for individuals who are being discharged to an SNF. While a new application is not required, Supplement A to the DOH-4220 is required if resource information must be captured.

2. Coverage for individuals who are being discharged to the custody of the United States Immigration and Customs Enforcement (ICE) must be discontinued.

3. Individuals who are being discharged to a NYS or local correctional facility will continue to have their coverage suspended.

4. Coverage must be discontinued for individuals who are being discharged to another state’s law enforcement.

5. Coverage for individuals who are being discharged to the Federal Bureau of Prisons must have their coverage discontinued. (MRG)

(other-eligibility-requirements)(page-112)Page 112#

UPDATED: JANUARY 2012

549.4

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIDUALS ADMITTED TO A PSYCHIATRIC CENTER

6. Coverage for individuals who are being discharged to an OMH operated living arrangement (i.e. a State operated family care home, community residence or residential care center for adults) must be discontinued. Once the county case is closed, OMH will open a case in District 97.

7. Coverage must be discontinued for individuals who have died in the psychiatric center.

8. The DFR prior to admission to the psychiatric center must discontinue coverage for individuals who turn 65 and remain in the psychiatric center. Once the district closes its case, OMH will determine eligibility for the individual.

9. Coverage for an individual discharged to an Office for People with Developmental Disabilities (OPWDD) must be discontinued. Once the district has closed its case, OPWDD will open a case in District 98.

10. Medicaid and FHPlus must be discontinued for individuals who have moved to another state.

11. Medicaid and FHPlus must be discontinued for individuals who are discharged to an out-of-state psychiatric center.

(MRG)

(other-eligibility-requirements)(page-113)Page 113#

UPDATED: NOVEMBER 2007

550

OTHER ELIGIBILITY REQUIREMENTS

LEGALLY RESPONSIBLE RELATIVES (LRRs)

Description: A legally responsible relative is a person who is legally responsible for the support and care of one or more relatives.

Policy: For Medicaid purposes, a legally responsible relative is:

• a spouse of a Medicaid A/R; or

• a parent of a child under the age of 21. However, the income and resources of a parent will not be considered in the determination of eligibility of a pregnant minor. In addition parental income/resources are not considered in the determination of eligibility of a certified blind or certified disabled child who is:

• 18 years of age or older;

• under the age of 18, but expected to be living separately from the parental household for 30 days or more; or

• participating in one of the home and community-based waivered programs provided pursuant to Section 1915(c) of the Social Security Act where the income/resources of the parents or step-parents are not considered in the determination of eligibility for the child.

References: SSL Sect.

101 366

Dept. Reg.

360-1.4(h) 360-4.3(f)

ADMs

OMM/ADM 97-2 89 ADM-47

GISs

00 MA/021

91 MA/007

(MRG)

(other-eligibility-requirements)(page-114)Page 114#

UPDATED: NOVEMBER 2007

551

OTHER ELIGIBILITY REQUIREMENTS

LEGALLY RESPONSIBLE RELATIVES (LRRs)

Interpretation: When an A/R is living with a legally responsible relative (LRR), the LRR's income and resources are generally considered available to the A/R.

When an A/R is residing in the community with an LRR and the LRR asserts that his/her income/resources are not available to the A/R, the eligibility determination depends on whether: (a) the LRR

(MRG)

(other-eligibility-requirements)(page-115)Page 115#

UPDATED: JUNE 2010

552

OTHER ELIGIBILITY REQUIREMENTS

LEGALLY RESPONSIBLE RELATIVES (LRRs)

provides financial information; or (b) the LRR refuses to provide the requested financial information.

(a) When the LRR provides information, but refuses to make his/her income/resources available to the A/R, eligibility for the A/R is determinable. When completing a budget, only the income/resources, as appropriate, actually available to an A/R are counted.

(b) When the LRR refuses to provide financial information, eligibility is generally indeterminable. However, if the A/R provides complete information concerning his/her own income and resources, as appropriate, including any jointly held resources, eligibility is determined based on the available information.

A dollar amount is budgeted for any non-medical needs that the LRR is meeting. For example, the LRR may be providing the A/R with food, shelter, and clothing. The value of these items would be considered income. The non-contributing LRR is not included in the household size.

If Medicaid is provided because of the failure or refusal of an LRR to make income and resources available, an implied contract is created with the non-contributing LRR. Recovery for the cost of any care provided may be pursued through legal channels.

NOTE: The income/resources of parents are not considered in the eligibility determination for their pregnant daughters (of any age), regardless of where the pregnant daughter resides.

(MRG)

(other-eligibility-requirements)(page-116)Page 116#

UPDATED: JUNE 2010

553

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs)

SPOUSE

Description: A spouse is an A/R's legal husband or wife. (See definitions in the GLOSSARY) A spouse is a legally responsible relative (LRR). A spouse may be of either sex.

Policy: The spouse of an individual in need of Medicaid, if of sufficient financial ability, is responsible for that person's medical needs. (See RESOURCES THIRD PARTY RESOURCES for utilization of third party health insurance benefits.)

References: SSL Sect. 101

366(3)(a)

Dept. Reg. 360-1.4(h)

360-4.3(f)

360-4.10

360-7.11(b)(ii)

ADMs OMM/ADM 97-2

91 ADM-37

91 ADM-31

90 ADM-29

89 ADM-47

82 ADM-20

82 ADM-6

GISs

08 MA/024

08 MA/023

Interpretation: Spouses Living Together When an A/R is living with his/her spouse, the spouse's income and resources are generally considered available to the A/R (See OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION and OWNERSHIP AND AVAILABILITY for budgeting methodologies and availability).

When the spouse asserts that his/her income/resources are not available to the A/R, the eligibility determination depends on whether: (a) the spouse provides financial information; or (b) the spouse refuses to provide the requested financial information. In both instances, at a minimum, a notation is entered into the case record. (See OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES for general treatment of legally responsible relatives.

(MRG)

(other-eligibility-requirements)(page-117)Page 117#

UPDATED: JUNE 2010

554

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs)

SPOUSE

Spouses Living Apart in the Community

When an A/R is residing in the community apart from his/her spouse who is also residing in the community, the spouse may be requested to contribute toward the cost of medical care provided to the A/R. The amount of the requested contribution depends on the spouse’s financial ability to support and the category of the A/R.

To determine the amount of the requested contribution from a spouse residing in the community, but not in the A/R's household:

• when there is a child in the household under the age of 21, the case is referred to the Child Support Enforcement Unit (IV-D);

• when the A/R is S/CC, local district Public Assistance procedures determine the contribution; or

• when the A/R is SSI-related, the spouse is requested to contribute twenty-five percent (25%) of his/her otherwise available income which exceeds the minimum monthly maintenance needs allowance (MMMNA), plus any family member allowance(s). (See RESOURCES PERSONS IN MEDICAL FACILITIES COMMUNITY SPOUSE and RESOURCES FAMILY MEMBER ALLOWANCE)

The local district requests the LRR other than a community spouse to contribute any excess resources, as appropriate, to the support of the Medicaid A/R. Only the income/resources, as appropriate, actually received from a spouse not residing in the A/R's household are counted when determining eligibility.

When the spouse asserts that his/her income/resources are not available to the A/R, at a minimum, a notation is entered into the case record.

Institutionalized Spouse with a Community Spouse

When an A/R is an institutionalized spouse and his/her spouse is a community spouse, spousal budgeting rules determine the (MRG)

(other-eligibility-requirements)(page-118)Page 118#

UPDATED: JANUARY 2009

555

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs)

SPOUSE

treatment of the couple’s income and resources. See INCOME PERSONS IN MEDICAL FACILITES ASSESSMENT/ DETERMINATION OF INCOME AVAILABLE FOR THE COST OF CARE for the full explanation of the assessment and budgeting of income/resources.

If Medicaid is provided, in the instance of failure or refusal, an implied contract is created with the non-contributing spouse. Recovery of the cost of any care provided may be pursued through legal channels.

Both Spouses Institutionalized

When both spouses are institutionalized they are treated as two separate households, whether or not they share a room.

Institutionalized Waiver Participant with a Community Spouse

When one spouse is a waiver participant and his/her spouse is a community spouse, spousal budgeting rules as specified in INCOME PERSONS IN MEDICAL FACILITIES BUDGETING FOR INSTITUTIONALIZED SPOUSES IN SPECIFIED HOME AND COMMUNITY BASED WAIVERS (HCBS) are applied.

(MRG)

(other-eligibility-requirements)(page-119)Page 119#

UPDATED: AUGUST 1999

556

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs)

PARENTS AND CHILDREN

Description: A child is a person under the age of 21. Generally, parents are legally responsible for their children under the age of 21.

Policy: A parent of a child under the age of 21 is legally and financially responsible for his/her child. However, the income and resources of a parent will not be considered in the determination of eligibility of a pregnant minor. In addition parental income/resources are not considered in the determination of eligibility of a certified blind or certified disabled child who is:

• 18 years of age or older; • under the age of 18 but expected to be living separately from the parental household for 30 days or more; or • participating in one of the home and community-based waivered programs provided pursuant to Section 1915(c) of the Social Security Act where the income/resources of the parents or step-parents are not considered in the determination of eligibility for the child.

References: SSL Sect.

101 366

Dept. Reg.

360-1.4(h) 360-4.3(f)

ADMs

OMM/ADM 97-2 82 ADM-6

LCM

95 LCM-106

GIS

91MA007

Interpretation: Generally, parents, including adoptive and step-parents (See OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES PARENTS AND CHILDREN STEP-PARENTS), are financially and legally responsible for their children under the age of 21. However, the income/resources of the parent or step-parent are not considered in the eligibility determination if the child is pregnant. In addition parental income/resources are not considered in the determination of eligibility of a certified blind or certified disabled child who meets one of the criteria specified above. (MRG)

(other-eligibility-requirements)(page-120)Page 120#

UPDATED: JUNE 2010

557

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs)

PARENTS AND CHILDREN

The income/resources of parents are counted in the determination of eligibility for certified blind/disabled child(ren) under the age of 18, unless the child is living or expected to be living separate and apart from the parent(s) for 30 days or more. Even though the child returns to the household in less than 30 days, if s/he was expected to be absent for 30 days, the income/resources of his/her parents are not considered in the eligibility determination for the child during the entire 30 days s/he was expected to be absent.

The income/resources of parents are considered in the eligibility determination for their certified blind/disabled child(ren). If the child is participating in one of the home and community-based waivered programs provided pursuant to Section 1915(c) of the Social Security Act the income/resources of the parents or step-parents are not considered in the determination of eligibility for the child.

The income/resources of parents are not considered in the eligibility determination for their pregnant daughters (of any age), regardless of where the child resides.

When the child's parent is absent from the household, a referral is made to the Child Support Enforcement Unit (IV-D). IV-D will pursue the absent parent for medical support and paternity establishment as appropriate.

Only the income/resources, as appropriate, actually received (from his/her absent parent) by an A/R are counted when determining eligibility.

See OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) for the general treatment of legally responsible relatives.

See OTHER ELIGIBILITY REQUIREMENTS OWNERSHIP AND AVAILABILITY for treatment of a non-cooperative parent residing with the A/R.

See OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES PARENTS AND CHILDREN STEP- PARENTS when the child has a step-parent.

Verify Status: When there is a certified blind/disabled or pregnant child in the household. (MRG)

(other-eligibility-requirements)(page-121)Page 121#

UPDATED: JUNE 2010

558

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs)

PARENTS AND CHILDREN

Documentation: (a) Certificate of blindness/disability.

(b) Proof of absence or expected absence of a certified blind/disabled child, such as a doctor's statement.

(d) Participation in a home and community-based waiver program where parental income/resources are not considered in the determination of eligibility.

(MRG)

(other-eligibility-requirements)(page-122)Page 122#

UPDATED: JUNE 2010

559

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

ABSENT PARENTS

Description: Absent parents are legally responsible for their children under the age of 21. Policy: Generally, the income of parents is considered in the eligibility determination of children under the age of 21. The income/resources of the parents of a pregnant minor are not considered in the determination of eligibility regardless of where the pregnant minor resides.

References: SSL Sect. 101

366

Dept. Reg. 360-1.4(h)

360-4.3(f)

360-7.11(b)(iii)

ADMs OMM/ADM 97-2

89 ADM-47

INFs

07 OHIP/INF-1

Interpretation: The income actually contributed by an absent parent is considered in the determination of eligibility. A referral is made to the Child Support Enforcement Unit (IV-D) to determine the amount of any contribution, medical support, paternity and any appropriate recovery.

In situations of evenly shared (physical and legal) custody of a child(ren) the child’s eligibility is determined using the parental income of the applying household and the child’s own income, if any. Child support payments count as income to the applying household that is in receipt of the payment and the payment is subject to the $100 child support disregard. If the child(ren) would be eligible in both parent’s separate households, the child’s Medicaid is authorized in the case of the household that applies first.

(MRG)

(other-eligibility-requirements)(page-123)Page 123#

UPDATED: NOVEMBER 2007

560

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

EMANCIPATED MINOR

Description: For Medicaid purposes, an emancipated minor is a person who: is age 16 or over; has completed his/her compulsory education; is living separate and apart from his/her family; and not in receipt of or in need of foster care.

Policy: Medicaid may be authorized for an emancipated minor who is otherwise eligible.

References: Dept. Reg.

349.5

Interpretation: When a child leaves his/her family household to live on his/her own, the child, if otherwise eligible, may receive Medicaid on his/her own behalf. This child must fulfill the requirements of an emancipated minor by being age 16 or over, having completed compulsory education, and living away from home and not in need of foster care.

The parents of an emancipated minor are legally responsible relatives for him/her. The parental liability for support should be established (See OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES PARENTS AND CHILDREN IV-D REQUIREMENTS) by an appropriate referral to the Child Support Enforcement Unit (IV-D) for medical support and paternity establishment as appropriate.

(MRG)

(other-eligibility-requirements)(page-124)Page 124#

UPDATED: JUNE 2010

561

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

Description: Title IV Section D (IV-D) of the Social Security Act was established to: secure and enforce child support and medical support from absent parents; establish paternity when necessary; and to provide a parent locator service. For more detailed information regarding IV-D refer to the Public Assistance Source Book, Section VIII-T.

Policy: Generally, a Medicaid household including a child under the age of 21, whose parent is absent from the home, must as a condition of eligibility meet the requirements to secure medical support and establish paternity, unless good cause not to cooperate exists OR they are otherwise exempt. Not all IV-D requirements apply to the Medicaid program; pursuit of cash support is not a requirement for Medicaid A/Rs.

NOTE: In situations of equally (50-50) shared custody of a child(ren) a referral to the Child Support Enforcement Unit (CSEU) should be made except when good cause is established, they are otherwise exempt, or instances where medical support/health insurance is already being provided. The referral would be made for the parent that does not reside in the household in which the child receives Medicaid unless they are otherwise exempt.

Cases to refer to IV-D: • MA cases that include a child under the age of 21 with an absent parent, and/or for whom paternity has not yet been established, provided the case does not meet the exemption criteria, shall be referred to the CSEU. At no time during a women’s pregnancy shall a referral be made for the pregnant woman or her children. Referrals are made after the end of the month of the 60 day post-partum period. ; Cases exempt from referral to IV-D: • Child-only MA cases for all children under the age of 21, including children living on their own and children in receipt of SSI; • Parents or step-parents who already provide health insurance and/or cash medical support for the child for whom paternity has already been established regardless of living arrangements; (MRG)

(other-eligibility-requirements)(page-125)Page 125#

UPDATED: JUNE 2010

562

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

• Intact households in which both parents (married or unmarried) reside together with their common children; however, a referral may be made for the establishment of paternity; • Transitional medical assistance (TMA) recipients; deceased absence parent; • A child released for or pending adoption; • When good cause is claimed by the A/R at any time during the application, determination or authorization period, until the final good cause determination is completed. If good cause is found to exist, the non-referral status continues until the reason for good cause no longer exists; and • Any case where the parents’ income and resources are not used in determining eligibility for the child, such as: o A child participating in one of the community-based waiver programs; o A pregnant minor o A certified blind or certified disabled child 18 years of age or older, or if under age 18, expected to be living separately from the parents’ household for at least 30 days; o A child who chooses to apply for, and/or is in receipt of family planning benefits only (coverage code 18); or o IV-E adoption children. (MRG)

(other-eligibility-requirements)(page-126)Page 126#

UPDATED: JUNE 2010

563

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

Under the Family Court Act (FCA), support orders must require legally responsible relatives to make use of any health insurance coverage available to cover the child on whose behalf a child support petition is brought. The cost of providing such health insurance for the child is prorated between the parents.

If neither parent has health insurance available, the FCA requires the court to direct the custodial parent to apply for Medicaid or Child Health Plus for the child. If the child is eligible for one of those programs, the parents’ obligation is to pay the cost of any required premium or family contribution, such as co-payments, that are the responsibility of the recipient under the Medicaid or Child Health Plus programs, which cost shall be prorated between the parents. The court also has the ability to order cash medical support when no health insurance is available by applying a formula.

A direction by the court to seek Medicaid or Child Health Plus for the child does not eliminate the parents’ obligation to utilize for the child’s benefit any health insurance coverage that may subsequently become available.

References: SSL Sect.

111

366.3

366.4(h)

367-a.2(b)

Dept. Reg.

369.2(b)

360-4.3(f)

360-7.11

441.2 (MRG)

(other-eligibility-requirements)(page-127)Page 127#

UPDATED: JUNE 2010

564

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

ADMs

99 ADM-5

92 ADM-40

89 ADM-47

89 ADM-23

INFs

07 OHIP/INF-1

90 INF-45

GIS

08 MA/031

Interpretation: The eligible parent or other caretaker/relative of a child under the age of 21 whose parent is absent from the home must meet the following IV-D requirements, for medical support only unless it is a child-only MA case:

Cooperate in good faith with the State and the local social services district to establish the paternity of a child born out of wedlock, to locate any absent parent or putative father and to establish, modify, and enforce support orders.

The term “cooperation” includes providing information for the A/R to complete the DSS-2860, Child Support Referral form and, if required, appearing at the local Child Support Enforcement Unit (CSEU) to be interviewed. A Medicaid applicant who is not pregnant or in the 60 day postpartum period or otherwise exempt must assist in completing the DSS-2860 appear at the CSEU, as necessary, and cooperate with the CSEU unless good cause not to cooperate is found to exist.

A Medicaid recipient’s continued cooperation with the CSEU is prerequisite to his or her ongoing eligibility to receive Medicaid. An A/R’s Medicaid eligibility is not delayed or denied, however, if the A/R is complying but, through no fault of the client, the IV-D process has not been completed.

(MRG)

(other-eligibility-requirements)(page-128)Page 128#

UPDATED: JUNE 2010

565

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

The local district:

(1) mails or provides all client books at application and recertification, including Client Information Book I (DSS- 4148A), which addresses clients’ rights and responsibilities regarding child support;

(2) advises all Medicaid-Only A/Rs in writing via the DOH-4220 (ACCESS NY application), unless they are otherwise exempt, that, as a condition of initial and ongoing eligibility, they will be required to cooperate in:

(a) obtaining third party health insurance (TPHI) and medical payments for themselves and any other individuals for whom the Medicaid-Only A/R can legally assign rights;

(b) establishing paternity of a child born out of wedlock for whom the Medicaid-Only A/R can legally assign rights; and

NOTE: Pregnant women should not be referred to the CSEU until after the 60-day post partum period. To the extent possible, prior to such referral, local districts continue to pursue the availability of TPHI. If a pregnant minor does not want her parents contacted, however, TPHI is not pursued. All other Medicaid-Only A/R’s must cooperate in establishing paternity and securing medical support.

An A/Rs failure, without good cause or other exemption, to cooperate renders such person ineligible for Medicaid. Their children under age 21, however, are authorized to receive Medicaid if they are otherwise eligible;

(MRG)

(other-eligibility-requirements)(page-129)Page 129#

UPDATED: JUNE 2010

566

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

(3) Medicaid worker or an appropriate designee determines whether an A/R who claims to have good cause for refusing to cooperate does have good cause that can be verified.

(4) refers to the CSEU cases which include a non-pregnant child under age 21 whose paternity has not been established or whose parent(s) are absent from the home unless they are in a child-only MA case. Mails or provides the DSS-2860 form and informs A/Rs who are required to appear in the CSEU that they must bring the completed DSS-2860 to their CSEU interview. Applicants are referred to the CSEU prior to their eligibility determination or, if practicable, prior to their eligibility interview;

(5) obtains necessary documentation from A/Rs;

(6) takes appropriate action (notices and procedures) when notified by CSEU via the DSS-2859, Child Support Information Transmittal that an A/R who is not pregnant has failed to cooperate.. The A/R’s children are not denied or discontinued from Medicaid for this reason;

(7) takes appropriate action in Medicaid cases reported in the IV- D/Medicaid Interface Report and in DSS-2859 referrals from the CSEU. The weekly IV-D/IV-A Interface Report provides information to Medicaid workers about status changes in child support cases, including location of absent parents, paternity establishment, support order actions and third party health insurance coverage; (MRG)

(other-eligibility-requirements)(page-130)Page 130#

UPDATED: JUNE 2010

567

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

(8) responds to CSEU requests for Medicaid eligibility and payment information via the OHIP-0030, Medicaid Medical Support Transmittal;

(9) at recertification and other client contacts, asks recipients for new and changed information about absent parents, forwards information to the CSEU via the OHIP-0030 form; and

(10) budgets child support as unearned income in a Medicaid- Only case with the $100 child support disregard.

The local district informs the A/R that s/he has a right to claim good cause as an exception to the cooperation requirement. The A/R may refuse to meet any or all of the IV-D requirements when s/he has good cause to do so. The following circumstances are considered good cause:

(1) when cooperation may be against the best interests of the child. Cooperation in establishing paternity or seeking support is deemed to be against the best interest of the child only if the A/R's cooperation in establishing paternity or securing support is reasonably anticipated to result in:

• physical harm to the child for whom support is sought;

• emotional harm to the child for whom support is sought;

• physical harm to the parent or caretaker relative with whom the child is living;

• emotional harm to the parent or caretaker relative with whom the child is living;

(2) the child for whom support is sought was conceived as a result of incest or forcible rape;

(3) legal proceedings for the adoption of the child are pending before a court of competent jurisdiction; or

(MRG)

(other-eligibility-requirements)(page-131)Page 131#

UPDATED: JUNE 2010

568

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

IV-D REQUIREMENTS

the A/R is currently being assisted by an authorized agency (LDSS or a voluntary agency) to resolve the issue of whether to parent the child or place him/her for adoption,

(4) and discussions have not gone on for more than three months.

If an A/R refuses to meet the IV-D requirements and s/he cannot show good cause, s/he is denied Medicaid.

Documentation: An A/R who claims good cause must provide corroborative evidence within 20 days from the day the claim was made. A district may extend this 20 day period when the A/R has difficulty obtaining evidence.

Statement from a medical provider that the A/R is pregnant including the EDC (due date).

(MRG)

(other-eligibility-requirements)(page-132)Page 132#

UPDATED: JUNE 2010

569

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

STEP-PARENTS

Description: A step-parent is the spouse of an A/R’s parent, including an adoptive parent. For Medicaid purposes step-parents are legally responsible for their step-children under the age of 21.

Policy: A step-parent of a child under the age of 21 is legally and financially responsible for his/her child. However, the income of a step-parent will not be considered in the determination of eligibility of a pregnant minor. In addition parental income/resources are not considered in the determination of eligibility of a certified blind or certified disabled child who is:

• 18 years of age or older;

• under the age of 18 but expected to be living separately from the parental household for 30 days or more; or

References: SSL Sect. 101

366

Dept. Reg. 360-4.3(f)

360-7.11

ADMs 91 ADM-8

82 ADM-6

75 ADM-21

Interpretation: Generally, step-parents are responsible for their step-children under the age of 21. However, the income/resources of step-parents are not considered in the determination of eligibility when the child is pregnant; age 18 or over and certified blind/disabled or participating in a home and community-based waiver program.

The income/resources of step-parents are not considered in the determination of eligibility for their certified blind/disabled step-child age 18 or older, regardless of where the child resides. The (MRG)

(other-eligibility-requirements)(page-133)Page 133#

UPDATED: JUNE 2010

570

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

STEP-PARENTS

income/resources of step-parents are considered in the determination of eligibility for their certified blind/disabled step-child under the age of 18, unless the child is living or expected to be living separate and apart from the step-parent for 30 days or more. Even though the child returns to the household in less than 30, days, if s/he was expected to be absent for 30 days his/her step-parent’s income/resources are not considered in the eligibility determination for the child during the entire 30 days s/he was expected to be absent.

The income/resources of a step-parent are not considered in the eligibility determination of a child participating in a home and community-based waiver program pursuant to Section 1115 of the Social Security Act.

Although step-parents are financially responsible for their step-children under Social Services Law, a local district may not presume that the step-parent's income/resources, as appropriate, are available to the child. The step-parent must actually be contributing to the support of the child for the step-parent's income/resources, as appropriate, to be considered when determining eligibility for the child. If a step-parent refuses to support the child for whom s/he is responsible, care is provided to the child, if s/he is otherwise eligible. The district may take action to recover the cost of care from the legally responsible step- parent.

When a step-parent is divorced from the child's parent, there is no longer an obligation on his/her part to support the step-child. In case of abandonment or desertion on the part of the step-parent, the obligation to support the child still exists under Social Services Law.

Verify Status: When the A/R indicates there is a step-parent in the household.

When there is a certified blind/disabled child in the household.

Documentation: (a) Marriage certificate, birth certificate.

(b) Certificate of blindness/disability.

(MRG)

(other-eligibility-requirements)(page-134)Page 134#

UPDATED: AUGUST 1999

571

OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES (LRRs) PARENTS AND CHILDREN

STEP-PARENTS

(d) Statement from a medical provider that the minor is pregnant.

(e) Participating in a home and community-based waiver program under Section 1115 of the Social Security Act wherein the income/resources of the parent or step-parent are not considered in the determination of eligibility of the child.

(MRG)

(other-eligibility-requirements)(page-135)Page 135#

UPDATED: JUNE 2010

572

OTHER ELIGIBILITY REQUIREMENTS

HOUSEHOLD COMPOSITION

Description: Household composition is defined as the individuals included in the Medicaid household. Certain individuals are required to be included in the Medicaid household whether or not they are applying for Medicaid (i.e., LRRs living in the household). The household composition varies depending on the category of the individuals for whom eligibility is being determined.

Policy: Medicaid may be given to an otherwise eligible individual, household, or a portion of the applying household. A Medicaid household’s size determines which income and resource, as appropriate, levels are used in the determination of eligibility.

References: SSL Sect.

365

366

Dept. Reg.

360-4.2

ADMs

OMM/ADM 97-2

82 ADM-6

INFs

07 OHIP/INF-1

Interpretation: This section discusses the following household compositions:

• Low Income Families (LIF), ADC-related, Pregnant Women and Children, family/household size

• SSI-related household size

• Singles/Childless Couples (S/CC) household size

(MRG)

(other-eligibility-requirements)(page-136)Page 136#

UPDATED: NOVEMBER 2009 573

OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION

LOW INCOME FAMILIES (LIF), ADC-RELATED, PREGNANT WOMEN AND CHILDREN

Description: For applicants in the Low Income Families (LIF) and ADC-related categories and pregnant women and children, the household/family size:

Must include: • The applicant and applying family members • Legally responsible relatives o Parents- The household of a parent with joint (equally shared) physical custody of their child who applies with his or her child(ren) includes both the parent and the child(ren). If the other parent in the second household with equally shared physical custody also applies for Medicaid, that household includes that parent and his or her children as well. o Stepparents when the stepparent has acknowledged that s/he is supporting the child. (See OTHER ELIGIBILITY REQUIREMENTS LEGALLY RESPONSIBLE RELATIVES PARENTS AND CHILDREN STEP-PARENTS for more information on stepparents.) o Spouses

May include: • Non applying siblings • Non applying related children • Applying related children (e.g. nieces) • Applying care taker relatives (e.g. aunts, uncles, grandparents) if there is no parent in the household AND the designated caretaker relative has taken a parental role for the child. The caretaker relative must be applying and if there is more than one person eligible to be designated as a caretaker relative in the household, only one can be designated as the caretaker for Medicaid purposes (See CATEGORICAL FACTORS ADC-RELATED RELATIONSHIP OF CHILD TO CARETAKER RELATIVE). • Unwed father of an unborn if paternity has been established AND he is making his income available to the pregnant woman • Children under the age of 21 of applying adults • Children eligible under Chaffee provisions • Children in receipt of an adoption subsidy

(MRG)

(other-eligibility-requirements)(page-137)Page 137#

UPDATED: JUNE 2010

574

OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION

LOW INCOME FAMILIES (LIF), ADC-RELATED, PREGNANT WOMEN AND CHILDREN

Must not include: • Children and siblings over the age of 21 • SSI cash recipients • Family Assistance/Safety Net Assistance cash recipients • Unrelated foster care children • Parents of pregnant minors • Non-legally responsible relatives over age 21 • Unrelated household members (e.g. roommates)

Determining eligibility is a two-step process: 1. Count as many persons in the household as possible. If the child or the person seeking eligibility is not found eligible; 2. Remove the “May Counts” from the household of the applicant(s) and determine eligibility.

Policy: Medicaid may be authorized for an entire household or the portion of a household that is determined eligible. All persons in a household may apply on the same application, regardless of whether or not their eligibility is determined in the same budget/household. A child(ren) in receipt of an adoption subsidy may be removed from the household for budgeting purposes if the child(ren) makes the rest of the family ineligible. Federal law mandates states provide Medicaid coverage for adopted IV-E children.

References: SSL Sect.

365

366

Dept. Reg.

360-4.2

ADMs

OMM/ADM 97-2

91 ADM-8

90 ADM-9

82 ADM-6

INFs

07 OHIP/INF-1

90 INF-45

LCMs

95 LCM-106

GISs

00 MA/021

00 MA/007

(MRG)

(other-eligibility-requirements)(page-138)Page 138#

UPDATED: JUNE 2010

575

OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION

LOW INCOME FAMILIES (LIF), ADC-RELATED, PREGNANT WOMEN AND CHILDREN

Interpretation: When determining eligibility, initially include all the Must counts and May counts in the household. In the event that the applicant(s) are not found eligible, the May Counts should be removed from the household. This option must be explained to the applicant. It is the A/R's choice of who is applying and who of the May Counts are counted in the household size.

A child who is eligible for and receiving Adoption Assistance payments is automatically eligible for Medicaid.

A single individual under age 21 living separate and apart from his/her parents is a one-person household.

Disposition: Families with children under age 21 residing in the household, persons under age 21 living alone, and pregnant women may all be eligible under LIF. This group includes families without a deprivation factor as well as families with a deprivation.

The household size of a pregnant woman is increased by one to account for the additional needs associated with pregnancy regardless of the number of expected births.

Children not found eligible for Medicaid, must be referred to Child Health Plus for an eligibility determination.

(MRG)

(other-eligibility-requirements)(page-139)Page 139#

UPDATED: NOVEMBER 2009 576

OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION

SSI-RELATED

Description: For adults (age 18 or over) who are aged, certified blind or certified disabled, a Medicaid household is the aged, blind or disabled person and his/her spouse who lives with him/her if the spouse is: (1) also aged, certified blind or certified disabled; or (2) has remaining income after allocations which is equal to or greater than the difference between the medically needy income level for one, and the medically needy income level for two.

For other aged, certified blind or certified disabled adults who live with their spouses, a Medicaid household consists of one person for income purposes, but consists of two persons for resource purposes.

For all other aged, certified disabled or certified blind A/Rs, a Medicaid household consists of one person.

Policy: Medicaid may be given to an otherwise eligible individual, household or a portion of the applying household.

References: SSL Sect.

365 366

Dept. Reg.

360-4.2

ADMs

OMM/ADM 97-2 91 ADM-27 82 ADM-6

Interpretation: A person who is SSI-related (at least age 65, certified disabled or certified blind) is only a household of two when residing with a spouse who:

• is also SSI-related; or

• has remaining income after allocations (See INCOME SSI- RELATED BUDGETING METHODOLOGY ALLOCATION) which is equal to or greater than the difference between the medically needy income level for one, and the medically needy income level for two.

(MRG)

(other-eligibility-requirements)(page-140)Page 140#

UPDATED: JUNE 2010

577

OTHER ELIGIBILITY REQUIREMENTS HOUSEHOLD COMPOSITION

SINGLES/CHILDLESS COUPLES (S/CC)

Description: An S/CC household is comprised of an individual or married couple who are (1) at least age 21 but not yet 65; (2) not certified blind or disabled; (3) not pregnant; and (4) not caretaker relatives of children under age 21.

Policy: Medicaid may be given to an otherwise eligible individual; household; or a portion of the applying household.

References: SSL Sect. 365

366

Dept. Reg. 360-4.2

ADMs OMM/ADM 97-2

Interpretation: The S/CC household includes the individual and his/her spouse residing with him/her.

If a spouse living in the household refuses to make his/her income available, eligibility for Medicaid must be determined by counting only the applicant’s income (household of one).

(MRG)

(other-eligibility-requirements)(page-141)Page 141#

UPDATED: NOVEMBER 2009

578

OTHER ELIGIBILITY REQUIREMENTS

IDENTITY

Policy: All A/Rs, as a condition of eligibility for Medicaid, must be identified.

References: SSL Sect. 366

Dept Reg. 351.11(b)(2)(ii)(a)

351.2(a)

360-2.3

INF

08 OHIP/INF-1

ADM 93 ADM-29

GIS

08 MA/028

08 MA/009

Interpretation: It is the responsibility of the applicant to establish his/her identity. When the A/R’s name changes due to marriage, divorce or legal proceedings, the local district documents the change as appropriate.

Effective July 1, 2006, the Deficit Reduction Act of 2005 (DRA) amended federal Medicaid statute to require that all United States (U.S.) citizens applying for or renewing Medicaid coverage provide “satisfactory documentary evidence” of their U.S. citizenship and identity.

NOTE: The provisions of the DRA do not apply to immigrants. Individuals with satisfactory immigration status can continue to receive Medicaid in New York State as described in OMM 04 ADM-07.

For individuals who present other than primary documents, including birth certificates, LDSS must obtain additional proof of identity, such as a driver’s license. If no other identity document is available for a child under age 16, a parent or guardian may certify to the child’s identity, as long as an affidavit has not been used to document citizenship.

Verification: Identity documents presented by applicants/recipients (A/Rs) must be originals or copies certified by the issuing agency. Districts may copy or scan the documents for the LDSS files. The worker should make photocopies of any original documents and annotate on the copy that she or he saw the original or a document certified by the issuing agency. (MRG)

(other-eligibility-requirements)(page-142)Page 142#

UPDATED: JUNE 2010

579

OTHER ELIGIBILITY REQUIREMENTS

IDENTITY

The DRA requires all states to obtain documentary evidence from citizen A/Rs and maintain this documentation in their case files, or risk losing federal matching funds. The federal government has stated that a U.S. passport book/card, or a Certificate of Naturalization (N-550 or N-570), or a Certificate of U.S. Citizenship (N-560 or N-561) issued by the United States Department of Homeland Security is considered a “primary” document. A New York State Enhanced Driver’s License (EDL) or Native American Tribal Document is also considered a primary document. If an individual states they do not have one of these documents, LDSS may and should continue to accept birth certificates as proof of U.S. citizenship, however, an additional identity document is required from the identity section in the attached desk aid.

Documentation: An A/R who uses a primary document, such as a U.S. passport book/card, to establish citizenship is not required to submit a second document to prove identity. All other A/R’s must establish their identity by providing a document from the following list or as otherwise specified below:

• Driver’s license issued by a State or Territory either with a photograph of the individual or other identifying information such as name, age, sex, race, height, weight or eye color. Canadian driver’s licenses may not be used.

• School identification card with a photograph of the individual.

• U.S. military card or draft record.

• Identification card issued by the Federal, State or local government with the same information included on a driver’s license.

• Military dependent’s identification card.

• Certificate of Degree of Indian Blood or other United States Native American/Alaska Native Tribal document with a photograph or other personal identifying information relating to the individual, such as age, weight, height, race, sex and eye color.

• U.S. Coast Guard Merchant Mariner card.

(MRG)

(other-eligibility-requirements)(page-143)Page 143#

UPDATED: NOVEMBER 2009 580

OTHER ELIGIBILITY REQUIREMENTS

IDENTITY

• A cross-match with a Federal or State government, public assistance, law enforcement, or corrections agency’s data system. Some examples are (but not limited to): State Data Exchange (SDX), Beneficiary Data Exchange (BENDEX) and State Online Query (SOLQ).

• If none of the above identity documents is available, a combination of three or more corroborating documents that, when taken as a whole, reasonably verify the A/R’s identity. Acceptable documents include marriage certificates, divorce decrees, employer identification cards, high school and college diplomas from accredited institutions (including general education and high school equivalency diplomas) and/or property deeds or titles. Voter registration cards are not acceptable. All corroborating documents must contain consistent identifying information. None of the documents may have been used to establish the A/R’s citizenship. This method of proving identity may be used only when the A/R submitted second or third level evidence of citizenship.

SPECIAL RULES FOR CHILDREN YOUNGER THAN AGE 16 Children who are younger than age 16 may have their identity documented through other means:

• Clinic, doctor or hospital record.

• School records, including report card or nursery or daycare record. The LDSS must verify the records with the issuing school.

• If no other documents are available, an affidavit signed under penalty of perjury by a parent, guardian or caretaker relative may be used. An identity affidavit should not be used if a citizenship affidavit was used. Affidavits need not be notarized. Identity affidavits may be used for children under age 18 when a school ID card or driver’s license is not available to the child until she or he is 18 years of age.

(MRG)

(other-eligibility-requirements)(page-144)Page 144#

UPDATED: NOVEMBER 2009 581

OTHER ELIGIBILITY REQUIREMENTS

IDENTITY

SPECIAL RULES FOR DISABLED INSTITUTIONALIZED INDIVIDUALS The LDSS may accept an identity affidavit signed under penalty of perjury by the director or administrator of a nursing facility or other residential care facility in which a disabled A/R resides. The LDSS should first pursue all other means to verify identity before accepting such an affidavit. The affidavit need not be notarized.

HOMELESS INDIVIDUALS Homeless individuals often need assistance from the eligibility worker in obtaining acceptable proof of identity, citizenship or immigration status. When the applicant is a homeless individual, it may be difficult for him/her to establish his or her identity, citizenship or immigration status. However, just because an individual is homeless, she/he still must be identified. Proving one’s identity is a requirement of the Medicaid program.

The eligibility worker may accept any of the aforementioned documents listed in the Identity section of the attached desk aide, as proof of identity for the homeless individual. If none of the identity documents listed above or in the desk aid is available, a combination of three or more corroborating documents may be used.

NOTE: If an individual is unable to verify his or her identity, citizenship or immigration status, workers should not assume she/he is therefore eligible for coverage of an emergency medical condition. The provisions of the DRA do not apply to immigrants applying for the treatment of an emergency medical condition. However, verification of identity is a requirement for this coverage and all other covered services.

“JOHN/JANE DOE” A Medicaid application submitted by a “John/Jane Doe” individual (i.e., an individual who is unable to verify his or her identity) should be evaluated in the same manner as any other Medicaid applicant, that is, these individuals are required to meet the same documentation requirements as any other Medicaid applicant. A true “John/Jane Doe” individual is not eligible for Medicaid coverage for the treatment of an emergency medical condition. Verification of identity is a requirement for this coverage and all other covered services. (MRG)

(other-eligibility-requirements)(page-145)Page 145#

(MRG)

UPDATED: NOVEMBER 2009

582

OTHER ELIGIBILITY REQUIREMENTS

IDENTITY

Desk Guide: The desk aid/chart entitled “Documents Establishing U.S. Citizenship and Identity” reflects the final federal regulations on acceptable documentation for citizenship and identity and is attached on the next page.

(other-eligibility-requirements)(page-146)Page 146#

UPDATED: NOVEMBER 2009

583

DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY Ver: 11/19/07

PRIMARY CITIZENSHIP DOCUMENTS Primary Documents

Explanation: Highest reliability; proves U.S. citizenship and identity. No other document required. United States passport The Department of State issues this document. A U.S. passport does not have to be currently valid to be accepted as evidence of U.S. citizenship. Note: Spouses and children were sometimes included on one passport through 1980. U.S. passports issued after 1980 show only one person. Consequently, the citizenship and identity of the included person can be established when one of these passports is presented. Certificate of Naturalization (DHS Forms N-550 or N-570) Department of Homeland Security (DHS) issues for naturalization. Certificate of U.S. Citizenship (DHS Forms N-560 or N-561) Department of Homeland Security (DHS) issues certificates of citizenship to individuals who derive citizenship through a parent.

SECONDARY CITIZENSHIP DOCUMENTS Secondary Documents

Explanation: Districts should attempt to obtain the most reliable document available. Satisfactory reliability when a primary document not available; also requires an identity document. A U.S. public birth certificate showing birth in: • One of the 50 U.S. States; • District of Columbia; • American Samoa; • Swain’s Island; • *Puerto Rico (if born on or after January 13, 1941); • *Virgin Islands of the U.S. (on or after January 17, 1917); • *Northern Mariana Islands (after November 4, 1986 (NMI local time); or • Guam (on or after April 10, 1899) The birth record document may be issued by the State, Commonwealth, territory or local jurisdiction. It must have been issued before the person was five years of age.

Note: If the document shows the individual was born in Puerto Rico, the Virgin Islands of the U.S., or the Northern Mariana Islands before these areas became part of the United States, the individual may be a collectively naturalized citizen. Collective naturalization occurred on certain dates listed for each of the territories. * See additional requirements for Collective Naturalization, on page 5.

Certification of Report of Birth issued by the Department of State (DS-1350)

The Department of State issues a DS-1350 to U.S. citizens in the U.S. who were born outside the U.S. and acquired U.S. citizenship at birth, based on the information shown on the FS-240. When the birth was recorded as a Consular Report of Birth (FS-240), certified copies of the Certification of Report of Birth Abroad (DS-1350) can be issued by the Department of State in Washington, D.C. The DS-1350 contains the same information as that on the current version of Consular Report of Birth FS-240. The DS-1350 is not issued outside the U.S. (MRG)

(other-eligibility-requirements)(page-147)Page 147#

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DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY continued Ver: 11/19/07

SECONDARY DOCUMENTS (continued) Secondary Documents continued Explanation: Satisfactory reliability when a primary document not available; also requires an identity document. A Report of Birth Abroad of a U.S. Citizen (FS-240)

The Department of State consular office prepares and issues this document. A Consular Report of Birth can be prepared only at an American consular office overseas while the child is under the age of 18. Children born outside the U.S. to U.S. military personnel usually have one of these. Certification of birth issued by Department of State (Forms FS-545 or DS-1350) Before November 1, 1990, Department of State consulates also issued Form FS-545 along with the prior version of the FS-240. In 1990, U.S. consulates ceased to issue Form-545. Treat an FS-545 the same as the DS-1350. United States Citizen Identification Card (I- 197 or prior version I-179)

The former Immigration and Nationality Services (INS) issued the I-179 from 1960 until 1973. It revised the form and renumbered it as Form I-197. INS issued the I-197 from 1973 until April 7, 1983. INS issued Form I-179 and I-197 to naturalized U.S. citizens living near the Canadian or Mexican border who needed it for frequent border crossings. Although neither form is currently issued, either form that was previously issued is still valid. Northern Mariana Identification Card (I-873) The former INS issued the I-873 to a collectively naturalized citizen of the U.S. who was born in the Northern Mariana Islands before November 4, 1986. The card is no longer issued, but those previously issued are still valid. American Indian Card (I-872) DHS issues this card to identify a member of the Texas Band of Kickapoos living near the U.S./Mexican border. A classification code “KIC” and a statement on the back denote U.S. citizenship. Final adoption decree

The adoption decree must show the child’s name and U.S. place of birth. In situations where an adoption is not finalized and the State in which the child was born will not release a birth certificate prior to final adoption, a statement from a State approved adoption agency that shows the child’s name and U.S. place of birth is acceptable. The adoption agency must state in the certification that the source of the birth information is an original birth certificate. Evidence of civil service employment by the U.S. government The document must show employment by the U.S. government before June 1, 1976. Official Military record of service showing U.S. place of birth The document must show a U.S. place of birth (for example a DD-214 or similar official document showing a U.S. place of birth). Evidence of qualifying for U.S. citizenship under the Child Citizenship Act of 2000 Evidence of meeting the automatic criteria for U.S. citizenship outlined in the Child Citizenship Act of 2000 (P.L. 106-395). Applies to adopted or biological children born outside the U.S.

THIRD LEVEL DOCUMENTS Third Level Documents Explanation: Satisfactory reliability when a primary or secondary document is not available; also requires an identity document Extract of hospital record on hospital letterhead established at the time of the person’s birth that was created at least 5 years before the initial application date and that indicates a U.S. place of birth DO NOT ACCEPT a souvenir “birth certificate” issued by the hospital.

Note: For children under 16, the document must have been created near the time of birth or 5 years before the date of application.

(MRG)

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UPDATED: NOVEMBER 2009

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DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY continued Ver: 11/19/07

THIRD LEVEL DOCUMENTS (continued) Third Level documents continued Explanation: Satisfactory reliability when a primary or secondary document is not available; also requires an identity document Life, health or other insurance record showing a U.S. place of birth that was created at least 5 years before the initial application date Life, health or other insurance records may show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth.

Note: For children under 16, the document must have been created near the time of birth or 5 years before the date of application. Religious record recorded in the U.S. within 3 months of birth showing a U.S. place of birth Religious record recorded in the U.S. within 3 months of birth showing a U.S. place of birth and either the date of birth or the individual’s age at the time the record was made. The record must be an official record recorded with the religious organization. Entries in a family bible are not considered religious records. Early school record showing U.S. place of birth Early school record showing date of admission, a U.S. place and date of birth and names and places of birth of the applicant’s parents. School records must be verified with the school’s administration.

FOURTH LEVEL DOCUMENTS Fourth Level Documents Explanation: Satisfactory reliability when a primary, secondary or third level document is not available; should be used only in the rarest of circumstances; also requires an identity document. Federal or State census record showing U.S. citizenship or a U.S. place of birth (Generally for persons born 1900 through 1950) The census record must also show the applicant’s age. Note: Census records from 1900 through 1950 contain certain citizenship information. To secure this information the applicant, recipient or social services district should complete a Form BC-600, Application for Search of Census Records for Proof of Age. Add in the remarks portion “U.S. citizenship data requested.” Also add that the purpose is for Medicaid eligibility. This form also requires a fee. Other documents as listed in the explanation column that were created at least 5 years before the application for Medicaid (For children younger than 16, near the time of birth or 5 years before the application) This document must be one of the following and show a U.S. place of birth: • Seneca Indian tribal census record; • Bureau of Indian affairs tribal census records of the Navajo Indians; • U.S. State Vital Statistics official notification of birth registration; • Delayed U.S. public birth record that was recorded more than 5 years after the person’s birth; • Statement signed by the physician/midwife who was in attendance at the time of birth; or • Bureau of Indian Affairs Roll of Alaska Natives.

(MRG)

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UPDATED: NOVEMBER 2009

586

DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY continued Ver: 11/19/07

FOURTH LEVEL DOCUMENTS (continued) Fourth Level Documents continued Explanation: Satisfactory reliability when a primary, secondary or third level document is not available; should be used only in the rarest of circumstances; also requires an identity document. Institutional admission papers from a nursing facility, skilled care facility or other institution (created at least 5-years before the application date) showing a U.S. place of birth Admission records generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth.

Written Affidavit Affidavits should ONLY be used in rare circumstances. The affidavit must contain the following information under the following circumstances: • There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship. • The two affidavits can be combined in a joint affidavit. • At least one of the individuals making the affidavit cannot be related to the applicant or recipient. • The person(s) making the affidavit must be able to provide proof of his or her own citizenship and identity for the affidavit to be accepted. • The affidavit must also be signed under penalty of perjury by the person making the affidavit, but need not be notarized. • A separate affidavit from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why documentary evidence does not exist or cannot be readily obtained must also be obtained.

(MRG)

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UPDATED: NOVEMBER 2009

587

DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY (continued) Ver: 11/19/07

When primary evidence of citizenship is not available, a document from the list of Secondary, Third, or Fourth Level Documents may be presented and must be accompanied by an identity document the list below.

IDENTITY DOCUMENTS Documents to Establish Identity

Explanation: This section includes a list of acceptable documents that establish identity when a primary document is not available:

• A driver’s license issued by State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight or eye color. Do not accept a Canadian driver’s license; • School identification card with a photograph of the individual; • U.S. military card or draft record; • Identification card issued by Federal, State, or local government with the same information included on the driver’s license; • Military dependent’s identification card; • Certificate of Degree of Indian Blood, or other U.S. Native American/Alaska Native Tribal document with photo or other identifying information; • U.S. Coast Guard Merchant Mariner card; • A cross-match with a Federal or State governmental, public assistance, law enforcement, or corrections agency’s data system; • If none of the above identity documents is available, a combination of three or more corroborating documents such as marriage certificates, divorce decrees, high school or college diplomas, employer ID cards or property deeds/titles. Voter registration cards are not acceptable; • Disabled individuals in residential care facilities may have their identity attested to by the facility director or administrator, on behalf of the individual in the facility when the individual does not have or cannot get any document listed above. This affidavit must be signed under penalty of perjury, but need not be notarized. • Children under age 16 may have their identity documented using other means: o Clinic, doctor or hospital record; o School records including report card, day care or nursery school record. Records must be verified with the issuing school; o If no other documents are available, an affidavit signed under penalty of perjury by a parent, guardian or caretaker relative may be used. An identity affidavit should not be used if a citizenship affidavit was used. Affidavits need not be notarized. Identity affidavits may be used for children under 18 when a school ID card or driver’s license is not available to the child until she or he is 18 years of age.

(MRG)

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(MRG)

UPDATED: NOVEMBER 2009

588

DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY (continued) Ver: 11/19/07

COLLECTIVE NATURALIZATION Territories Explanation: Evidence that establishes U.S. citizenship for collectively naturalized individuals. Puerto Rico • Evidence of birth in Puerto Rico on or after April 11, 1899 and the applicant’s or recipient’s statement that he or she was residing in the U.S., a U.S. possession or Puerto Rico on January 13, 1941; or • Evidence that the applicant/recipient was a Puerto Rican citizen and the applicant’s/recipient’s statement that he or she was residing in Puerto Rico on March 1, 1917 and that he or she did not take an oath of allegiance to Spain. U.S. Virgin Islands • Evidence of birth in the U.S. Virgin Islands, and the applicant/recipient’s statement of residence in the U.S., a U.S. possession or the U.S. Virgin Islands on February 25, 1927; or • The applicant/recipient’s statement indicating residence in the U.S. Virgin Islands as a Danish citizen on January 17, 1917 and residence in the U.S., a U.S. possession or the U.S. Virgin Islands on February 25, 1927, and that he or she did not make a declaration to maintain Danish citizenship; or • Evidence of birth in the U.S. Virgin Islands and the applicant/recipient’s statement indicating residence in the U.S., a U.S. possession or territory or the Canal Zone on June 28, 1932).

Northern Mariana Islands (NMI) (formerly part of the Trust Territory of the Pacific Island [TTPI]) • Evidence of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. territory or possession on November 3, 1986 (NMI local time) and the applicant/recipient’s statement that he or she did not owe allegiance to a foreign state on November 4, 1986 (NMI local time); • Evidence of TTPI citizenship, continuous residence in the NMI since before November 3, 1981 (NMI local time), voter registration prior to January 1, 1975 and the applicant/recipient’s statement that he or she did not owe allegiance to a foreign state on November 4, 1986 (NMI local time); or • Evidence of continuous domicile in the NMI since before January 1, 1974 and the applicant/recipient’s statement that he or she did not owe allegiance to a foreign state on November 4, 1986 (NMI local time). NOTE: If a person entered the NMI as a nonimmigrant and lived in the NMI since January 1, 1974, this does not constitute continuous domicile and the individual is not a U.S. citizen.

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UPDATED: JUNE 2010

589

OTHER ELIGIBILITY REQUIREMENTS

CITIZENSHIP AND IMMIGRATION STATUS

Policy: Medicaid is provided to otherwise eligible residents of the United States who are citizens, nationals, or individuals in satisfactory immigration status (i.e. qualified or persons Permanently Residing in the United States Under Color of Law (PRUCOL). Medicaid coverage is limited to coverage for the treatment of emergency medical conditions for otherwise eligible individuals who are not qualified (i.e. temporary non-immigrants, short term visa holders, foreign students, etc.) or who are not in satisfactory immigration status (i.e., undocumented).

Citizens, nationals, qualified immigrants and PRUCOL immigrant applicants for Medicaid must provide appropriate documentation of their citizenship or satisfactory immigration status. Such individuals must also sign a declaration, under penalty of perjury, that they are citizens, nationals or immigrants with satisfactory immigration status and must provide or apply for a Social Security Number.

Individuals who are initially eligible for Medicaid as a “deemed” newborn are considered to have provided satisfactory documentation of citizenship and identity, by virtue of being born in the United States, and will not be required to further document citizenship or identity at any subsequent Medicaid eligibility redetermination/renewal.

NOTE: Special provision is made for individuals who are not qualified, but who, on August 4, 1997, were residing in certain residential facilities or were diagnosed with AIDS (as defined by the Centers For Disease Control) and receiving Medicaid based on a determination that they were “permanently residing in the United States under color of law” (PRUCOL). Such individuals will continue to receive full Medicaid benefits if they are otherwise eligible.

NOTE: Citizenship and immigration status are not considered when determining Medicaid eligibility for a pregnant woman. A pregnant woman does not need to document her citizenship/immigration status until the month following the month in which the 60-day postpartum period ends.

References: SSL Sect

122

131-k

Dept Reg.

349.3

351.1

351.2

360-3.2(j)

(MRG)

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UPDATED: JUNE 2010

590

OTHER ELIGIBILITY REQUIREMENTS

CITIZENSHIP AND IMMIGRATION STATUS

ADMs

04 ADM 07

97 ADM-23

88 ADM-22 88 ADM-4

82 ADM-24

INFs

07 OHIP/INF-2

06 OMM/INF-5

GISs

10 MA/006 08 MA/009

04 MA/014

02/MA/016

02 MA/002

01 MA/033

01 MA/030 01 MA/026

(MRG)

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UPDATED: NOVEMBER 2009 591

OTHER ELIGIBILITY REQUIREMENTS

CITIZENSHIP AND IMMIGRATION STATUS

This section deals with the following groups:

Citizens:

Nationals;

Native Americans;

Satisfactory Immigration Status:

Qualified;

Battered;

Veterans and Active Duty Exceptions;

Victims of Trafficking;

PRUCOL (permanently residing in the United States under

color of law);

Temporary Protected Status (TPS);

Visa Statuses:

Temporary non-immigrants (immigrants admitted on a

temporary basis); and

Special non-immigrants (immigrants admitted on a K, S,

V, U visa); and

Undocumented/illegal:

Treatment of an Emergency Medical Condition (MRG)

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UPDATED: JANUARY 2011

592

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

Description: A citizen is a person who was born in the United States or who has been naturalized.

Policy: Medicaid may be given to citizens of the United States who are residents of New York State and who are otherwise eligible. The Deficit Reduction Act of 2005 (DRA) amended federal Medicaid Statute to require that all United States citizens applying for or renewing Medicaid coverage provide “satisfactory documentary evidence” of their citizenship. For applications submitted after October 1, 2010 individuals declaring to be U.S. citizens and presenting a valid SSN will have their citizenship confirmed via the Social Security Administration (SSA) citizenship verification process.

NOTE: Naturalized citizens will not have their citizenship verified through the SSA process.

Applicants/recipients (A/Rs) declaring to be U.S. citizens, who are eligible for or enrolled in Medicare or receiving Supplemental Security Income (SSI) are exempt from documenting both citizenship and identity. These individuals have already established their citizenship and identity to the Social Security Administration (SSA).

The Tax Relief and Health Care Act of 2006 (PL 109-432) amended the DRA further to exempt A/Rs in receipt of Social Security Disability Insurance (SSDI) and children under Title IV-B on the basis of being a child in foster care and IV-E on the basis of adoption or receiving foster care assistance.

The provisions of Section 211 of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 also eliminates citizenship documentation requirements for deemed newborns.

References: SSL Sect. 122

131-k

Public Law 109-432

Dept. Reg. 349.3

360-3.2(f)

ADM 10 OHIP/ADM-8

INF

08 OHIP/INF-1 (MRG)

(other-eligibility-requirements)(page-156)Page 156#

UPDATED: JANUARY 2011

593

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

GIS

10 MA/006

Interpretation: Natural born citizens and individuals who acquire citizenship through naturalization and who are residents of the State of New York may receive Medicaid, if otherwise eligible. For the Medicaid program, identity, citizenship and/or satisfactory immigration status must be documented. For the purposes of qualifying as a United States citizen, the United States includes the 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands and the Northern Mariana Islands. Nationals from American Samoa or Swain’s Island are also regarded as United States citizens for the purpose of Medicaid eligibility.

All persons who were born in the United States are, with rare exception, United States citizens. United States citizenship can also be acquired by naturalization or acquired by persons who are born in another country and whose parent(s) are citizens of the United States. Lengthy residence in this country or marriage to a U.S. citizen does not by itself bestow citizenship.

Newborns processed through the existing newborn process are excluded from being sent for citizenship verification.

Applicants declaring to be U.S. citizens do not have to provide proof of citizenship as a condition of initial eligibility. The response from SSA will be displayed in the Welfare Management System as a Birth Verification Indicator (BVI). A BVI value of “1” is generated when a recipient’s allegation of citizenship is consistent with SSA data. No further action is required and no additional documentation of citizenship, identity or date of birth is required. If the SSA verification process fails to confirm citizenship and identity and the LDSS is unable to resolve any inconsistency, the A/R must be given 90 days to either authorize the LDSS to obtain verification of birth from Vital Records and provide the LDSS with identity documentation or provide the district with original documentary evidence to support their declaration of citizenship and identity.

(MRG)

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UPDATED: JANUARY 2011

594

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

A/Rs may also bring their original documents or certified copies to a Facilitated Enroller (FE) or other qualified entity designated by the LDSS for this purpose. If the FE processed the original application, the FE will forward the verified copies to the LDSS. Otherwise, the facilitator will photocopy the original documents and notate on the copies that the originals or certified copies were seen, and return the documents to the recipient. The recipient must send the copies to the LDSS.

During the 90 day period, the individual remains enrolled in Medicaid. After 90 days, if documentary evidence has not been provided to verify citizenship and identity, the district must discontinue Medicaid for the individual with timely notice. However, the recipient continues to be eligible for any remaining months in a six-month managed care guarantee enrollment period. NOTE: If a parent or caretaker relative does not comply with providing citizenship and identity documentation to the district for an applying child under the age of twenty-one when the SSA match fails, ONLY the child’s Medicaid eligibility can be discontinued.

Naturalized citizens are required to show documentary proof of their acquired citizenship by presenting their original or certified copy of the Certificate of Naturalization or their US Passport to the LDSS, FE or qualified entity designated by the LDSS. These individuals are allowed 90 days from the date of notification to supply their original or certified copy of naturalization document or US Passport. NOTE: Medicaid coverage must not be delayed pending receipt of such documentation if the individual is otherwise eligible.

Once a person’s citizenship is documented, it need not be re- documented unless that person’s citizenship becomes questionable.

However, individuals who re-apply after their declaration of citizenship did not validate and who did not comply with the request to provide proof of citizenship and identity, will not be forwarded to SSA for citizenship verification. These individuals will be required to provide documentation of identity and U.S. citizenship or immigration status at reapplication.

Documentation: If the SSA verification process fails to confirm citizenship and identity and the LDSS is unable to resolve any inconsistency, original documentary evidence to support their declaration of citizenship and identity must be obtained. (MRG)

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UPDATED: JANUARY 2011

595

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

The following are examples of items which constitute primary documentation of U.S. citizenship:

Documents which Establish both Citizenship and Identity • U.S. passport book/card; • Certificate of Naturalization (N-550 or N-570); • Certificate of U.S. Citizenship (N-560 or N-561); • NYS Enhanced Driver’s License (EDL); Or • Native American Tribal Document

Secondary Documents which Establish Citizenship but also require one identity document from the Identity Documentation list below: • U.S. Birth Certificate showing birth in one of the 50 U.S. States, District of Columbia, American Samoa, Swain’s Island, Puerto Rico (if born on or after 4/11/1899), Virgin Islands of the U.S. (on or after 2/25/1927), Northern Mariana Islands (after 11/3/1986 [NMI local time]), or Guam (on or after 4/10/1899); • Certification of Report of Birth issued by the Department of State (DS-1350) ; • Report of Birth Abroad of a U.S. Citizen (FS-240); • Certification of birth issued by Department of State (Forms FS-545 or DS-1350); • U.S. Citizen Identification Card (I-197 or I-179); • Northern Mariana Identification Card (I-873); • American Indian Card with classification code of “KIC” (I-872); • Final adoption decree showing U.S. place of birth;

(MRG)

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UPDATED: JUNE 2010

596

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

• Evidence of U.S. civil service employment before 6/1/1976; • Military record of service showing U.S. place of birth (i.e., DD- 214); or • Evidence of qualifying for U.S. citizenship under the Child Citizenship Act of 2000.

Third Level Documents which Establish Citizenship but are less reliable than Secondary Documents (Also requires an identity document) • Extract of hospital record on hospital letterhead. The record must have been established at the time of birth and the extract must have been created at least 5 years before the Medicaid application date (or, for children younger than 16, near the time of birth) and must show a U.S. place of birth; • Life, health or other insurance record, if it shows a U.S. place of birth and was created at least 5 years prior to the application date (or, for children younger than 16, near the time of birth); • Religious record recorded in the U.S. within 3 months of birth showing a U.S. place of birth and either the date of birth or the individual’s age at the time the record was made; or • Early school record showing date of admission, a U.S. place and date of birth and names and places of birth of the applicant’s parents.

Fourth Level Documents which Establish Citizenship but are the least reliable and should only be used in rarest of circumstances (Also requires an identity document) • Federal or State census record showing U.S. citizenship or a U.S place of birth; or • The following other documents are acceptable if they indicate a U.S. place of birth and were created at least 5 years prior to the application date (or, for children younger than 16, near the time of birth): o Medical (clinic, doctor, or hospital) record; o Seneca Indian tribal census; o Bureau of Indian Affairs tribal census records of the Navajo Indians; o U.S. State Vital Statistics official notification of birth registration; o Delayed U.S. public birth record that is recorded more than 5 years after the person’s birth; (MRG)

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UPDATED: JUNE 2010

597

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

o Statement signed by the physician/midwife who was in attendance at the time of birth; or o Bureau of Indian Affairs Roll of Alaska Natives;

• Institutional admission papers from a nursing facility, skilled care facility or other institution (created at least 5 years before the application date) showing a U.S place of birth; or • Written affidavit (to be used only in rare instances). The affidavit must contain the following information under the following circumstances: o There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship. o The two affidavits can be combined in a joint affidavit. o At least one of the individuals making the affidavit cannot be related to the applicant or recipient. o The person(s) making the affidavit must be able to provide proof of his or her own citizenship and identity for the affidavit to be accepted. o The affidavit must also be signed under penalty of perjury by the person making the affidavit, but need not be notarized. A separate affidavit from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why documentary evidence does not exist or cannot be readily obtained must also be obtained.

Evidence that Establishes U.S. Citizenship for Collectively Naturalized Individuals

Puerto Rico • Evidence of birth in Puerto Rico on or after 4/11/1899 and the applicant’s or recipient’s (A/R’s) statement that he or she was residing in the U.S., a U.S. possession or Puerto Rico on 1/13/1941; or • Evidence that the A/R was a Puerto Rican citizen and the A/R’s statement that he or she was residing in Puerto Rico on 3/1/1917 and that he or she did not take an oath of allegiance to Spain. (MRG)

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UPDATED: JANUARY 2009

598

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

U.S. Virgin Islands • Evidence of birth in the U.S. Virgin Islands, and the A/R’s statement of residence in the U.S., a U.S. possession or the U.S. Virgin Islands on 2/25/1927; or • The A/R’s statement indicating residence in the U.S. Virgin Islands as a Danish citizen on 1/17/1917 and residence in the U.S., a U.S. possession or the U.S. Virgin Islands on 2/25/1927, and that he or she did not make a declaration to maintain Danish citizenship; or • Evidence of birth in the U.S. Virgin Islands and the A/R’s statement indicating residence in the U.S., a U.S. possession or territory or the Canal Zone on 6/28/1932.

Northern Mariana Islands (NMI) (formerly part of the Trust Territory of the Pacific Islands [TTPI]) • Evidence of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. territory or possession on 11/3/1986 (NMI local time) and the A/R’s statement that he or she did not owe allegiance to a foreign state on 11/4/1986 (NMI local time); or • Evidence of TTPI citizenship, continuous residence in the NMI since before 11/3/1981 (NMI local time), voter registration prior to 1/1/1975 and the A/R’s statement that he or she did not owe allegiance to a foreign state on 11/4/1986 (NMI local time), or • Evidence of continuous domicile in the NMI since before 1/1/1974 and the A/R’s statement that he or she did not owe allegiance to a foreign state on 11/4/1986 (NMI local time). If a person entered the NMI as a non-immigrant and lived in the NMI since 1/1/1974, this does not constitute continuous domicile and the individual is not a U.S. citizen. (MRG)

(other-eligibility-requirements)(page-162)Page 162#

UPDATED: NOVEMBER 2009

599

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

HOMELESS INDIVIDUALS

Homeless individuals often need assistance from the eligibility worker in obtaining acceptable proof of identity, citizenship or immigration status. When the applicant is a homeless individual, it may be difficult for him/her to establish his or her identity, citizenship or immigration status. However, just because an individual is homeless, she/he still must be identified. Proving one’s citizenship is a requirement of the Medicaid program.

The eligibility worker may accept any of the aforementioned documents listed in the citizenship section above or in the attached desk aide, as proof of citizenship for the homeless individual.

“JOHN/JANE DOE”

A Medicaid application submitted by a “John/Jane Doe” individual (i.e., an individual who is unable to verify his or her identity) should be evaluated in the same manner as any other Medicaid applicant, that is, these individuals are required to meet the same documentation requirements as any other Medicaid applicant. A true “John/Jane Doe” individual is not eligible for Medicaid coverage for the treatment of an emergency medical condition. Verification of identity is a requirement for this coverage and all other covered services.

(MRG)

(other-eligibility-requirements)(page-163)Page 163#

UPDATED: NOVEMBER 2009 600

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

Documentation Guide Citizenship and Immigrant Eligibility for Health Coverage in New York State Category 1: U.S. Citizens Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement United States Citizen: (Includes the 50 U.S. States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and American Samoa, Swain’s Island and the Northern Mariana Islands for purposes of Medicaid eligibility.)

Note: Listed are the most common documents used to prove U.S. citizenship. The list is not exhaustive and there are other documents that can establish U.S. citizenship.

CITIZENSHIP REMINDERS: A birth certificate can no longer be accepted as proof of both citizenship and identity. If the birth certificate is presented as proof of citizenship, the worker must obtain another form of identity document from the Identity documentation list, such as a driver’s license. All documents must be originals or copies certified by the issuing agency. Workers are required to photocopy the original/certified copy and annotate the copy with their initials and the date of the review. Primary Documents (No other document required) ►U.S. Passport; ►Certificate of Naturalization (N-550 or N-570); or ►Certificate of U.S. Citizenship (N-560 or N-561). __________________________________________ Secondary Documents (When a primary document is unavailable, a secondary document may be used, but also requires ONE identity document from the identity documentation list below.) ►U.S. Birth Certificate showing birth in one of the 50 U.S. States, District of Columbia, American Samoa, Swain’s Island, Puerto Rico (if born on or after 1/13/1941), Virgin Islands of the U.S. (on or after 1/17/1917), Northern Mariana Islands (after 11/4/1986 [NMI local time]), or Guam (on or after 4/10/1899); ►Certification of Report of Birth issued by the Department of State (DS-1350); ►Report of Birth Abroad of a U.S. Citizen (FS-240); ►Certification of birth issued by Department of State (Forms FS-545 or DS-1350); ►U.S. Citizen Identification Card (I-197 or I-179); ►Northern Mariana Identification Card (I-873); ►American Indian Card with classification code of “KIC” (I-872); ►Final adoption decree showing U.S. place of birth; ►Evidence of U.S. civil service employment before 6/1/1976; ►Military record of service showing U.S. place of birth (i.e., DD-214); or ►Evidence of qualifying for U.S. citizenship under the Child Citizenship Act of 2000.

YES

A SSN is an eligibility requirement for all citizens applying for Medicaid or FHP.

Note: Pregnant women are excluded from this requirement. (MRG)

(other-eligibility-requirements)(page-164)Page 164#

UPDATED: NOVEMBER 2009 601

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

Category 1: U.S. Citizens continued Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement U.S. Citizen (Includes the 50 U.S. States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and American Samoa, Swain’s Island and the Northern Mariana Islands for purposes of Medicaid eligibility.)

Third Level Documents (When a primary or secondary document is not available; also requires an identity document.) ►Extract of hospital record on hospital letterhead. The record must have been established at the time of birth and the extract must have been created at least 5 years before the Medicaid application date (or, for children younger than 16, near the time of birth) and must show a U.S. place of birth; ►Life, health or other insurance record, if it shows a U.S. place of birth and was created at least 5 years prior to the application date (or, for children younger than 16, near the time of birth); (When a primary or a secondary document is not available: also requires ONE identity document.) ►Religious record recorded in the U.S. within 3 months of birth showing a U.S. place of birth and either the date of birth or the individual’s age at the time the record was made; or ►Early school record showing date of admission, a U.S. place and date of birth and names and places of birth of the applicant’s parents.

YES

A SSN is an eligibility requirement for all citizens applying for Medicaid or FHP.

Note: Pregnant women are excluded from this requirement.

(MRG)

(other-eligibility-requirements)(page-165)Page 165#

UPDATED: NOVEMBER 2009

602

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

Fourth Level Documents (Are the least reliable and should only be used in rarest of circumstances; also requires an identity document.) ►Federal or State census record showing U.S. citizenship or a U.S place of birth; or ►The following other documents are acceptable if they indicate a U.S. place of birth and were created at least 5 years prior to the application date (or, for children younger than 16, near the time of birth): Medical (clinic, doctor, or hospital) record; Seneca Indian tribal census; Bureau of Indian Affairs tribal census records of the Navajo Indians; U.S. State Vital Statistics official notification of birth registration; Delayed U.S. public birth record that is recorded more than 5 years after the person’s birth; Statement signed by the physician/midwife who was in attendance at the time of birth; or Bureau of Indian Affairs Roll of Alaska Natives; ►Institutional admission papers from a nursing facility, skilled care facility or other institution (created at least 5 years before the application date) showing a U.S. place of birth; or ►Written affidavit (to be used only in rare instances). The affidavit must contain the following information under the following circumstances: • There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship. • The two affidavits can be combined in a joint affidavit. • At least one of the individuals making the affidavit cannot be related to the applicant or recipient. • The person(s) making the affidavit must be able to provide proof of his or her own citizenship and identity for the affidavit to be accepted. • The affidavit must also be signed under penalty of perjury by the person making the affidavit, but need not be notarized. A separate affidavit from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why documentary evidence does not exist or cannot be readily obtained must also be obtained.

YES

A SSN is an eligibility requirement for all citizens applying for Medicaid or FHP.

Note: Pregnant women are excluded from this requirement.

(MRG)

(other-eligibility-requirements)(page-166)Page 166#

UPDATED: NOVEMBER 2009

603

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

Category 1: U.S. Citizens continued

Category Documentation

WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement

Collectively Naturalized

Evidence that establishes U.S. Citizenship for Collectively Naturalized individuals.

Puerto Rico ►Evidence of birth in Puerto Rico on or after 4/11/1899 and the applicant’s or recipient’s (A/R’s) statement that he or she was residing in the U.S., a U.S. possession or Puerto Rico on 1/13/1941; or ►Evidence that the A/R was a Puerto Rican citizen and the A/R’s statement that he or she was residing in Puerto Rico on 3/1/1917 and that he or she did not take an oath of allegiance to Spain.

U.S. Virgin Islands ►Evidence of birth in the U.S. Virgin Islands, and the A/R’s statement of residence in the U.S., a U.S. possession or the U.S. Virgin Islands on 2/25/1927; or ►The A/R’s statement indicating residence in the U.S. Virgin Islands as a Danish citizen on 1/17/1917 and residence in the U.S., a U.S. possession or the U.S. Virgin Islands on 2/25/1927, and that he or she did not make a declaration to maintain Danish citizenship; or ►Evidence of birth in the U.S. Virgin Islands and the A/R’s statement indicating residence in the U.S., a U.S. possession or territory or the Canal Zone on 6/28/1932.

Northern Mariana Islands (NMI) (formerly part of the Trust Territory of the Pacific Islands [TTPI]) ►Evidence of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. territory or possession on 11/3/1986 (NMI local time) and the A/R’s statement that he or she did not owe allegiance to a foreign State on 11/4/1986 (NMI local time); or ►Evidence of TTPI citizenship, continuous residence in the NMI since before 11/3/1981 (NMI local time), voter registration prior to 1/1/1975 and the A/R’s statement that he or she did not owe allegiance to a foreign State on 11/4/1986 (NMI local time); or ►Evidence of continuous domicile in the NMI since before 1/1/1974 and the A/R’s statement that he or she did not owe allegiance to a foreign State on 11/4/1986 (NMI local time). If a person entered the NMI as a nonimmigrant and lived in the NMI since 1/1/1974, this does not constitute continuous domicile and the individual is not a U.S. citizen.

YES

A SSN is an eligibility requirement for all citizens applying for Medicaid or FHP.

Note: Pregnant women are excluded from this requirement

(MRG)

(other-eligibility-requirements)(page-167)Page 167#

UPDATED: NOVEMBER 2009 604

Category 1: U.S. Citizens continued Category Identity Documents (One identity document must be used with secondary, third or fourth level citizenship documentation). WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement U.S. Citizen (Includes the 50 U.S. States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and American Samoa, Swain’s Island and the Northern Mariana Islands for purposes of Medicaid eligibility.)

►A driver’s license issued by State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight or eye color. Canadian driver’s licenses may not be used; ►School identification card with a photograph of the individual; ►U.S. military card or draft record; ►Identification card issued by Federal, State, or local government with the same information included on the driver’s license; ►Military dependent’s identification card; ►Certificate of Degree of Indian Blood, or other U.S. Native American/Alaska native tribal document with photo or other identifying information; ►U.S. Coast Guard Merchant Mariner card; ►A cross-match with a Federal or State governmental, public assistance, law enforcement, or corrections agency’s data system; ►If none of the above identity documents is available, a combination of three or more corroborating documents such as marriage certificates, divorce decrees, high school or college diplomas, employer ID cards or property deeds/titles. Voter registration cards are not acceptable; ►Disabled individuals in residential care facilities may have identity attested to by the facility director or administrator, on behalf of the individual in the facility, when the individual does not have or cannot get any document listed above. This affidavit must be signed under penalty of perjury but need not be notarized. ►Children under age 16 may have their identity documented using other means: Clinic, doctor or hospital record; School records including report card, day care or nursery school record. Records must be verified with the issuing school; Affidavit signed under penalty of perjury by a parent, guardian or caretaker relative stating the date and place of the child’s birth, if no other documents are available. An identity affidavit should not be used if a citizenship affidavit was used. Affidavits need not be notarized. Identity affidavits may be used for children under 18 when a school ID card or driver’s license is not available to the child until he or she is 18 years of age.

Not applicable to identity documents

(MRG)

(other-eligibility-requirements)(page-168)Page 168#

UPDATED: NOVEMBER 2009 605

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

NATIVE AMERICANS

Policy: Native Americans born in the United States are citizens of the United States and will have the same types of documentation of citizenship as do other U.S. citizens.

Native Americans born outside the U.S. are eligible for Medicaid without regard to immigration status restrictions, if they reside in New York State and are:

► A non-citizen member of a federally recognized tribe; or

► A Native American, who is at least fifty percent American Indian blood and was born in Canada;

A Native American born in Canada may freely enter and reside in the U.S. and is considered to be lawfully admitted for permanent residence if s/he is of at least one-half American Indian blood. As such, s/he is considered a U.S. citizen for the purposes of Medicaid eligibility and coding. This does not include a non-citizen whose membership in an Indian tribe or family is created by adoption unless such person is at least fifty percent Indian blood.

NOTE: The tribal membership card demonstrates membership in a U.S. Federally recognized Indian Tribe. For the purposes of Medicaid eligibility, Medicaid will accept a tribal membership card, with a date of birth, as proof of age, identity and citizenship status.

References: SSL Sect. 122

131-k

Dept. Reg. 349.3

360.3.2(j)

ADM 04 OMM/ADM-7

GIS

08 MA/009

05 MA/ 028 (MRG)

(other-eligibility-requirements)(page-169)Page 169#

UPDATED: JANUARY 2011

606

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

NATIVE AMERICANS

Documentation: The following items can be used to verify Native American status or membership in a federally recognized tribe

NOTE: Tribal documents are considered to be as reliable as a U.S. passport and are to be treated as “primary” documents. Additional identity documentation is not required.

Native American Indians born in Canada:

► I-94 coded “S1-3”; ► I-551 Permanent Resident Card stamped “S1-3”; ►Temporary I-551 stamp in a Canadian passport coded “S1-3”; ►Tribal Record or document certifying at least 50% American Indian blood, as required by Section 289 of the INA; ►Birth or Baptismal Certificate issued on a reservation or other satisfactory evidence of birth in Canada;

Member of federally recognized Native American tribe born outside of

the U.S:

►A membership card or other tribal document demonstrating membership in a federally recognized Indian Tribe under Section 4 (e) of the Indian Self-determination and Education Assistance Act [25 U.S.C. §450b (e) and satisfactory evidence of birth outside the U.S].

(MRG)

(other-eligibility-requirements)(page-170)Page 170#

UPDATED: JANUARY 2011

607

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

NATIVE AMERICANS

Category

Documentation WMS ACI CODE Federal Financial Participation SSN Requirement Native Americans born outside the U.S. who belong to a federally recognized tribe ► A membership card or other tribal document demonstrating membership in a federally recognized Indian Tribe under Section 4 (e) of the Indian Self- determination and Education Assistance Act [25 U.S.C. §450b (e)] and satisfactory evidence of birth outside the U.S.

YES

YES Canadian born Native Americans ►I-94 coded “S1-3”; ►I-551 Alien Registration Card stamped “S1-3”; ►Temporary I-551 stamp coded S1-3 in a Canadian passport; ►Tribal Record or document certifying at least 50% American Indian blood, as required by Section 289 of the INA; and satisfactory evidence of birth in Canada, such as a birth certificate or baptismal Certificate issued on a reservation;

YES

YES Native Americans born in Canada ►I-94 coded “S1-3”; ►I-551 Permanent Resident Card stamped “S1-3”; ►Temporary I-551 stamp coded S1-3 in a Canadian passport; ►Tribal Record or document certifying at least 50% American Indian blood, as required by Section 289 of the INA; and satisfactory evidence of birth in Canada, such as the following: -a Birth certificate or Baptismal Certificate issued on a reservation; -Letter from Canadian Department of Indian Affairs; or -School Records.

YES For the purpose of Medicaid, Native Americans are classified as U.S. citizens.

A SSN is an eligibility requirement for all citizens applying for Medicaid of FHP.

Note: Pregnant women are excluded from this requirement.

Native Americans belonging to a Federally recognized Tribe born outside the U.S. -Membership card or other tribal document demonstrating (i.e., tribal card), membership in U.S. federally recognized Indian tribe under Section 4(e) of the Indian Self-Determination and Education Assistance Act and satisfactory evidence of birth outside the U.S.

C YES

(MRG)

(other-eligibility-requirements)(page-171)Page 171#

UPDATED: JUNE 2010

608

OTHER ELIGIBILITY REQUIREMENTS

SATISFACTORY IMMIGRATION STATUS

Description: Immigrants in satisfactory immigration status are otherwise eligible for Medicaid, Family Health Plus (FHPlus) and Child Health Plus (CHPlus) and include qualified aliens and persons permanently residing in the United States under color of law (PRUCOL).

Policy: All immigrants in satisfactory immigration status regardless of the date they physically entered into the United States can be eligible for Medicaid provided they meet all other eligibility requirements. The only difference is that Federal Financial Participation (FFP) should be claimed for some groups but must not be claimed for others or must not be claimed until the individual has resided in the United States as a qualified alien for five years (i.e., the Federal five-year ban). • Qualified aliens who entered the U.S. prior to August 22, 1996 receive full Medicaid coverage with Federal Financial Participation (FFP); • Certain qualified aliens who entered the U.S. on or after August 22, 1996 receive Medicaid coverage with FFP; and • Certain qualified aliens who entered the U.S. on or after August 22, 1996, receive Medicaid coverage with State and local funds (FNP) until they have resided in the U.S. as a qualified alien for five years (five year ban). • Persons permanently residing in the United States under color of law (PRUCOL) are eligible for Medicaid, provided they meet all other eligibility requirements. There is no Federal Financial Participation for this group. This means the federal government will not pay a share of their Medicaid costs. The shares are generally split 50% State/50% local. (Refer to the PRUCOL section of this document)

References: Public Law P.L. 100-202

SSL Sect. 122

131-k

Dept. Reg. 349.3

351.1

351.2

360-3.2(j)

ADMs 04 ADM 07

97 ADM-23

92 ADM-10

(MRG)

(other-eligibility-requirements)(page-172)Page 172#

UPDATED: JUNE 2010

609

OTHER ELIGIBILITY REQUIREMENTS

SATISFACTORY IMMIGRATION STATUS

88 ADM-47 88 ADM-22

82 ADM-24

INF

06 OMM INF-5

GISs 09 MA/028 09 MA/009 98 MA/21

97 TA/DC022

Interpretation: Medicaid eligibility is based on whether the immigrant is in satisfactory immigration status and meets all the other requirements of the Medicaid program(s). Immigrants who are not in a satisfactory immigration status may be eligible for the treatment of an emergency medical condition.

Individuals who file United States Citizen Immigration Services (USCIS) applications and/or petitions at certain facilities have the option to receive an e-mail and/or text message informing them that USCIS has accepted their application or petition. The E-Notification does not constitute official notice of application acceptance; the A/R will receive an official notice of application acceptance (I-797) through the U.S. Postal Service. The e-mail or text message does not grant any type of immigration status or benefit and cannot be accepted or used as evidence that USCIS has granted the individual any immigration status or benefit. Receipt of the transmission cannot be used as supporting evidence of satisfactory immigration status for any Medicaid benefit.

SPECIAL NOTE: HOMELESS INDIVIDUALS

Homeless individuals often need assistance from the eligibility worker in obtaining acceptable proof of identity, citizenship or satisfactory immigration status. When the applicant is a homeless individual, it may be difficult for him/her to establish his or her identity, citizenship or immigration status. However, just because an individual is homeless, she/he still must be identified. Proving one’s identity is a requirement of the Medicaid program. (See OTHER ELIGIBILITY REQUIREMENTS IDENTITY).

NOTE: If an individual is unable to verify his or her identity, citizenship or satisfactory immigration status, workers should not assume she/he is therefore eligible for coverage of an emergency medical condition.

(MRG)

(other-eligibility-requirements)(page-173)Page 173#

UPDATED: JANUARY 2009

610

OTHER ELIGIBILITY REQUIREMENTS

SATISFACTORY IMMIGRATION STATUS

“JOHN/JANE DOE”

(MRG)

(other-eligibility-requirements)(page-174)Page 174#

UPDATED: NOVEMBER 2009 611

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS

QUALIFIED ALIENS

Description: Immigrants considered “Qualified aliens” include the following: • Persons lawfully admitted for permanent residence; • Persons admitted as refugees; • Persons granted asylum; • Persons granted status as Cuban and Haitian entrants; • Persons admitted as Amerasian immigrants; • Persons whose deportation has been withheld; • Persons paroled into the United States for at least one year; • Persons granted conditional entry; • Persons determined to be battered or subject to extreme cruelty in the United States by a family member; • Victims of trafficking; or • Veterans or persons on active duty in the Armed Forces and their immediate family members.

Policy: QUALIFIED ALIENS WHO ENTERED THE U.S. PRIOR TO AUGUST 22, 1996:

A qualified alien who entered the United States prior to August 22, 1996, may receive all care and services available under the Medicaid program, provided he or she is determined to be otherwise eligible. This provision includes individuals who attained qualified immigrant status subsequent to August 22, 1996, and who can demonstrate to the district’s satisfaction that they continuously resided in the United States until attaining qualified alien status. Federal Financial Participation (FFP) should be claimed for Medicaid provided to these qualified aliens.

QUALIFIED ALIENS WHO ENTERED THE U.S. ON OR AFTER AUGUST 22, 1996 AND ARE IN CERTAIN CATEGORIES EXEMPT FROM THE FEDERAL FIVE YEAR BAN ON MEDICAID:

The following qualified aliens who entered the United States on or after August 22, 1996, may receive all care and services available under the Medicaid program, provided they are determined to be otherwise eligible. • Persons who have been granted asylum under Section 208 of the INA;

(MRG)

(other-eligibility-requirements)(page-175)Page 175#

UPDATED: NOVEMBER 2009 612

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS

QUALIFIED ALIENS

• Persons for whom deportation has been withheld under Section 243(h) or 241 (b) (3) of the INA; • Cuban/Haitian entrants, as defined in Section 501(e) of the Refugee Education Assistance Act of 1980 (P.L. 96-422); • Qualified immigrants lawfully residing in the State who are on active duty in the armed forces, or who have received an honorable discharge from the armed forces and their spouses and unmarried dependent children, who are also qualified aliens.

NOTE: Non-citizen veterans and Active Duty Military personnel and their spouses and children are exempt from most of the immigration status related restrictions under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). For example they are eligible for Supplemental Security Income (SSI) and Food Stamps and are exempt from the five year ban.

• Refugees under Section 207 of the INA (including Amerasian immigrants admitted under the provisions of Public Law 100-202). • Victims of a severe form of trafficking are qualified aliens who receive Medicaid to the same extent as refugees. A comprehensive discussion of this group is in the section “Victims of Trafficking” of this Reference Guide. Federal Financial Participation (FFP) should be claimed for Medicaid provided to these qualified aliens.

ALL OTHER QUALIFIED ALIENS WHO ARE NOT IN THE ABOVE TWO GROUPS:

This group of qualified aliens may receive all care and services available under the Medicaid program, provided s/he is determined to be otherwise eligible. However, for these individuals the date they physically entered the United States will determine whether or not Federal Financial Participation (FFP) is available. This date is called the “Date Entered Country” (DEC). During their first five years in the U.S. with a status as qualified alien, FFP is not available. The cost of their Medicaid coverage will be born solely by State and local shares (50% State/50% local). Once a qualified alien in this group has resided in the United States as a qualified alien for a period of five years, FFP will become available. This means the federal government will pay a share of their Medicaid costs.

Qualified aliens in this group include the following: (MRG)

(other-eligibility-requirements)(page-176)Page 176#

UPDATED: NOVEMBER 2009 613

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS

QUALIFIED ALIENS

• Persons lawfully admitted for permanent residence (i.e. LPRs- “green card holders”) under the Immigration and Nationality Act (INA); • Persons paroled into the United States under Section 212(d)(5) of the INA for a period of at least one year; • Persons granted conditional entry pursuant to Section 203(a)(7) Immigration and Nationality ACT (INA); and • Persons who have been determined by the social services district to be in need of Medicaid as a result of being battered or subject to extreme cruelty in the United States by a spouse, parent, or by a member of the spouse’s or parent’s family residing in the same household as the alien family member at the time of the battering or extreme cruelty. (Refer to the section of this Reference Guide entitled “Battered Qualified Alien”)

References: SSL Sect

122

131-k

Dept Reg.

349.3

351.1

351.2

360-3.2 (j)

ADMs

04 ADM 07

97 ADM 23

88 ADM 22

88 ADM 4

82 ADM 24

INFS

06 INF-5

Interpretation: Applicants who meet the criteria above are considered to be in satisfactory immigration status and, if otherwise eligible, may receive all care and services provided by the Medicaid program.

Documentation: The following chart indicates examples of acceptable USCIS forms/documentation for qualified aliens who are in satisfactory immigration status. (MRG)

(other-eligibility-requirements)(page-177)Page 177#

UPDATED: NOVEMBER 2009 614

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS1

QUALIFIED ALIENS Category 2: Qualified Aliens

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement

Native Americans born in Canada ►I-94 coded “S1-3”; ►I-551 Permanent Resident Card stamped “S1-3”; ►Temporary I-551 stamp coded S1-3 in a Canadian passport; or ►Tribal Record or document certifying at least 50% American Indian blood, as required by Section 289 of the INA; and satisfactory evidence of birth in Canada, such as the following: - Birth certificate or Baptismal Certificate issued on a reservation; -Letter from Canadian Department of Indian Affairs; or -School Records.

YES

For the purposes of Medicaid, Native Americans are classified as U.S. citizens.

An SSN is an eligibility requirement for all citizens applying for Medicaid or FHP.

Note: Pregnant women are excluded from this requirement. Native Americans belonging to a Federally recognized Tribe born outside the U.S. -Membership card or other tribal document demonstrating (I.E., tribal card), membership in federally recognized Indian tribe under Section 4(e) of the Indian Self-Determination and Education Assistance Act and satisfactory evidence of birth outside the U.S.

YES Refugees ►I-94 or foreign passport with annotation “Section 207” of the INA or “Refugee” RE1, RE2, RE3, or RE4; ►I-551 coded R8-6, RE6, RE-7, RE-8, or RE-9; ►I-571 Refugee Travel Document; ►I-688B Employment Authorization Card annotated 8 C.F.R. 274a.12(a)(3); or ►I-766 Employment Authorization Document annotated “A3”.

YES Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement. Asylees ►I-94 or foreign passport annotated “granted Asylum under Section 208” of the INA , “Section 208” or “Asylee”; ►I-551 coded AS1, AS2, AS3, AS6, AS7 or AS8; ►I-571 Refugee Travel Document; ►I-688B Employment Authorization Card annotated 8 C.F.R. 274a.12(a)(5); ►I-766 Employment Authorization Document annotated “A5”; or ►Grant letter/order from the USCIS2 Asylum Office or Immigration judge granting asylum.

YES (MRG)

(other-eligibility-requirements)(page-178)Page 178#

UPDATED: NOVEMBER 2009 615

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS QUALIFIED ALIENS Category 2: Qualified Aliens continued

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement Persons granted withholding of deportation or removal (Non-citizens whose deportation or removal has been withheld based on a finding that the person’s life or freedom is threatened in the country of deportation based on race, religion, nationality, or membership in a particular social group or political opinion.) ►I-94 or foreign passport stamped “Section 243(h)” or “Section 241(b)(3)”; ►I-766 Employment Authorization Document annotated “A10”; ►Order issued by an immigration judge , the Board of Immigration appeals or a federal court showing the date that deportation was withheld under Section 243(h) of the INA, as in effect prior to April 1, 1997, or removal withheld under Section 241 (b)(3) of the INA.

YES Immigrants with or without work authorization are required to apply for a Social Security Number.

LDSS must provide Immigrants with a letter addressed to SSA for those immigrants without work authorization who met all the eligibility requirements for federal or state benefits, except for having an SSN. (08 OHIP INF-2) Note: Pregnant women are excluded from this requirement. Cuban/Haitian Entrants ►I-94 with annotation “Cuban-Haitian Entrant” Section 212(d)(5) of the INA, or CU6, CU7 or any other notation indicating “parole” under 212 (d)(5) on or after 10/10/80; and satisfactory evidence that the parolee has been a citizen of Cuba or Haiti; ►I-551 coded CU6, CU7, CH6, CN-P, LB-2, LB-6 or LB-7; ►Temporary I-551 stamp coded “CU-6” or “CU-7” in a foreign passport; ►I-688B Employment Authorization Card annotated 8 C.F.R. 274a.12(c)(8), and satisfactory evidence that the parolee has been a citizen of Cuba or Haiti; ►I-766 Employment Authorization Document annotated “C8” and satisfactory evidence that the parolee has been a citizen of Cuba or Haiti;; ►Order to Show Cause (OSC), I-221S, or Notice to Appear (NTA), I-862, indicating pending exclusion, removal or deportation proceedings and satisfactory evidence that the parolee has been a citizen of Cuba or Haiti; or ►Any document indicating pending asylum application or filing of I-589 Application for Asylum with satisfactory evidence on the document that the person has been a citizen of Cuba or Haiti

YES Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement. (MRG)

(other-eligibility-requirements)(page-179)Page 179#

UPDATED: NOVEMBER 2009

616

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS QUALIFIED ALIENS

Category 2: Qualified Aliens continued

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement Amerasians

►I-94 Arrival/Departure Record of Vietnamese passport or exit visa stamped “AM1, AM2, AM3, AM6, AM7, or AM8”; ►I-551 Permanent Resident Card coded “AM1, AM2, AM3, AM6, AM7, or AM8”; ►Temporary I-551 stamp in Vietnamese passport “AM1, AM2, AM3, AM6, AM7, or AM8”; or ►I-571 Refugee Travel Document.

YES

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement. Victims of a Severe Form of Human Trafficking ►I-94 Arrival/Departure Record coded T1, T2, T3, T4 or T5 stating admission under Section 212(d)(5) of the INA if status is granted for at least one year; ►Certification letter (for adults) or eligibility letter (for children) from the Office of Refugee Resettlement. Must call 1-866-401-5510 for verification; or ►I-797 Notice of Action acknowledging receipt of I-914, Application for T non- immigrant status.

D Upstate

R NYC

YES Veterans

(Immediate family members: documentation of relationship to veteran.) ►DD Form 214 showing “Honorable” discharge; or ►Original or notarized copy of the veteran’s discharge papers.

YES Persons on active duty in the Armed Forces and their immediate family members ►Military I.D. card -DD Form 2 (active); ►Original or notarized copy of current orders showing the person is on full-time duty in U.S. Armed Forces;

(Immediate family members must show documentation of relationship to the person on active duty.)

YES (MRG)

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Category 2: Qualified Aliens continued

Please note: Qualified Aliens who are Eligible for State Medicaid until becoming Eligible for Federal Medicaid after a 5 Year Waiting Period: Qualified aliens listed below, who entered the U.S before August 22, 1996, are eligible for federal Medicaid, if otherwise eligible. However, qualified aliens in these four categories who entered the U.S. on or after August 22, 1996, are subject to the federal five year ban. This means that they are not eligible for federally funded Medicaid until they have resided in the U.S. for five years in a qualified alien status. Until becoming eligible for federally funded Medicaid, these qualified aliens are eligible for State funded Medicaid coverage of all medically necessary care and services, if they meet the program’s other eligibility requirements. Districts must enter the appropriate State/federal charge codes to assure proper claiming of federal and State shares. For these individuals the date they physically entered the U.S. will determine whether or not Federal Financial Participation (FFP) is available. This date is called the “Date Entered Country” (DEC). During their first five years in the U.S the cost of their Medicaid coverage will be born solely by the State and local share (50% State/50% local). Once a qualified alien in this group has resided in the United States as a qualified alien for a period of five years, FFP will become available. This means the federal government will pay a share of their Medicaid costs.

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement Lawful Permanent Residents (LPRs or “green card” holders) ►I-94 Arrival/Departure Record or foreign passport stamped I-551; ►I-551 Lawful Permanent Resident Card “green card”; ►I-327 Re-entry permit’; or ►I-181 Memorandum of Creation of Record of Lawful Permanent Residence with approval stamp.

K (without 40 quarters) S (with 40 quarters)

YES After 5 yrs in a qualified status

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement.

Parolees admitted into the U.S. for at least one year

(Non-citizen who have been allowed to come into the U.S. for humanitarian or public interest reasons.) ►I-94 Arrival/Departure Record with annotation “Paroled Pursuant to Section 212(d)(5)” or “parole” or “PIP” or “public interest” with the date of entry and date of expiration indicating at least one year; ►I-688B Employment Authorization Card annotated “ 8 C.F.R. 274a.12(a)(4) or 274a.12(c)(11)”; or ►I-766 Employment Authorization Document annotated “A4” or “C11”.

YES After 5 yrs in a qualified status

Conditional Entrants

(Status granted to refugees before 1980.)

►I-94 Arrival/Departure Record stamped Section 203(a)(7), or otherwise indicating status as a conditional entrant;; ►I-688B Employment Authorization Card annotated “8 C.F.R. 274a.12(a)(3)”; or ►I-766 Employment Authorization Document annotated “A3”.

YES

After 5 yrs in a qualified status

(MRG)

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OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS

QUALIFIED ALIENS

Category 2: Qualified Aliens continued

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement Victims of Battery/Abuse

The term “battered qualified alien” includes the following immigrants described at 8 U.S.C. §1641(c): • an alien who has been battered or abused in the U.S. by a spouse or parent, or by a member of the spouse’s or parent’s family residing in the same household as the alien; or • the parent of a battered or abused child; or • the child of a battered or abused parent.

A substantial connection must also exist between the battery or abuse and the need for public benefits such as Medicaid. The alien must no longer be living with the batterer or abuser. A variety of documents provide evidence that an alien meets this definition. ►I-797 Notice of Action indicating that the alien has an approved I-360 self petition (Do NOT refer to DVL); ►I-797 Notice of Action indicating that the alien has a pending I-360 self petition that has established a prima facie case (Do NOT refer to DVL); ►Order from the Executive Office for Immigration Review (“EOIR”) granting or finding a prima facie case for granting, suspension of deportation or cancellation of removal. (Do NOT refer to DVL); or ►I-797 Notice of Action indicating that the alien has a pending I-360 self petition AND credible evidence of battery or abuse (Request permission to refer to DVL); or ►I-797 Notice of Action indicating the alien is the beneficiary of a pending or approved I-130 petition and credible evidence of battery and/or abuse (Request permission to refer to DVL); or ►I-94 coded K3, K4, V1, V2 or V3 and credible evidence of battery or abuse(Request alien’s permission to refer to DVL); or ►Any other USCIS document indicating the alien has a K or V visa and a pending or approved I-130 petition with credible evidence of battery or abuse. (Request permission to refer to DVL); or

YES

After 5 yrs in a qualified status

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement.

Continued on next page (MRG)

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OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS

QUALIFIED ALIENS

Category 2: Qualified Aliens continued

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement (from previous page)

(from previous page) ►I-94 or Foreign passport annotated CR1, CR2, CR6, CR7 with credible evidence of battery and/or abuse (Request permission to refer to DVL); or; ►I-688B Employment Authorization Card annotated:274a.12(a)(9)- spouse/children of USC or LPR (K or V visa); 274a.12(a)(15)-spouses and dependents of LPR (K or V visa); 274a.12(c)(10)-applicant for suspension of deportation with credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ; ►I-766 Employment Authorization Document annotated A9, A15 or C10 with credible evidence of battery and/or abuse (Request alien’s permission to refer to DVL).

NOTE: Referral to a domestic violence liaison (DVL): Medicaid-only offices may refer alien applicants and recipients who must demonstrate that they are credible victims of domestic violence to be considered qualified for Medical assistance as “battered aliens” to the DVL for a credibility assessment. Those applicants and recipients who cannot document eligibility in any other category and cannot document that the United States Citizenship and Immigration Services (USCIS) or immigration court has determined the alien has in fact been subject to battery or extreme cruelty will need to see the district/s DVL for a credibility determination. If districts are unable to verify that an acceptable immigration document has been filed with USCIS, districts can accept the alien’s written attestation and then refer the alien to an immigration attorney or legal services for assistance. The DVL does not have the authority to determine eligibility for assistance.

REVISED 03/03/08

(MRG)

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UPDATED: NOVEMBER 2009 620

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

Description: An immigrant who, or whose child or parent, has been battered or subjected to extreme cruelty in the United States by a U.S. citizen or lawful permanent resident spouse or parent can be considered a qualified alien. An immigrant whose child has been battered/abused by the child's U.S. citizen or lawful permanent resident other parent is similarly eligible, as are immigrant children, whose parent has been abused by the parent's U.S. citizen or lawful permanent resident spouse residing in the same household. The immigrant can be considered a qualified alien when it is determined that there is substantial connection between the battery, abuse or cruelty and the need for benefits. Policy: Battered immigrants are considered qualified aliens and are said to be in satisfactory immigration status.

References: SSL Sect. 122

131-k

Dept Reg. 349.3

351.1

351.2

360-3.2(j)

ADMs 04 ADM-7

97 ADM-23

92 ADM-10

88 ADM-47

88 ADM-22

88 ADM-24

INFs 06 OMM-INF-5

GISs 08 MA/009

Interpretation: Battery or extreme cruelty is defined as including, but not limited to, being a victim of any act or threatened act of violence, including forceful detention, which results or threatens to result in physical or mental injury or psychological or sexual abuse or exploitation, including rape, molestation, incest, or forced prostitution. (MRG)

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UPDATED: NOVEMBER 2009 621

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

Immigrant victims of battery/abuse can be treated as a “qualified alien” for Medical Assistance benefit purposes if they meet the following four requirements:

1. Be a credible victim of battery/abuse or extreme cruelty, who or who’s child or parent has been battered, abused or subject to extreme cruelty in the U.S., by a spouse or a parent, or by a member of the spouse’s or parent’s family residing in the same household; and 2. Be able to show a substantial connection between the need for benefits sought and the battery or extreme cruelty; and 3. No longer resides in the same household as the abuser, and 4. Have an appropriate immigration status including a pending or approved I-130 petition for a alien relative (K or V visa status), a pending or approved I-360 self petition, or Notice of Prima Facie Case determination (I-797 Notice of Action), or an Executive Office for Immigration Review (EOIR) order/letter granting suspension or cancellation under 8 U.S.C 1229b(b)(2) and 8 U.S.C. 1254(a)(3) or evidence that an application for suspension of deportation/cancellation of removal has been made with evidence that sets forth a prima facie case.

EVIDENCE OF ABUSE: An applicant who has an approved petition or court order granting him/her protection from the abuser has already shown battery or extreme cruelty and a new determination should not be made by the eligibility worker. Other evidence of battery/abuse that immigrants may present includes, but is not limited to: reports or affidavits from police, judges, court officials, medical personnel, school officials, clergy, social workers; counseling or mental health personnel; proof of a domestic violence conviction, and proof of seeking safe-haven in a battered shelter.

SUBSTANTIAL CONNECTION: There must be a substantial connection between the battery/abuse or extreme cruelty to which the immigrant, immigrant's child, or immigrant child's parent has been subjected to and the need for the medical assistance. The following list demonstrates circumstances in which a substantial connection exists between the battery and the need for medical assistance benefits:

o where the benefits are needed to enable the immigrant, immigrant's child, or an immigrant child's parent to become self-sufficient following separation from the abuser; (MRG)

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OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

o where the benefits are needed to enable the immigrant, immigrant's child, or an immigrant child's parent to escape the abuser and/or the community in which the abuser lives and to ensure safety; o where the benefits are needed due to a loss of financial support resulting from the immigrant's separation from the abuser; o where the benefits are needed because the battery/abuser or extreme cruelty, separation from the abuser, work absences, or lower job performance resulting from the abuse or court-related proceeding cause the immigrant, the immigrant's child, or immigrant child's parent to leave or lose employment; o where the benefits are needed because the battery/abuse or extreme cruelty has caused the immigrant, the immigrant's child, or immigrant child's parent to require medical attention/counseling or become disabled; o where the benefits are needed because of the loss of a dwelling or source of income or because fear of the battery/abuse after separation diminishes the immigrant's, or immigrant child's parent's ability to care for the children; o where the benefits are needed to alleviate nutritional risks and needs following battery/abuse and/or after separation; o where the benefits are needed to provide medical care during pregnancy resulting from sexual assault or the relationship with the abuser; and o where medical coverage or health care services for the immigrant, the immigrant's child, or immigrant child's parent are needed to replace the services provided while living with the abuser. NON-RESIDENCY WITH THE BATTERER: The following examples will serve as credible evidence to support the claim of non- residency with the batterer and include, but are not limited to: o a civil protection order requiring the batterer to stay away from the battered immigrant, immigrant child, or immigrant child's parent; (MRG)

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UPDATED: NOVEMBER 2009 623

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

o an eviction notice removing the batterer from the immigrant's residence; o employment records; o utility receipts; o school records; o hospital or medical bills; o rental records from a building or property manager; o affidavit from a staff member at a battered or homeless shelter o affidavits from witnesses, including landlords and neighbors; and O any other records establishing that the immigrant, immigrant's child, or immigrant child's parent no longer resides with the abusive abuser. NOTE: Districts should be cautioned that they should not contact the abuser for any verification or documentation of living arrangements or other factors of eligibility. Information with respect to victims of domestic violence must not be released to any outside party or other governmental agencies unless the information is required to be disclosed by law, or unless authorized in writing by applicant/recipient. Districts need to be concerned about how information is shared (i.e., insure that information pertaining to good cause or domestic violence is mailed to the victims’ homes). Notices and other information may be mailed to an alternate mailing address (i.e., shelter) or held at district office. The client must decide the safest way to obtain the information. REFERRAL TO A DOMESTIC VIOLENCE LIAISON (AVL): Battered Immigrants are "qualified aliens" and may receive Medical Assistance benefits if all of the following criterions are met, including financial requirements: A battered qualified alien must be:

(MRG)

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UPDATED: NOVEMBER 2009 624

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

• an alien who has been battered or subjected to extreme cruelty (“abused”) in the U.S. by a spouse or parent or by a member of the spouse’s or parent’s family residing in the same household as the alien; or • the parent of a battered or abused child; or • the child of a battered or abused parent.

Applicants and recipients who cannot document that the United States Citizenship and Immigration Services (USCIS) or immigration court has determined the immigrant has in fact been subject to battery/abuse or extreme cruelty will need to see the district’s DVL for a credibility determination. These individuals must demonstrate that they are credible victims of domestic violence in order to be considered qualified for Medical Assistance as a “battered qualified alien”. If districts are unable to verify that an acceptable immigration document has been filed with USCIS, districts can accept the alien’s written attestation and then refer the alien to an immigration attorney or legal services for assistance. The DVL does not have the authority to determine eligibility for assistance.

VERIFICATION OF IMMIGRATION STATUS: Battered or abused aliens will typically possess one or more of the following documents:

• I-797 Notice of Action indicating that the alien has an approved I-360 self-petition (entitled Petition for Amerasian, Widow(er) or Special Alien) under the Violence Against Women Act (VAWA) to obtain lawful permanent residence status as the battered or abused spouse or child of a U.S. citizen or lawful permanent resident [Do not refer to the domestic violence liaison (DVL)]; or • I-797 Notice of Action indicating that the alien has a pending I-360 self-petition under VAWA that has established the alien’s prima facie eligibility for obtaining lawful permanent resident status as the battered or abused spouse or child of a U.S. citizen or lawful permanent resident (Do not refer to the DVL); or • Order from the Executive Office for Immigration Review (EOIR) granting or finding a prima facie case for granting, suspension of deportation or cancellation of removal based on battery or abuse by a U.S. citizen or lawful permanent resident spouse or parent (Do not refer to the DVL); or • I-797 Notice of Action indicating that the alien has a pending I-360 self-petition under VAWA to established lawful permanent resident status as the battered or abused spouse or child of a U.S. citizen or lawful permanent resident and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL); or

(MRG)

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UPDATED: NOVEMBER 2009 625

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

• I-797 Notice of Action indicating that the alien is the beneficiary of a pending or approved I-130 Petition for Alien Relative as the battered or abused spouse or child of a U.S. citizen or lawful permanent resident and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL;); or • I-94 Arrival/Departure Record stamped “K3”, “K4”, “V1”, “V2”, or “V3” and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL); or • Any other USCIS document indicating that the alien has a “K” or “V” visa and a pending or approved I-130 Petition for Alien Relative and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL;); or • I-94 Arrival/Departure Record or foreign passport stamped “CR-1”, “CR-2”, “CR-6” or “CR-7" and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL); or • I-688B Employment Authorization Card coded “274a.12(a)(9),” “274a.12(a)(15)” or “274a.12(c)(10)” and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL); or • I-766 Employment Authorization Document coded “A9”, “A15” or “C10” and credible evidence of battery or abuse (Request alien’s permission to refer to the DVL).

Districts must determine if the USCIS or the EOIR has approved an applicant’s I-360 self- petition or has found that an applicant’s pending petition set-forth a prima facie case by reviewing the applicant’s documents. • The worker must carefully examine the documents provided by the immigrant applicant. • If based on the documentation provided to show citizenship, immigration or qualified alien status the worker can conclude that the applicant is not a "qualified alien" (i.e. the applicant presents documents such as a tourist visa or other documents that do not make them eligible for Medical Assistance), the worker does not need to verify the applicant's status. • If the documentation provided does not appear on its face to be genuine or does not appear to relate to the person presenting it, this should not serve as a basis to conclusively deny benefits without first checking with the USCIS. (Through SAVE or by filing a G-845 “Verification Request” [non-SAVE agencies] with USCIS. Refer to 04 ADM-7). (MRG)

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UPDATED: NOVEMBER 2009 626

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED AIENS

BATTERED QUALIFIED ALIENS

• If the USCIS notifies the applicant that they have an immigration status that makes him/her a qualified alien the eligibility worker should accept the USCIS verification and proceed to determine whether the applicant satisfies the remaining program requirements. If the USCIS notifies the applicant that she/he does not have immigration status that makes him/her a qualified alien, the worker should notify the applicant of her appeal rights. If the applicant is a battered immigrant and the documentation provided does not appear on its face to be genuine or does not appear to relate to the person presenting it, the worker should contact the Immigration Court that is handling the case or the USCIS Vermont Service Center at 75 Lower Welden Street, Saint Albans, Vermont, 05479. THE FIVE YEAR BAN TO BENEFITS ACCESS: Battered immigrants who first entered the United States after 8/22/96 and become "qualified aliens" are not eligible to receive federal Medical Assistance benefits until they have attained five years in a qualified alien status. This is called the federal "five year bar." This bar applies to all immigrants who entered the United States after 8/22/96.

New York State covers “battered” qualified aliens with State only funds until the five-year ban expires. (MRG)

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UPDATED: NOVEMBER 2009 627

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

BATTERED QUALIFIED ALIENS

SOCIAL SECURITY NUMBERS (SSNs) FOR BATTERED QUALIFIED ALIENS: The Social Security Administration (SSA) does not routinely assign new SSNs. However, SSA will do so when evidence shows the immigrant is being harassed, a victim of family violence, abused or their life is endangered.

Qualified aliens must provide a social security number. If they do not have a SSN, they must apply for one. An exception applied to pregnant women. Pregnant women are not required to provide or apply for a SSN for the duration of the pregnancy and the sixty-day period that begins on the last day of the pregnancy and including, but not exceeding, the last day of the month in which the sixty-day post-partum period ends.

If a qualified alien applies for a SSN, but is denied a SSN based on immigration status, the alien is not required to reapply for a SSN until his or her status changes. In these situations districts are to use WMS Social Security Code N, “State Benefits Eligible Alien”.

ALIEN NUMBER (A#) REQUIREMENT FOR BATTERED QUALIFIED ALIENS: Providing an alien registration number is no longer an eligibility requirement for Public Assistance, Medical Assistance or Food Stamp Assistance for battered aliens (ACI Code "B"). This change is a result of MKB litigation.

Although not required, if an alien number is presented by the applicant/recipient, the alien number should be entered into the Welfare Management System (WMS).

(MRG)

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UPDATED: NOVEMBER 2009 628

BATTERED QUALIFIED ALIENS DESK AID

Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement Victims of Battery/Abuse The term “battered qualified alien” includes the following immigrants described at 8 U.S.C. §1641(c): an alien who has been battered or abused in the U.S. by a spouse or parent, or by a member of the spouse’s or parent’s family residing in the same household as the alien; or • the parent of a battered or abused child; or • the child of a battered or abused parent. A substantial connection must also exist between the battery or abuse and the need for public benefits such as Medicaid. The alien must no longer be living with the batterer or abuser. A variety of documents provide evidence that an alien meets this definition. ►I-797 Notice of Action indicating that the alien has an approved I-360 self petition (Do not refer to DVL); ►I-797 Notice of Action indicating that the alien has a pending I-360 self-petition that has established a prima facie case (Do not refer to DVL); ►Order from the Executive Office for Immigration Review (“EOIR”) granting or finding a prima facie case for granting, suspension of deportation or cancellation of removal (Do not refer to DVL); or ►I-797 Notice of Action indicating that the alien has a pending I-360 self petition AND credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ►I-797 Notice of Action indicating the alien is the beneficiary of a pending or approved I-130 petition and credible evidence of battery and/or abuse (Request alien permission to refer to DVL); or ►I-94 coded, K3, K4, V1 V2 or V3 and credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ►Any other USCIS document indicating the alien has a K or V visa and a pending or approved I-130 petition with credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ►I-94 or Foreign passport annotated CR1, CR2, CR6, CR7 with credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ►I-688B Employment Authorization Card annotated 274a.12(a)(9)-spouse/children of USC or LPR (K or V visa), 274a.12(a)(15)-spouses and dependents of LPR (K or V visa), 274a.12(c)(10)-applicant for suspension of deportation with credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ►I-766 Employment Authorization Document annotated A9, A15 or C10 with credible evidence of battery or abuse (Request alien’s permission to refer to DVL).

YES

After 5 yrs in a qualified status

Immigrants with or without work authorization are required to apply for a Social Security Number.

LDSS must provide immigrants with a letter addressed to SSA for those immigrants without work authorization who met all the eligibility requirements for federal or state benefits, except for having an SSN. (08 OHIP INF-2)

Note: Pregnant women are excluded from this requirement. NOTE: Referral to a domestic violence liaison (DVL): Medicaid-only offices must refer alien applicants and recipients who must demonstrate that they are credible victims of domestic violence to be considered qualified for medical assistance as “battered aliens” to the DVL for a credibility assessment. Those applicants and recipients who cannot document eligibility in any other category and cannot document that the United States Citizenship and Immigration Services (USCIS) or immigration court has determined the alien has in fact been subject to battery or extreme cruelty will need to see the district’s DVL for a credibility determination. If districts are unable to verify that an acceptable immigration document has been filed with USCIS, districts can accept the alien’s written attestation and then refer the alien to an immigration attorney or legal services for assistance. The DVL does not have the authority to determine eligibility for assistance. (MRG)

(other-eligibility-requirements)(page-192)Page 192#

UPDATED: JANUARY 2011

629

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

REFUGEE MEDICAL ASSISTANCE (RMA)

Description: A refugee is an individual who comes to the United States because he/she faces persecution or fear of persecution in his/her home country. New York State provides the services of resettlement agency case workers to help refugees in applying for short-term cash and medical assistance upon arrival in the United States. The program under which this service/support is provided is known as Refugee Cash Assistance (RCA) and Refugee Medical Assistance (RMA).

Policy: The Refugee Medical Assistance (RMA) Program is primarily limited to refugees who are single or childless couples (S/CCs) who are not living with a dependent child, are not pregnant, or certified blind or disabled and who:

• Are eligible for or receiving Safety Net Assistance (SNA); or • Are financially ineligible for Medicaid Under the S/CC category of assistance or FHPlus; and • Meet immigration status and identification requirements set forth below; and • Provide the name of the resettlement agency which resettled them, if he/she is a refugee or entrant; and • Are not full-time students in an institution of higher education, except where such enrollment is expected to be approved as part of an individual employability plan.

References: SSL Sect. 358 (3)

Dept. Reg. 373-2

ADMs 05 OTDA/ADM-01

INFs 10 OHIP/INF-2

06 OMM/INF-5

Interpretation: The term refugee includes the following groups: Refugees, Asylees, Cuban and Haitian Entrants and Amerasians. Aliens who are considered “refugees” for the purpose of Medicaid eligibility also include federally certified victims of a severe form of human trafficking, certain family members of certified trafficking victims, and Special Immigrant Visa Holders (SIV) from Afghanistan and Iraq.

(MRG)

(other-eligibility-requirements)(page-193)Page 193#

UPDATED: JANUARY 2011

630

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

REFUGEE MEDICAL ASSISTANCE (RMA)

Eligibility for RMA is based on the applicant’s income on the date of application. The LDSS must NOT average income prospectively for the application-processing period to determine income eligibility for RMA. A sponsor’s income (solely because the person is serving as a sponsor), in-kind services and shelter provided to an applicant by a sponsor or resettlement agency and any cash grant received by the applicant from the United States Department of State or Department of Justice during the initial 30-day Reception and Placement Program period are exempt in determining the applicant’s eligibility. All other Medicaid rules and regulations apply in determining eligibility under RMA.

NOTE: Match grants provided to an applicant by a voluntary agency under direct agreement with the Office of Refugee Resettlement (ORR) must be counted in determining eligibility. However, a Match grant should not cause the individual to be ineligible for Medicaid.

Eligibility is first determined for S/CC. If the individual is not eligible as an S/CC, then eligibility under FHPlus is determined. If the applicant is not eligible as an S/CC or under FHPlus, an ADC budget is performed and the S/CC is allowed to spend-down to the Medically Needy Income Level.

If a refugee who is receiving RMA receives new or increased earnings from employment after eligibility for RMA has been determined, the increased earning will not affect his/her continued RMA eligibility.

If during the initial eligibility period an individual who is receiving “regular” Medicaid becomes ineligible for “regular” Medicaid due to increased earnings, the individual must be transferred to RMA without an RMA eligibility re-determination. This includes refugees receiving Medicaid through Family Assistance (FA) Program or under Low Income Family (LIF) category of assistance. However, before transferring the individual to RMA, the case must first be evaluated for eligibility under Transitional Medical Assistance (TMA).

Should earnings/income decrease during the initial eligibility period, eligibility must be redetermined. If the individual is now eligible under regular Medicaid or FHPlus, authorize coverage as appropriate. If the individual continues to be ineligible under regular Medicaid or FHPlus, as an S/CC, but the decrease in earnings/income results in a decrease

(MRG)

(other-eligibility-requirements)(page-194)Page 194#

UPDATED: JANUARY 2011

631

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

REFUGEE MEDICAL ASSISTANCE (RMA)

in the excess income amount under the ADC-related budget, notify the individual of his/her decrease in excess income.

NOTE: Refugee families with children can receive RMA during their first eight months in the U.S. only if they become ineligible for the State’s “regular” State Plan Medicaid Program.

Disposition: The following refugees are eligible for RMA for the time periods specified:

• Refugees, Cuban/Haitian entrants and Amerasian immigrants are eligible for eight months from the date of arrival into the United States. • Asylees are eligible for eight months from the date that asylum status is granted. • Trafficking victims are eligible for RMA benefits for eight months from the date indicated in the certification letter (for adults) or eligibility letter (for children) issued by the ORR. • Certain family members of victims of a severe form of human trafficking are eligible for eight months from the date they acquired the Derivative T-Visa status: o For family members who received the Derivative T-Visa in the United States, the date of eligibility for RMA benefits is the notice date found on the I-797 Notice of Action. o For family members who enter the United States with a Derivative T-Visa, the date of eligibility is the date the individual entered the country which is stamped on the individual’s passport or I-94 Arrival/Departure Record. • Iraqi/Afghan Special Immigrant Visa Holders’ eligibility continues for eight months from the date they entered the U.S. or, if already in the U.S., for eight months from the date that they acquired their Special Immigrant Status.

Documentation: RMA applicants must provide proof of his/her immigration status including, as appropriate, Arrival/Departure Record (I-94), Permanent Resident Card (I-551), or a USCIS Notice of Action (I-797). The various immigration statuses that may be found on the immigration documents include:

• Admitted as a conditional entrant under Section 203 (a) (7) of the Immigration and Nationality Act (INA). • Admitted as a refugee under Section 207 of the INA. (MRG)

(other-eligibility-requirements)(page-195)Page 195#

UPDATED: JANUARY 2011

632

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

REFUGEE MEDICAL ASSISTANCE (RMA)

• Granted asylum under Section 208 of the INA. • Any national of Cuba or Haiti granted parole status as a Cuban/Haitian Entrant (status pending) or granted any other special status subsequently established under the immigration laws for nationals of Cuba or Haiti, regardless of the status of the individual at the time assistance or services are provided. • Any other national of Cuba or Haiti who: o Was paroled into the U.S. and has not been given any other status under the INA; or is facing exclusion or deportation proceedings under the INA; or has an application for asylum pending with the USCIS; and o With respect to whom a final, non-appealable, and legally enforceable order of deportation or exclusion has not been entered. • Amerasian immigrants (aliens who were born in Vietnam after January 1, 1962 and before January 1, 1976, and whose fathers were U.S. citizens and such alien’s spouses or minor children) who are admitted to the U.S. as immigrants pursuant to Section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988 (as contained in Section 101 (d) of Public Law 100-202 and as amended by Public Law 100-461). • Adjusted to permanent resident status from one of the previously held eligible statuses described above. • Office of Refugee Resettlement documentation for trafficking victims, as described in 06 OMM/INF-5. There are two categories of trafficking victims: o Adult (18 years of age or older) victims of a severe form of human trafficking who are certified by ORR of the Federal Department of Health and Human Services. These individuals must submit the original certification letter to the LDSS. This letter is used instead of USCIS documents; and o Children younger than 18 years of age do not have to be certified but are issued an eligibility letter by the ORR stating that they are eligible for benefits as victims of a severe form of human trafficking. The ORR certification or eligibility letter is proof of the alien’s immigration status. However, the Medicaid worker must call the Trafficking Verification Line (1-866-401-5510) to verify the document(s).

(MRG)

(other-eligibility-requirements)(page-196)Page 196#

UPDATED: JANUARY 2011

633

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

REFUGEE MEDICAL ASSISTANCE (RMA)

Certain family members of victims of a severe form of trafficking are also eligible for RMA benefits and services to the same extent as refugees. These individuals will have either a T-2, T-3, T-4 or T-5 visa, which is referred to as a Derivative T-Visa. Derivative T- Visas may be issued while the immigrant is in the U.S. or an individual may be issued a Derivative T-Visa upon entering the U.S. • Iraqi and Afghan Special Immigrant Visa Holders (SIV) category/code “SI” will be stamped in the foreign passport or appear on the I-551-Lawful Permanent Resident Card (“green card”).

(MRG)

(other-eligibility-requirements)(page-197)Page 197#

UPDATED: NOVEMBER 2009 634

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

U.S. ARMED FORCES ACTIVE DUTY AND VETERANS

Description: Qualified aliens who are on active military duty or who are veterans are eligible for Medical Assistance, if they are otherwise eligible.

Policy: Medicaid may be authorized for a qualified alien who is on active duty or who is a veteran of the U.S. Armed Forces, provided that s/he is otherwise eligible.

References: Balanced Budget Act of 1997

SSL Sect. 122

Dept Reg. 349.3

351.1

351.2

360-3.2(j)

ADMs 04 ADM-7

INF

06 INF-5

GISs 08 MA/009

Interpretation: Active Military Duty-The individual must be on full-time duty in the Army, Navy, Air Force, Marine Corps, or Coast Guard. Active Duty for training and full time National Guard duty are not included in this interpretation.

Medicaid is also provided to the immigrant’s spouse and unmarried dependent children who are qualified aliens.

Veterans - The veteran’s discharge must have been characterized as “honorable”, and not because of his or her immigration status. Medicaid is also provided to the veteran’s qualified alien’s spouse, including his or her un-married surviving spouse if the veteran is deceased, and any unmarried dependent children of the veteran who are qualified aliens. (MRG)

(other-eligibility-requirements)(page-198)Page 198#

UPDATED: NOVEMBER 2009 635

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

U.S. ARMED FORCES ACTIVE DUTY AND VETERANS

NOTE: The Balanced Budget Act of 1997 provided that Hmong and other Highland Lao veterans who fought on behalf of the Armed Forces of the United States during the Vietnam conflict and have been lawfully admitted to the United States for permanent residence are to be considered veterans for the purpose of this provision.

Documentation: U.S. ARMED FORCES-ACTIVE DUTY AND VETERANS

Category 2: Qualified Aliens Continued

Category

Documentation

WMS ACI Code

Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement Veterans

(Immediate family members: documentation of relationship to veteran or person on active duty) ►DD Form 214 showing “Honorable” discharge; or ►Original or notarized copy of the veteran’s discharge papers.

YES

YES Immigrants with or without work authorization are required to apply for a Social Security Number.

Persons on active duty in the Armed Forces and their immediate family members

►►Military I.D. card – DD Form 2 (active); ►Original or notarized copy of current orders showing the person is on full- time duty in U.S. Armed forces;

(Immediate family members must show documentation of relationship to the person on active duty.)

YES

(MRG)

(other-eligibility-requirements)(page-199)Page 199#

UPDATED: JUNE 2010

636

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

VICTIMS OF TRAFFICKING

Description:

The federally eligible immigration category, “victims of a severe form of trafficking”, Section 107(b) of The Trafficking Victims Protection Act of 2000 (P.L. 106-386) makes victims of “a severe form of trafficking in persons” eligible for Medicaid and other benefits (if otherwise eligible) to the same extent as an alien who is admitted to the United States as a refugee under section 207 of the Immigration and Nationality Act (INA).

Policy:

Victims of “a severe form of trafficking in persons” (VOTs) are eligible for Medicaid and other benefits (if otherwise eligible) to the same extent as an alien who is admitted to the United States as a refugee under section 207 of the Immigration and Nationality Act. Individuals with letters of certification or eligibility as victims of severe forms of trafficking are eligible for medical assistance. They retain this eligibility for seven years from the date of certification contained in the letter.

References: The Trafficking Victims Protection Act of 2000 Sect.107(B)

P.L. 106-386

The Trafficking Victims Reauthorization Protection Act of 2003

Chapter 74 of the Laws of 2007

P.L. 108-193

Dept. Regs. 360.3.2 (j)

ADMs 09 ADM-01(OTDA) 04-OMM/ADM-7 03-ADM-1(OTDA)

INF 06 OMM INF-5

GIS 10 MA/002 08 MA/009

Interpretation: A “victim of a severe form of trafficking in persons” means a person:

(MRG)

(other-eligibility-requirements)(page-200)Page 200#

UPDATED: JUNE 2010

637

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

VICTIMS OF TRAFFICKING

1) Who has been subjected to a “severe form of trafficking in persons,” which is defined as “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery”; and

2) Who has not attained the age of 18 years or who is the subject of a certification issued by the federal government pursuant to Section 107(b)(1)(E) of the Act.

For individuals who meet the above criteria, the Office of Refugee Resettlement (ORR) will issue the certification letters for adults and the eligibility letters for children. To receive a certification or a letter, a victim of trafficking must be willing to assist with the investigation and prosecution of trafficking cases AND either:

(1) Have made a bona fide application for a “T” visa that has not been denied. OR (2) Be an individual whose continued presence the Attorney General is ensuring to effectuate a Trafficking prosecution.

When a victim of trafficking applies for Medicaid, local districts must follow their normal procedures for establishing Medicaid eligibility for refugees. Local districts must also:

1. Accept the certification letter for adults, or eligibility letter for children in place of USCIS documentation. Please note, as of November 6, 2001, certification letters for adults and eligibility letters for children no longer contain an eight- month expiration date. Victims of severe forms of trafficking do not need to provide any other documentation of their immigration status. The local district must call the trafficking verification line at 1-866-401-5510 to verify the validity of the documentation. 2. Use the certification date as the “Date of Status” (DOS) for Medicaid purposes. The certification date is in the body of the certification letter or the eligibility letter for children. 3. Issue benefits to the same extent as other refugees, provided the victim of a severe form of trafficking meets other program eligibility criteria (e.g., income levels). (MRG)

(other-eligibility-requirements)(page-201)Page 201#

UPDATED: JUNE 2010

638

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

VICTIMS OF TRAFFICKING

4. Upstate WMS: Districts should use citizenship/alien code (ACI) “D”- Victim of Human Trafficking. 5. New York City WMS: Workers should use ACI code “R”- Person Admitted as a Refugee” for Victim of Human Trafficking. For purposes of Medicaid/Family Health Plus and/or Child Health Plus eligibility, victims of a severe form of trafficking, (holders of a T-visa/T- 1, and holders of T-2, T-3, T-4 and T-5 [“Derivative” T-visas]) who are the minor children, spouses and in some cases the parents and siblings of victims of severe forms of trafficking in persons, may receive Medicaid benefits to the same extent as refugees. Recipients of a “T” visa are eligible for employment authorization. “T” visa recipients also may, if eligible, adjust their status to that of lawful permanent resident after three years. Victims may also apply for other immigration benefits such as an “S” visa (See section on OTHER VISA STATUSES) or asylum.

New York State “Confirmed” Victims of Human Trafficking:

Effective November 1, 2007 human trafficking was established as a crime in New York State. Under the law, a process to “confirm” victims of human trafficking as a means of providing assistance to such victims was established. State “confirmed” human trafficking victims who are citizens or aliens with a satisfactory immigration status who are otherwise eligible, are eligible for Medicaid benefits and services to the same extent as any other citizen or alien with satisfactory immigration status.

State “confirmed” human trafficking victims who do not have a satisfactory immigration status who are otherwise eligible for Medicaid may receive coverage and care necessary for the treatment of an emergency medical condition. (See OTHER ELIGIBLITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS UNDOCUMENTED/ILLEGAL ALIENS TREATMENT OF AN EMERGENCY MEDICAL CONDITION) When the State “confirmed” adult or minor victim is an alien without satisfactory immigration status, local districts must contact the Office of Temporary and Disability Assistance (OTDA), Bureau of Refugee and Immigration Affairs (BRIA) Anti-Trafficking Program Coordinator. BRIA will refer the victim to a specific regional case management agency and/or other local resources that may be able to assist the victim. (MRG)

(other-eligibility-requirements)(page-202)Page 202#

UPDATED: JUNE 2010

639

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

VICTIMS OF TRAFFICKING

At the time of application, the “confirmed” adult victim should have received a letter from OTDA indicating that she/he is a state “confirmed” victim of human trafficking. Each “confirmed” adult victim must present evidence of confirmation. Should the victim not present the letter to the intake worker or she/he does not appear to have a letter, or if additional information about the case is needed, the local district must contact the BRIA Anti-Trafficking Program Coordinator.

Minor children who are State ”confirmed” trafficking victims who are otherwise eligible, may be provided medical coverage without regard to immigration status under the Child Health Plus program. BRIA will notify the LDSS by telephone and follow-up letter of any minor victims of human trafficking whether “confirmed” or “not confirmed”, and whether a “victim” or “possible victim” of human trafficking.

State “confirmed” human trafficking victims who are pregnant and otherwise eligible may be provided Medicaid at any time without regard to immigration status.

NOTE: State “confirmed” victims of human trafficking are not to be confused with the federally “certified” alien victims of human trafficking. Federally “certified” adults will have a Certification Letter from the Office of Refugee Resettlement (ORR). Children victims of human trafficking (under age 18) will have a letter of eligibility from ORR.

(MRG)

(other-eligibility-requirements)(page-203)Page 203#

UPDATED: NOVEMBER 2009 640

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS QUALIFIED ALIENS

VICTIMS OF TRAFFICKING

Documentation: Victims of Trafficking will have the following documentation:

Category 2: Qualified Immigrants Continued

Category

Documentation

WMS ACI Code

Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement Victims of Trafficking

►I-94 Arrival/Departure Record coded T1, T2, T3, T4, or T5 stating admission under Section 212(d)(5) of the INA if status is granted for at least one year; ►Certification letter (for adults) or eligibility letter (for children) from the Office of Refugee Resettlement. Must call 1-866-401-5510 for verification; or ►I-797 Notice of Action acknowledging receipt of I-914, Application for T non- immigrant status. D- Upstate

R-NYC

YES

Immigrants with or without work authorization are required to apply for a Social Security Number.

LDSS must provide immigrants with a letter addressed to SSA for those immigrants without work authorization who met all the eligibility benefits, except for having an SSN. (08 OHIP INF-2)

Note: Pregnant women are excluded from this requirement.

(MRG)

(other-eligibility-requirements)(page-204)Page 204#

UPDATED: NOVEMBER 2009 641

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

Description: The United States Citizenship and Immigration Services (USCIS) (formerly the Immigration and Naturalization Services [INS]), or Immigration and Customs Enforcement (ICE), under the umbrella of the Department of Homeland Security (DHS), and/or the Executive Office for Immigration Review (EOIR), under the Department of State, are collectively referred to in this document as “the federal immigration agency” or “agency”.

PRUCOL is an acronym for persons Permanently Residing Under Color Of Law. The federal immigration agency does not determine whether an alien is PRUCOL and does not grant PRUCOL status. This is because PRUCOL is not a federal immigration status. Rather, PRUCOL is a public benefits eligibility status. Immigrants who are PRUCOL for Medicaid eligibility purposes and who may be eligible for Medicaid are any immigrants who are permanently residing in the United States with the knowledge and permission or acquiescence of the federal immigration agency and whose departure from the United States the federal immigration agency does not contemplate enforcing.

An immigrant will be considered as one whose departure the agency does not contemplate enforcing if:

a. Based on all the facts and circumstances in that particular case, it appears that the federal immigration agency is otherwise permitting the immigrant to reside in the United States indefinitely; or

b. It is the policy or practice of the federal immigration agency not to enforce the departure of immigrants in a particular category.

Policy: The Medicaid eligibility worker must determine whether the alien is PRUCOL based upon the documentation that the alien, or the alien’s representative, presents. An alien who establishes that he or she is PRUCOL is eligible for State Medicaid and FHPlus benefits if the alien meets the programs’ financial and other eligibility requirements, regardless of the date the immigrant entered the U.S. (Aliessa v. Novello, 06/01). There is no longer a five-year waiting period. (MRG)

(other-eligibility-requirements)(page-205)Page 205#

UPDATED: JANUARY 2011

642

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

Previously, Section 122 of the Social Services Law (SSL) provided an exception for certain PRUCOL immigrants who, on August 4, 1997, were residing in certain residential settings or who were diagnosed with AIDS and receiving Medicaid. Such individuals will continue to be provided Medicaid coverage to the extent they are otherwise eligible. The settings included are: • Residential health care facilities licensed by the NYS Department of Health; • Residential facilities licensed, operated or funded by the NYS Office of Mental Health (OMH), including psychiatric centers; residential treatment facilities; family care; community residences; teaching family homes; family based treatment; and residential care centers for adults; and • Residential facilities licensed, operated or funded by the NYS Office for People with Developmental Disabilities (OPWDD), including: developmental centers and small residential units; intermediate care facilities for the developmentally disabled; family care; community residences; individual residential alternatives; and OPWDD certified schools for the mentally retarded.

References: SSL Sect.

122

131-k

Dept. Reg.

360-3.2(j)(1)(ii)

ADM

04 OMM/ADM-7

INFs

07 OHIP INF-2 08 OHIP INF-4

GISs

08 MA/009 04 MA/014 04 MA/002 02 MA/016 02 MA/002 01 MA/033 01 MA/030

01 MA/026

(MRG)

(other-eligibility-requirements)(page-206)Page 206#

UPDATED: NOVEMBER 2009 643

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

Interpretation: Some aliens are PRUCOL because the federal immigration agency has granted them a particular immigration status or relief. These aliens are permanently residing in the U.S. with the “knowledge and permission” of the federal agency. Examples include, but are not limited to, aliens paroled (admitted) into the U.S. for less than one year, aliens residing in the U.S. under an order of supervision, aliens granted an indefinite stay of deportation and aliens granted voluntary departure, deferred action or temporary protected status. A more complete list is included in the “Documentation Guide to Citizenship and Immigrant Eligibility for Health Coverage in New York State,” pages 9-10, issued on March 26, 2008, as part of GIS 08 MA/009. Each of these aliens will have a form of documentation, as listed in this desk guide, issued by the federal immigration agency that shows that the agency has granted the alien a particular status or relief.

Other aliens may be PRUCOL because they have applied for or otherwise requested a particular immigration status or relief from removal and are awaiting the federal immigration agency’s decision. The federal agency has received their application or request for relief and has not yet approved or denied the request. Under certain circumstances, and as further explained in this document, these aliens are PRUCOL pending the federal immigration agency’s determination. Until the agency has adjudicated the application or request, these aliens are residing in the U.S. with the “knowledge and acquiescence” of the federal immigration agency.

(MRG)

(other-eligibility-requirements)(page-207)Page 207#

UPDATED: JANUARY 2009

644

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

Verification: PRUCOL CATEGORIES

a. Immigrants Paroled into the United States pursuant to Section 212 (d)(5) of the Immigration and Nationality Act (INA) showing status for less than one year, except Cuban/Haitian entrants. (1) Immigrants in this category are admitted to the United States for similar reasons as a refugee, i.e. humanitarian. However, this category, unlike refugee, does not grant legal residence status. (2) Parole status allows the immigrant temporary status until a USCIS determination of his/her admissibility has been made, at which time another status may be granted. (3) Immigrants in this category will have an Arrival/Departure Record (Form I-94) indicating that the bearer has been paroled pursuant to Section 212 (d)(5) of the INA. Possession of a properly annotated Form I-94 constitutes evidence of permanent residence in the U.S. under color of law, regardless of the date the Form I-94 is annotated. b. Immigrants residing in the United States pursuant to an Order of Supervision. (1) Immigrants in this category have been found deportable; however, certain factors exist which make it unlikely that the federal immigration agency would be able to remove the immigrant. Such factors include age, physical condition, humanitarian concerns, and the availability of a country to accept the deportee. (2) Immigrants in this category are required to report to USCIS periodically; if the factors preventing deportation are eliminated one of the federal immigration agencies will initiate action to remove the immigrant. (3) Immigrants in this category will have USCIS Form I-94 or I- 120B. c. Deportable immigrants residing in the United States pursuant to an Indefinite Stay of Deportation. (1) Immigrants in this category have been found to be deportable, but the federal immigration agency may defer deportation indefinitely due to humanitarian reasons. (MRG)

(other-eligibility-requirements)(page-208)Page 208#

UPDATED: JANUARY 2009

645

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

(2) Immigrants in this category will have a letter and/or a Form I-94 showing that the immigrant has been granted an indefinite stay of deportation.

d. Immigrants residing in the United States pursuant to an Indefinite Voluntary Departure. (1) Immigrants in this category will have a letter and/or Form I-94 indicating that the immigrant has been granted voluntary departure for an indefinite time period.

e. Immigrants in this category on whose behalf an Immediate Relative Petition (Form I-130) has been approved and their families covered by the petition, who are entitled to voluntary departure and whose departure the agency does not contemplate enforcing.

NOTE: An immediate relative for USCIS purposes is: husband, wife, father, mother, or child (unmarried and under age 21).

(1) Immigrants in this category are the immediate relatives of a United States citizen or lawful permanent resident (LPR) and have had filed on their behalf a Form I-130 petition for issuance of an immigrant visa. (2) If this petition has been approved, a visa will be prepared, which will allow the alien to remain in the United States permanently. (3) Immigrants in this category may have a Form I-94 and/or Voluntary Departure Letter (I-210 Letter). These documents, or others, indicate that the immigrant is to depart on a specified date (usually 3 months from date of issue); however, USCIS expects the immigrant’s visa to be available within this time. If it is not, extensions may be granted until the visa is ready. (MRG)

(other-eligibility-requirements)(page-209)Page 209#

UPDATED: JULY 2008

646

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

f. Immigrants who have filed applications for Adjustment of Status pursuant to section 245 of the INA that USCIS has accepted as “properly filed” or has granted and whose departure the agency does not contemplate enforcing. (1) Immigrants in this category have filed for lawful permanent resident status. (2) Immigrants in this category may have Form I-94 or Memorandum of Creation of Record of Lawful Permanent Residence (Form I-181). Form I-181 or their passports will be stamped with either of the following: “Adjustment application” or “employment authorized during status as adjustment applicant.” g. Immigrants granted Stays of Deportation by court order, statute or regulation, or by individual determination of the federal immigration agency pursuant to section 243 of the INA whose departure the agency does not contemplate enforcing. (1) Immigrants in this category have been found to be deportable, but the agency may defer deportation for a specified period of time due to humanitarian reasons. (2) Immigrants in this category will have a letter or copy of the court order and/or a Form I-94. h. Immigrants granted Voluntary Departure pursuant to section 242(b) of the INA whose departure the agency does not contemplate enforcing. (1) Immigrants in this category are awaiting a visa. (2) Such immigrants are provided Forms I-94 and/or Form I-210 which indicate a departure within 60 days. This may be extended if the visa is not ready within the time allotted. i. Immigrants granted Deferred Action Status pursuant to agency operating policy. Immigrants in this category will have a Form I-210 or a letter indicating that the immigrant’s departure has been deferred. (MRG)

(other-eligibility-requirements)(page-210)Page 210#

UPDATED: NOVEMBER 2009 647

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

j. Immigrants who entered and have Continuously Resided in the United States since before January 1, 1972. Immigrants in this category are presumed by the federal immigration agency to meet certain criteria for lawful permanent residence. Obtain any documentary proof establishing entry and continuous residence. k. Immigrants granted Suspension of Deportation pursuant to section 244 of the INA whose departure the federal immigration agency does not contemplate enforcing. (1) Immigrants in this category have been found deportable, have met a period of continuous residence and have filed an application for the agency to suspend deportation, which has been granted. (2) Immigrants in this category will have a letter/order from an immigration judge and a Form I-94 showing suspension of deportation granted. After lawful permanent residence is granted, the immigrant will have a Lawful Permanent Resident Card (Form I-551 “green card”). l. Any other immigrant living in the U.S. with the knowledge and permission or acquiescence of the federal immigration agency and whose departure that agency does not contemplate enforcing. (1) Immigrants in this category may be in a status not listed above. But, based on a determination by one of the federal immigration agencies or documentation supplied by the immigrant or his or her representative that indicates the immigrant is present in the U.S. with the knowledge of the federal immigration agency and with the permission or acquiescence of the agency, local districts may find them to be PRUCOL. Examples include, but are not limited to: • Applicants for adjustment of status to Lawful Permanent Residence (LPR), asylum, suspension of deportation or cancellation of removal or requesting deferred action; or • Deferred Enforced Departure (DED) due to conditions in their home country; or • Permanent non-immigrants, pursuant to P.L. 99-239 (applicable to citizens of the Federated States of Micronesia and the Marshall lslands); or • Persons granted Temporary Protected Status (TPS); or • Applicants for Temporary Protected Status; or • Persons having a “K”, “V”, “S” or “U” visa. (MRG)

(other-eligibility-requirements)(page-211)Page 211#

UPDATED: NOVEMBER 2009 648

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

DETERMINING PRUCOL STATUS

The following paragraphs describe the Department’s policy regarding the PRUCOL status of aliens who: 1. have filed official applications with the federal immigration agency, typically USCIS or EOIR, for a particular immigration status or to obtain other relief; or 2. have submitted letters or other correspondence to the federal immigration agency, typically ICE, for relief, such as deferred action, for which no official application form exists.

I. Applications filed on federal immigration agency forms There are many types of immigration statuses or relief for which an alien may apply by submitting an official application to the federal immigration agency on its application forms. Examples include applications to USCIS for adjustment of status to that of a lawful permanent resident (Form I-485), asylum and withholding of removal (Form I-589), or temporary protected status (Form I-821). An alien in removal proceedings may also apply to EOIR for suspension of deportation (EOIR-40), cancellation of removal (EOIR-42A) and for certain other forms of relief. It is the Department’s understanding that the federal immigration agency generally confirms its receipt of an official application by issuing an I-797 Notice of Action.

It is the Department’s policy, as stated in 04 OMM/ADM-7, 07 OHIP/INF-2, and 08 OHIP/INF- 4 that the alien is PRUCOL during the period of time that the federal agency is determining whether to approve the application by granting the requested immigration status or other relief. Local departments of social services should continue to follow the procedures described in these directives when the alien, or the alien’s representative, presents documentation that an application has been submitted to the federal immigration agency on the agency’s forms. In particular, the district should

(MRG)

(other-eligibility-requirements)(page-212)Page 212#

UPDATED: JANUARY 2009

649

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

attempt to verify whether the application remains pending or whether the federal immigration agency has adjudicated the application by granting or denying the requested status or relief. There are a few ways that the district can verify the current status of an application. The alien may have an I-797 Notice of Action, employment authorization document or other federal immigration agency document that contains a 13 character receipt number. If so, the district worker can access the USCIS website at www.uscis.gov and follow the instructions for checking the case status online. This on-line search can confirm the accuracy of the information in the document as well as whether the agency has approved the request.

However, if the alien does not have a document with a receipt number, or the district worker does not have access to the USCIS website, the worker should send a Document Verification Request, Form G-845, (also known as a Systematic Alien Verification for Entitlements (SAVE) request) to USCIS. The worker should include copies of all documentation that the alien has submitted to, or received from, the federal immigration agency, and request that it verify the alien’s current status. As a general rule, the district worker should also send a G-845 Document Verification Request when the documentation does not clearly indicate a particular immigration status, the alien has presented expired documents or the worker has reason to believe that the documentation may be questionable in any respect.

The Medicaid worker should find the alien to be PRUCOL if the alien’s application remains pending with the federal immigration agency, not having yet been approved or denied, unless contradictory evidence indicates that the federal immigration agency is contemplating enforcing the alien’s departure from the U.S.

The alien would be PRUCOL from the date that the federal immigration agency received the application. The I-797 Notice of Action indicates the date of receipt. If the alien does not have an I-797 Notice of Action, the date of receipt can be verified from a U.S. Postal Service return receipt, a “signature confirmation” or a “delivery confirmation.” (MRG)

(other-eligibility-requirements)(page-213)Page 213#

UPDATED: JANUARY 2009

650

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

If the federal immigration agency denies the application or otherwise indicates that it is not permitting the alien to remain in the U.S., the alien is not PRUCOL. The alien would be eligible only for Medicaid coverage for the treatment of an emergency medical condition, if otherwise eligible.

II. Other letters or requests for relief from removal There are various forms of relief from removal or deportation for which no formal application form or process exists. Two examples are deferred action and voluntary departure.

An alien whom the federal immigration agency would regard as illegal, and thus subject to removal, may still, under certain circumstances, be PRUCOL for purposes of eligibility for State Medicaid benefits and Family Health Plus (FHPlus).

DEFERRED ACTION/VOLUNTARY DEPARTURE

Deferred action is a form of relief that the Department of Homeland Security, in its’ discretion, may afford to an otherwise removable alien whom DHS has decided not to prosecute for removal before the immigration courts, whether for humanitarian or administrative reasons. According to DHS estimates, the vast majority of cases in which deferred action is granted involve medical grounds. The former INS had operating instructions for making deferred action determinations under which the INS would consider the age or physical condition affecting an alien’s ability to travel as well as the presence of sympathetic factors. Although the INS withdrew these operating instructions in 1997, deferred action continues to be available, according to DHS.

Voluntary departure permits an otherwise removable alien to depart the U.S. at his or her own expense, thus avoiding the stigma of being subjected to a removal proceeding. It is available both during and prior to removal proceedings. An alien may request voluntary departure to return to his or her home country or another country, if he or she can secure entry there.

Because no formal application process exists for these types of relief, the federal immigration agency might not timely respond to, or even acknowledge receipt of, the alien’s letter requesting relief. Several months may pass before the agency responds to the informal request, if it responds at all. It is also (MRG)

(other-eligibility-requirements)(page-214)Page 214#

(MRG)

UPDATED: JANUARY 2009

651

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

more difficult for local departments of social services to verify the current status of the federal immigration agency’s review of a request for deferred action or other relief made by letter rather than the current status of a formal application filed on official USCIS or EOIR application forms. However, an alien who has made a letter request for deferred action or other relief from removal may still be PRUCOL under certain circumstances.

Sections A through C of this document, which follow, present guidelines for local departments of social services to apply when determining the PRUCOL status of an otherwise removable alien who has requested, by informal letter, the federal immigration agency to grant relief from removal including, but not limited to, deferred action, voluntary departure or any other relief that may reasonably be construed as humanitarian relief.

A. Initial contact with the federal immigration agency

The letter or other correspondence to the federal immigration agency must clearly state the type of relief sought, which must be a recognized form of relief from removal or a recognized immigration status. The letter should summarize pertinent facts and circumstances of the alien’s case that would support the granting of the relief. For example, if the alien is requesting deferred action or other humanitarian relief from removal based on the alien’s medical condition, this information would include such factors as the following: date of birth and nationality; address in the U.S.; family ties in the U.S., if any; immigration history; criminal history, if any; and, in particular, the alien’s current medical condition with a rationale for why the federal immigration agency should grant deferred action relief based on the alien’s medical condition. If the alien is requesting voluntary departure, the alien must be capable of departing the U.S. if the federal immigration agency grants voluntary departure under the applicable federal regulations at 8 C.F.R. § 240.25 or § 1240.26. If the alien is represented by an attorney, the attorney should include an executed copy of the “Notice of Appearance as Attorney or Representative.”

The alien, or the alien’s representative, must present documentation sufficient to show that the letter was mailed to, and received by, the federal immigration agency. There is more than one way to establish mailing and receipt. A letter sent via the U.S. Postal Service by certified mail proves that the letter was mailed on a certain date. A

(other-eligibility-requirements)(page-215)Page 215#

MRG

UPDATED: JANUARY 2009

652

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

certified letter, return receipt requested, is proof not only of mailing but also of receipt. A U.S. Postal Service “signature confirmation” or “delivery confirmation” also verifies receipt. In addition, a letter that is properly addressed, stamped and mailed by regular first-class mail is presumed to have been received, although this presumption can be rebutted.

B. Affording the federal immigration agency a “reasonable period of time” to adjudicate the request for relief

The alien is not considered PRUCOL immediately upon mailing of the initial letter requesting relief. Before the alien may be considered PRUCOL, the federal immigration agency must be afforded a “reasonable period of time” to consider and act upon the request. This is consistent with 04 OMM/ADM-7, in which the Department stated that an alien may be PRUCOL when the federal immigration agency, despite having been notified of the alien’s presence in the U.S., fails after “a reasonable period of time” to respond to the alien’s letter requesting relief or fails to take any action to enforce the alien’s departure from the U.S.

Under federal law, the federal immigration agency is required to conclude matters presented to it “within a reasonable time” (5 U.S.C. § 555). There is no hard and fast rule that defines a “reasonable time.” What is “reasonable” depends on all the facts and circumstances of a case. However, local departments of social services may consider that a “reasonable period of time” is six months. This six-month period is measured from the date that the alien, or the alien’s representative, mailed to the federal immigration agency the initial letter requesting relief.

C. Subsequent contacts with the federal immigration agency within the six-month period

A single letter or other piece of correspondence requesting relief from the federal immigration agency does not establish PRUCOL status. (An exception applies to applications to USCIS or EOIR that are filed on official application forms, as previously discussed.) It is reasonable to expect that any alien who has submitted a good faith request for relief to a federal immigration agency would take steps to follow-up on the status of the original request. The same principle applies here.

The Medicaid applicant, or the applicant’s representative, must make reasonable efforts to follow-up with the federal immigration agency on

(other-eligibility-requirements)(page-216)Page 216#

MRG

UPDATED: JANUARY 2009

653

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

the status of the request for deferred action or other relief. These efforts to monitor the status of the initial request must occur during the six-month period that begins with the date that the alien, or the alien’s representative, mailed to the federal immigration agency the initial letter requesting relief. If the applicant, or the applicant’s representative, fails to make any effort to follow-up on the request within this period, this indicates that the request was not a “good faith” effort to seek relief.

This policy is consistent with court cases that have found otherwise removable aliens to be PRUCOL when the federal immigration agency was made aware on numerous occasions of the alien’s presence in the U.S. but neither responded to the alien’s letters nor took any action to enforce the alien’s departure.

Applying these guidelines, local departments of social services should determine that the alien is PRUCOL when, based on all the facts and circumstances of the particular case, it appears that the federal immigration agency is acquiescing, at least for now, to the alien’s presence in the U.S. Three examples of circumstances in which the local department of social services should conclude that federal acquiescence to the alien’s presence exists, and the alien is thus PRUCOL, are illustrated below:

1. The federal immigration agency does not respond to the alien’s initial or subsequent letters within six months after mailing and made no effort within that six-month period to enforce the alien’s departure from the U.S.

In this example, the alien would be PRUCOL effective on the date that is six months after the alien, or the alien’s representative, mailed the initial letter requesting relief provided that the alien, or the alien’s representative, made reasonable and good faith efforts to follow-up on the status of the initial request during this six-month period. An exception applies if other evidence indicates that the federal immigration agency contemplates enforcing the alien’s departure from the U.S.

2. The federal immigration agency responded to the alien’s initial letter within six months after mailing by referring the matter to another entity and the entity to which the letter was referred did not respond within that same initial six-month period.

(other-eligibility-requirements)(page-217)Page 217#

MRG

UPDATED: NOVEMBER 2009 654

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

For example, ICE responded to the alien’s initial letter within six months of the date it was mailed by referring the matter to another wing of the Department of Homeland Security, namely USCIS, and USCIS did not respond within that same initial six-month period.

In this example, the alien would be PRUCOL effective on the date that is six months after the alien, or the alien’s representative, mailed the initial request that was then referred to another entity. This presumes, however, that the alien, or the alien’s representative, made reasonable and good faith efforts to follow-up on the status of the request for relief during this six month period. Again, an exception applies if other evidence indicates that the federal immigration agency is contemplating enforcing the alien’s departure from the U.S.

3. The federal immigration agency responds to the alien’s initial letter within six months of mailing and the agency’s response can be reasonably interpreted as indicating that the agency does not contemplate enforcing the alien’s departure from the U.S. at this time.

In this example, the federal immigration agency has responded within six months after the alien, or the alien’s representative, mailed the initial letter. If the agency had granted the alien’s request for relief, the alien would be PRUCOL effective on the date of the agency’s response. However, the alien may still be PRUCOL if the agency’s response, although not granting the requested relief, also does not show that the agency intends to enforce the alien’s departure from the U.S. For example, the federal immigration agency may have responded that the alien is not in any form of formal expulsion proceedings or is not under a final order of removal and that the agency is returning the request for deferred action or other relief without adjudicating the request; that is, without determining whether to grant or deny the requested relief. In that example, the alien would be PRUCOL effective on the date of the federal immigration agency’s response.

NOTE: As a general rule, the Medicaid worker should determine that an alien is not PRUCOL when the federal immigration agency denies the alien’s request for relief from removal or indicates that it is not permitting or acquiescing to the alien’s continued presence in the U.S. or, from all the facts and circumstances of the particular case, it appears that the agency is contemplating enforcing the alien’s departure from the U.S.

(other-eligibility-requirements)(page-218)Page 218#

MRG

UPDATED: NOVEMBER 2009

655

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

For example, the federal agency might respond to an alien’s letter seeking deferred action or other relief by stating that the alien has been placed in formal removal proceedings or is under a final order of removal. In that case, the alien is not PRUCOL and is eligible only for Medicaid coverage for the treatment of an emergency medical condition, if financially and otherwise eligible.

Also as a general rule, Medicaid applicants are responsible for providing information and documentation necessary to establish their eligibility for Medicaid. This obligation includes providing information and documentation necessary to establish eligibility for Medicaid as a PRUCOL alien. Among other factors, an applicant who asserts that the federal immigration agency has a policy or practice of not enforcing the departure of aliens in a particular category, and that he or she falls within that category, is responsible for establishing that the federal immigration agency has such a policy or practice.

The desk aids that follow this section describe the documentation that a PRUCOL individual may present.

(other-eligibility-requirements)(page-219)Page 219#

MRG

UPDATED: NOVEMBER 2009

656

Category 3: Persons who are Permanently Residing in the U.S. Under Color of Law (PRUCOL)* *PRUCOL is not an immigration status. PRUCOL is not granted by the federal immigration agency. PRUCOL is a public benefits eligibility category.

Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement a. Persons paroled into the U.S. for less than a year. (Non-citizens allowed to come into the U.S. without being granted admission.) ►I-94 Arrival/Departure Record with annotation “Paroled Pursuant to Section 212(d)(5)” of the INA or “parole” or “PIP”; ►I-688B Employment Authorization Card annotated 8 C.F.R. 274a.12(a)(4) or 274a.12(c)(11); or ►I-766 Employment Authorization Document annotated “A4” or “C11”.

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement. b. Persons under an Order of Supervision. (Non-citizens who have been found deportable; however certain factors exist which make it unlikely that they will be deported.) ►I-94 Arrival/Departure Record annotated “Order of Supervision”; ►I-220B Order of Supervision; ►I-688B Employment Authorization Card annotated 8 C.F.R. 274a.12 (c)(18); or ►I-766 Employment Authorization Document annotated “C18”.

NO c. Persons granted indefinite stay of deportation (Non-citizens who have been found deportable, but deportation is deferred indefinitely due to humanitarian reasons.) ►I-94 Arrival/Departure Record coded 106 “granted Indefinite Stay of Deportation”; or ►Letter/order from the immigration agency, immigration judge or a federal court granting indefinite stay of deportation.

NO d. Persons granted indefinite voluntary departure (Status that was granted before April, 1997 to non- citizens who have been found deportable, but deportation is deferred indefinitely due to humanitarian reasons.) ►I-94 Arrival/Departure Record or letter/order from the immigration agency or immigration judge granting voluntary departure for an indefinite time period.

NO e. Persons on whose behalf an immediate relative petition has been approved and family members covered by the petition. (Non-citizens who are immediate relatives (spouse, father, mother, or unmarried child under 21) of a U.S. citizen/LPR who has filed an I- 130 Relative Petition on their behalf.) ►I-94 Arrival/Departure Record or I-210 indicating departure on a specified date, however, the USCIS expects the non- citizen’s visa will be available within this time; or ►I-797 indicating I-130 Relative Petition has been approved.

NO REVISED 03/03/08

(other-eligibility-requirements)(page-220)Page 220#

MRG

UPDATED: NOVEMBER 2009

657

Category 3: PRUCOL continued Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement f. Persons who have filed applications for adjustment of status to lawful permanent resident under Section 245 of the INA that the USCIS has accepted as “properly filed”. (Non-citizens who filed for legal permanent resident status.) ►I-94 Arrival/Departure Record or foreign passport with annotation “adjustment application” or “employment authorized during status as adjustment applicant”; ►I-688 Temporary Resident Card or I-688A Employment Authorization Card annotated “245A”; ►I-688B Employment Authorization Card annotated 8 C.F.R. 274a.12 (c)(22); or ►I-766 Employment Authorization Document annotated “C22”.

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement. g. Persons granted stays of deportation (Non- citizens who have been found deportable, but the federal immigration agency may defer deportation for a specified period of time due to humanitarian reasons.) ►I-94 Arrival/Departure Record or letter/order from the immigration agency, immigration judge or court granting stay of deportation.

NO h. Persons granted voluntary departure under Section 242(b). (This section of the INA has been repealed.) ►I-797 Notice or form showing grant of extended voluntary departure; ►I-688B Employment Authorization Card annotated 274a.12(a)(11); or ►I-766 Employment Authorization Document annotated A11.

NO i. Persons granted deferred action status. ►I-797 or any document from the federal immigration agency granting deferred action status; ►I-688B Employment Authorization Card annotated 8 C.F.R 274a.12 (c)(14); or ►I-766 Employment Authorization Document annotated “C14”.

NO j. Persons who entered and continuously resided in the U.S. before January 1, 1972. (Non-citizens are presumed by the USCIS to meet certain criteria for legal permanent residence.) ►Any documentary proof establishing entry and continuous residence; or ►I-688B or I-766 coded 274a.12(c)(16) or C16; or ►I-797, letter/notice from the USCIS or court indicating registry application is pending.

NO k. Persons granted suspension of deportation pursuant to Section 244 of the INA; the USCIS does not contemplate enforcing departure (Non-citizens in this category have been found deportable, have met a period of continuous residence and have filed an application for the USCIS to suspend deportation, which has been granted.) ►I-797, letter/notice from an immigration judge or court; and ►I-94 Arrival/Departure Record showing suspension of deportation granted. (After Lawful Permanent Residence is granted the person will have a “green Card” Form I- 551).

NO REVISED 03/03/08

(other-eligibility-requirements)(page-221)Page 221#

MRG

UPDATED: NOVEMBER 2009

658

Category 3: PRUCOL continued Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement l. Other persons living in the U.S. with the knowledge and permission or acquiescence of the federal immigration agency and whose departure the agency does not contemplate enforcing: Examples include, but are not limited to: ►Applicants for adjustment of status to LPR1, asylum2, suspension of deportation or cancellation of removal3 or requesting deferred action; or ►Persons granted Deferred Enforced Departure (DED)4 due to conditions in their home country; or ►Permanent non- immigrants, pursuant to P.L. 99-239 (applicable to citizens of the Federated States of Micronesia and the Marshall lslands5; ►Persons granted Temporary Protected Status6; or ►Applicants for Temporary Protected Status7 (TPS); or ►Persons having a K, V, S or U Visa.8 ►I-94 Arrival/Departure Record coded K1, K2, K3, K4, V1, V2, or V3, U, or S; ►I-688B Employment Authorization Card annotated 8 C.F.R.274a.12(c)(9)1 , 274a.12(c)(8)2 274a.12(c)(10)3 , 274a.12(a)(11)4 274a.12(a)(8)5, 274a.12(a)(12)6 or 274a.12(c)(19)7 , 274a.12(a)(9)8, 274a.12(a)(13) 8, 274a.12(a)(15) 8, 274a.12(c)(21)8,and 274a.12(c)(24)8 ►I-766 Employment Authorization Document annotated C91, C82, C103, A114, A85, A126, C197, A98, A138, A158, C218 or C248. ►I-797 indicating the USCIS has received an application or petition or request for change of status; or ►Postal Return Receipt addressed to the federal immigration agency* or a copy of a cancelled check to the federal immigration agency, and a copy of the application, petition or request submitted to the federal immigration agency. (* USCIS-United States Citizenship and Immigration Services; ICE-Immigration and Customs Enforcement; EOIR-Executive Office of Immigration Review.)

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement. REVISED 03/03/08

(other-eligibility-requirements)(page-222)Page 222#

MRG

UPDATED: NOVEMBER 2009

659

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

DOCUMENTATION GUIDE FOR PRUCOL ALIEN CATEGORIES rev. 09/15/08

PRUCOL: (Permanently Residing in the United States Under Color Of Law) are any aliens who are residing in the United States with the knowledge and permission or acquiescence of the federal immigration agency (formerly the Immigration and Naturalization Services [INS]), now the United States Citizenship and Immigration Services (U.S.C.I.S.), or the United States Immigration and Customs Enforcement (I.C.E) or the Executive Office of Immigration Review (EOIR) and whose departure from the United States the agency does not contemplate enforcing.

ALIEN CATEGORIES GENERAL INFORMATION DOCUMENTATION/FORMS a) Aliens paroled into the United States pursuant to Section 212(d)(5) of the INA showing status for less than one year, except for Cuban/Haitian entrants. Aliens in this category are admitted to the United States for similar reasons as a refugee, i.e., humanitarian. However, this category, unlike refugee status, does not grant legal residence status. Parole status allows the alien temporary status until USCIS determination of his/her admissibility has been made; at which time another status may be granted. Aliens in this category will have a FORM I-94 indicating that the bearer has been paroled pursuant to Section 212 (d)(5) of the INA. Possession of a properly annotated Form I-94 constitutes evidence of permanent residence in the U.S. under color of law, regardless of the date the Form I-94 is annotated. b) Aliens residing in the United States pursuant to an Order of Supervision. Aliens in this category have been found deportable; however, certain factors exist which make it unlikely that the federal immigration agency would be able to remove the alien. Such factors include age, physical condition, humanitarian concerns, and the availability of a country to accept the deportee. Aliens in this category are required to report to the federal immigration agency periodically; if the factors preventing deportation are eliminated, the agency will initiate action to remove the alien. Aliens in this category will have an USCIS Form I-94 or I-220B. c) Deportable aliens residing in the United States pursuant to an indefinite stay of deportation. Aliens in this category have been found to be deportable, but the federal immigration agency may defer deportation indefinitely due to humanitarian reasons.

Aliens in this category will have a letter and/or FORM I-94 showing that the alien has been granted an indefinite stay of deportation. d) Aliens residing in the United States pursuant to an indefinite voluntary departure.

Aliens in this category will have a letter and/or Form I-94 indicating that the alien has been granted departure for an indefinite time period. e) Aliens on whose behalf an immediate relative petition has been approved and their families covered by the petition, who are entitled to voluntary departure and whose departure the federal immigration agency does not contemplate enforcing. NOTE: An immediate relative for USCIS purposes is: husband, wife, father, mother, or child (unmarried and under 21). Aliens in this category are the immediate relatives of an American citizen/LPR and have had filed on their behalf a Form I-130 petition for issuance of an immigration visa. If this petition has been approved, a visa will be prepared, which will allow the alien to remain in the United States permanently. Aliens in this category may have a Form I-94 and/or I-210 letter. These documents, or others, indicate that the alien is to depart on a specified date (usually 3 months from date of issue), however, USCIS expects the alien’s visa to be available within this time. If it is not, extensions may be granted until the visa is ready.

(other-eligibility-requirements)(page-223)Page 223#

MRG

UPDATED: NOVEMBER 2009

660

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

DOCUMENTATION GUIDE FOR PRUCOL ALIEN CATEGORIES continued

ALIEN CATEGORIES GENERAL INFORMATION DOCUMENTATION/FORMS f) Aliens who have filed applications for adjustment of status pursuant to Section 245 of the INA that USCIS has accepted as “properly filed” or has granted and whose departure the federal immigration agency does not contemplate enforcing. Aliens in this category have filed for lawful permanent resident status.

Aliens in this category may have Form I-94 or Form I-181 or their passports will be stamped with either of the following: “adjustment application” or “employment authorized during status as adjustment applicant”.

g) Aliens granted stay of deportation by court order, statute or regulation, or by individual determination of the federal immigration agency pursuant to Section 243 of the INA whose departure BCIS does not contemplate enforcing. Aliens in this category have been found to be deportable, but the federal immigration agency may defer deportation for a specified period of time due to humanitarian reasons.

Aliens in this category will have a letter or copy of the court order and/or a Form I-94. h) Aliens granted voluntary departure pursuant to Section 242(b) of the INA whose departure the federal immigration agency does not contemplate enforcing. Aliens in this category are awaiting a visa. NOTE: N/A

SECTION 242 (b) OF THE INA HAS BEEN REPEALED Such aliens are provided Forms I-94 and/or I-210 which indicate a departure within 60 days. This may be extended if the visa is not ready within the time allotted. i) Aliens granted deferred action status pursuant to the federal immigration agency’s operating policy.

Aliens in this category will have Form I-210 or a letter indicating that the alien’s departure has been deferred. j) Aliens who entered and have continuously resided in the United States since before January 1, 1972. Aliens in this category are presumed by the federal immigration agency to meet certain criteria for lawful permanent residence.

Obtain any documentary proof establishing entry and continuous residence. k) Aliens granted suspension of deportation pursuant to Section 244 of the INA whose departure the federal Immigration agency does not contemplate enforcing. Aliens in this category have been found deportable, have met a period of continuous residence and have filed an application for the federal immigration agency to suspend deportation, which has been granted.

Aliens in this category will have a letter/order from an immigration judge and a Form I-94 showing suspension of deportation granted. After lawful permanent residence is granted the alien will have a Form I-551.

(other-eligibility-requirements)(page-224)Page 224#

MRG

UPDATED: NOVEMBER 2009

661

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

PRUCOL

DOCUMENTATION GUIDE FOR PRUCOL ALIEN CATEGORIES continued

ALIEN CATEGORIES GENERAL INFORMATION

DOCUMENTATION/FORMS l) Any other aliens living in the U.S. with the knowledge and permission or acquiescence of the federal immigration agency and whose departure that agency does not contemplate enforcing. Aliens in this category may be in a status not listed above, but based on a determination by the federal immigration agency or documentation supplied by the alien or his or her representative that indicates the alien is present in the U.S. with the knowledge of the agency and with the permission or acquiescence of the agency, local districts may find them to be PRUCOL. Examples include, but are not limited to:

Applicants for adjustment of status to LPR, asylum, suspension of deportation or cancellation of removal or requesting deferred action; or Persons granted Deferred Enforced Departure (DED) due to conditions in their home country; or

Permanent non-immigrants, pursuant to P.L. 99-239 (applicable to citizens of the Federated States of Micronesia and the Marshall lslands);

Persons granted Temporary Protected Status; or Applicants for Temporary Protected Status (TPS); or Persons having a K, V, S or U Visa. Aliens in this category may have: I-94 Arrival/Departure Record; or I-688B Employment Authorization Card; or I-766 Employment Authorization Document; or I-797 “Notice of Action” indicating the USCIS has received an application or petition or request for change of status; or a Postal Return Receipt addressed to the federal immigration agency* or a copy of a cancelled check to the federal immigration agency, and a copy of the application, petition or request submitted to the federal immigration agency. (* USCIS-United States Citizenship and Immigration Services; ICE-Immigration and Customs Enforcement; EOIR-Executive Office of Immigration Review.)

(other-eligibility-requirements)(page-225)Page 225#

MRG

UPDATED: JANUARY 2011

662

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS TEMPORARY PROTECTED STATUS (TPS)

Description: “Temporary protected status (TPS)” is a temporary immigration status granted under federal law at 8 U.S.C. 1254a to aliens who are physically present in the United States and who are from certain countries designated by the U.S. Secretary of Homeland Security as unsafe to accept their return because of ongoing environmental disasters or other extraordinary and temporary conditions. At present, the following countries have TPS designation: Angola, Burundi, El Salvador, Honduras, Liberia, Montserrat, Nicaragua, Sierra Leone, Somalia, and Sudan. [A list of countries designated for TPS is located at the United States Citizenship and Immigration Services’ (USCIS) (formerly the Immigration and Naturalization Service-INS), website, at: http://www.uscis.gov]

NOTE: The Department of Homeland Security (DHS) has designated Haiti for Temporary Protected Status beginning January 21, 2010 and ending January 18, 2011. TPS will apply only to those Haitians who were in the United States on or before January 12, 2010, even if such individuals were illegally in the United States. TPS protects these individuals from deportation until January 18, 2011 and allows them to work in the U.S. Haitians who attempt to travel into the U.S. after January 12, 2010, will not be eligible for TPS.

Policy: Immigrants who have been granted Temporary Protected Status (“TPS”) may be eligible for Medicaid, Family Health Plus (FHP) or Child Health Plus (CHPlus) based on their status as permanently residing in the United States under color of law (PRUCOL), if they meet such programs’ requirements.

Immigrants who have applied for TPS may also be considered to be PRUCOL and may thus be eligible for Medicaid, Family Health Plus or Child Health Plus, if otherwise eligible.

References: ADMs 04 ADM-7

GISs 10 MA/019 10 MA/005 08 MA/009

Interpretation: Immigrants Granted Temporary Protected Status (TPS): These immigrants should be treated as PRUCOL for purposes of their eligibility for Medicaid, FHP or CHPlus “Persons granted TPS are authorized to remain in the United States for a specific limited period; the U. S. Secretary of Homeland Security can extend it for a further specified period. Prior to 1990, a similar status called “Extended Voluntary Departure” was used in the same way to provide relief to

(other-eligibility-requirements)(page-226)Page 226#

MRG

UPDATED: NOVEMBER 2009 663

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS TEMPORARY PROTECTED STATUS (TPS)

particular nationalities.

Immigrants who have been granted TPS will have the following documentation: • Form I-688B; or • Form I-766 EAD coded 274a.12(a) (12) or A12; or • A letter, verification or correspondence from USCIS, such as a Notice of Action (I-797) indicating temporary protected status has been granted.

Immigrants who have applied for Temporary Protected Status (TPS): These immigrants should be treated as PRUCOL for purposes of their eligibility for Medicaid, Family Health Plus or Child Health Plus if it reasonably appears, based on all the facts and circumstances of the case, that they are present in the United States with the knowledge and permission or the acquiescence of the federal immigration agency and that such agency is not presently contemplating deporting them. Social services districts should request proof from the immigrant that he or she filed the Application for Temporary Protected Status (Form I-821) and the Application for Employment Authorization (Form I-765) to the USCIS or its predecessor, the INS. For example, the immigrant may have a receipt or letter from the federal immigration agency that shows that such agency received these documents. However, the immigrant does not need to have written confirmation from the federal immigration agency acknowledging its receipt of these documents. An immigrant can be considered PRUCOL if the immigrant can prove that he or she mailed these documents to the federal immigration agency on a certain date. When the federal immigration agency has not acted on the application after a reasonable period of time after mailing, the district may reasonably presume that the applicant is PRUCOL.

Documentation: Immigrants applying for temporary protected status will have one of the following types of documentation: • Receipt or notice showing filing of Form I-821 (Application for Temporary Protected Status) and Form I-765 (Application for Employment Authorization); or • Form I-688B; or • Form I-766 EAD codes 274a.12 (c) (19) or C19; or • Any letter, verification or correspondence from USCIS or a U.S. Postal Return Receipt.

(other-eligibility-requirements)(page-227)Page 227#

UPDATED: NOVEMBER 2009 664

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

TEMPORARY PROTECTED STATUS (TPS)

Category 3: Persons who are Permanently Residing Under Color of Law (PRUCOL)* *PRUCOL is not an immigration status. PRUCOL is not granted by the USCIS. PRUCOL is a public benefits eligibility category. Category

Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement l. Other persons living in the U.S. with the knowledge and permission or acquiescence of the USCIS and whose departure the USCIS does not contemplate enforcing: Examples include, but are not limited to: ►Applicants for adjustment of status to LPR1, asylum2, suspension of deportation or cancellation of removal3 or requesting deferred action; or ►Persons granted Deferred Enforced Departure (DED)4 due to conditions in their home country; or ►Permanent non-immigrants, pursuant to P.L. 99-239 (applicable to citizens of the Federated States of Micronesia and the Marshall lslands5); ►Persons granted Temporary Protected Status6 ; or ►Applicants for Temporary Protected Status7 (TPS); or ►Persons having a K, V, S or U visa.8 ►I-94 Arrival/Departure Record coded K1, K2, K3, K4, V1, V2, or V3, T, U, or S; ►I-688B Employment Authorization Card annotated 8 C.F.R.274a.12(c)(9)1 , 274a.12(c)(8)2 , 274a.12(c)(10)3 , 274a.12(a)(11)4 , 274a.12(a)(8)5, 274a.12(a)(12)6 or 274a.12(c)(19)7, 274a.12(a)(9)8, 274a.12(a)(13)8, 274a.12(a)(15)8, 274a.12(c)(21) 8, and 274a.12(c)(24)8 ►I-766 Employment Authorization Document annotated C91, C82, C103, A114, A85, A126, or C197, or A98, A138, A158, C218 and C248. ►I-797 indicating the USCIS has received an application or petition or request for change of status; or ►Postal Return Receipt addressed to federal immigration agency* or a copy of a cancelled check to the federal immigration agency, and a copy of the application, petition or request submitted to the federal immigration agency.

(* USCIS-United States Citizenship and Immigration Services; ICE-Immigration and Customs Enforcement; EOIR-Executive Office of Immigration Review.)

Immigrants with or without work authorization are required to apply for a Social Security Number.

Note: Pregnant women are excluded from this requirement.

MRG

(other-eligibility-requirements)(page-228)Page 228#

UPDATED: JANUARY 2011

665

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

OTHER VISA STATUSES

Visa Statuses: K, S, T, U, and V

There have been several new visa categories issued by the United States Citizenship and Immigration Services (USCIS) [formerly the Immigration and Naturalization Services (INS)] over the past several years.

Some categories of non-immigrant status allow the status (visa) holder to work and eventually adjust to lawful permanent residence. These categories allow the individual to apply for adjustment to Lawful Permanent Resident (LPR) status after he or she has had the nonimmigrant status for a period of time.

Such visa statuses include, for example:

K status: For the spouse, child, or fiancé (e) of a U.S. citizen S status: For informants providing evidence for a criminal investigation. Also known as the “Snitch Visa”.

T status: For victims of Trafficking.* U status: For victims or witnesses of specified crimes (who have suffered substantial physical or mental abuse and agrees to cooperate with the government) V status: For spouses and children of LPR’s whose visa petitions have been pending for at least three years.

[Law found at 8 U.S.C. section 1101 (a)(15)(K), (S), (T), (U), and (V).]

*Victims of Trafficking receive benefits to the same extent as refugees (06 OMM INF-5). (See OTHER ELIGIBILITY REQUIREMENTS VICTIMS OF TRAFFICKING) . MRG

(other-eligibility-requirements)(page-229)Page 229#

UPDATED: JANUARY 2011

666

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

“NON-IMMIGRANTS” NON-IMMIGRANTS ADMITTED ON A TEMPORARY BASIS

Description: TEMPORARY NON-IMMIGRANT: A temporary non-immigrant is an individual who has been allowed to enter the United States for a specific purpose and for a limited period of time. Examples include tourists, foreign students, and visitors on business or pleasure. For the purpose of Medicaid eligibility, non-immigrants may be eligible only for the treatment of an emergency medical condition.

Policy: Immigrants admitted on a temporary basis are “non-immigrants” and if otherwise eligible, are limited to Medicaid coverage for the care and services necessary for the treatment of an emergency medical condition.

References: SSL Sect 122

366(1)(b)

Dept. Reg. 360.3.2(j)

ADMs 04 ADM-07

92 ADM-10

88 ADM-47

88 ADM-22

88 ADM-4

GISs 09 MA/017 08 MA/015 08 MA/012 08MA/009 04 MA/016 04 MA/002 03 MA/005

Interpretation: Certain immigrants may be lawfully admitted to the United States temporarily for a specific purpose and for a specified period of time. Foreign students, visitors, tourists, some workers and diplomats are admitted but restricted due to the temporary nature of their admission status. Thus, although these individuals may be residing in the United States with the knowledge and permission of the USCIS, they are not qualified aliens.

Otherwise eligible non-immigrants who are admitted on a temporary basis and who require immediate medical care which is not otherwise available may receive MRG

(other-eligibility-requirements)(page-230)Page 230#

UPDATED: JANUARY 2011

667

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

“NON-IMMIGRANTS” NON-IMMIGRANTS ADMITTED ON A TEMPORARY BASIS

Medicaid coverage for the care and the treatment of an emergency medical condition only. Such non-immigrants may receive this coverage, provided that they have not entered the State for the purpose of obtaining medical care. MRG

(other-eligibility-requirements)(page-231)Page 231#

UPDATED: NOVEMBER 2009

668

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

“NON-IMMIGRANTS” NON-IMMIGRANTS ADMITTED ON A TEMPORARY BASIS

Verification: Non-immigrants admitted on a temporary basis will have the following types of documentation:

Category 4: Temporary Non-Immigrants Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement Temporary Non-immigrants include but are not limited to the following visa types: A –Foreign government representatives on official business; B-1 or B-2 – Visitors for business or pleasure; D – Crewmen on shore leave; E – Treaty Traders and investors; F – Foreign students; G – Representatives of international organizations; H – Temporary workers (including agricultural workers); I - Members of the foreign press; J – Exchange visitors, L- Intra-company transferee; O – Persons with extraordinary ability or achievement; P – Artists, Entertainers and Athletes; Q – Cultural Exchange Visitors; and R – Religious workers. ►I-94 Arrival/Departure record or foreign passport stamped with non- immigrant code; ►I-185 Canadian Border Crossing Card*; ►I-586 Mexican Border Crossing Card*; ►I-444 Mexican Border Visitor’s Permit; or ►I-95A Crewmen’s Landing Permit. ►I-688B Employment Authorization Card ►I-766 Employment Authorization Document *B-1/B-2 Visa/Border Crossing Card (BCC) is now issued in place of these documents

(Temporary non-immigrants are lawfully admitted to the U.S. for a temporary or specified period of time.)

Only eligible for the treatment of an Emergency medical condition

YES

NOT Required

However, may be assigned an SSN if USCIS/DHS has granted permission to work.

MRG

(other-eligibility-requirements)(page-232)Page 232#

UPDATED: NOVEMBER 2009

669

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

“SPECIAL NON-IMMIGRANT”

Description: SPECIAL NON-IMMIGRANT: Some categories of “special” non immigrant statuses allow the status (visa) holder to work in the United States and eventually adjust to Lawful Permanent Resident (LPR) status. These categories allow the individual to apply for adjustment to Lawful Permanent Resident (LPR) status after he or she has had the non-immigrant status for a period of time. These statuses are included in the category defined as: “other persons living in the U.S. with the knowledge and permission and acquiescence of USCIS and whose departure USCIS does not contemplate enforcing.”

Such statuses include, for example: K status: For the spouse, child, or fiancé(e) of a U.S. citizen. S Status: For informants providing evidence for a criminal investigation. Also known as the “Snitch Visa”. U Status: For victims or witnesses of specialized crimes (who have suffered substantial physical or mental abuse and agrees to cooperate with the government). V Status: For spouses and children of LPR’s whose visa petitions (Form I-130) have been pending for at least three years.

Policy: Immigrants granted a “K”, “V”, “S”, or “U” visa category, if otherwise eligible should be authorized for Medicaid, Family Health Plus and Child Health Plus as a person who is Permanently Residing in the U.S. Under Color of Law (PRUCOL).

Interpretation: Non-immigrant visas V (Visa codes V-1, V-2 and V-3) and K (Visa codes K-3 and K-4) are two new categories of “special” non-immigrant visas that were created by the Legal Immigration and Family Equity Act (LIFE Act) and are issued to persons intending to live permanently in the United States. The V visa may be issued to alien spouses and minor children of lawful permanent residents whose family petitions (the I-130) have been pending for some time. The V visa is intended to permit family reunification while the immigration cases of the lawful permanent resident’s spouse and children are pending. The K visa allows the spouse and minor children of United States citizens to enter the United States legally and obtain work authorization. Individuals issued any of these visas may enter the United States as non- immigrants to complete the immigration process.

MRG

(other-eligibility-requirements)(page-233)Page 233#

UPDATED: NOVEMBER 2009

670

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

“SPECIAL NON-IMMIGRANT”

Holders of the S (Visa codes S-5, S-6 and S-7) or U visas (Visa codes U-1, U-2, U-3, and U-4) are considered PRUCOL and, if otherwise eligible, may receive Medicaid, FHPlus or CHPlus.

The S visa status is given to aliens who assist U.S. law enforcement to investigate and prosecute crimes and terrorist activities. S visa holders are allowed to adjust status to permanent resident under Section 245(j) of the Immigration and Nationality Act.

The U visa status is given to aliens who are victims and/or witnesses of certain crimes who are assisting an investigation or prosecution. This status allows the non-immigrant to remain in the U.S. and to work. After three years in this status, a U status holder can apply to adjust their status.

With respect to the U visa status, the USCIS has directed that individuals who satisfactorily demonstrate to USCIS that they are eligible for a U visa are to be granted Deferred Action status. As such, holders of U visas are to be considered PRUCOL and, if otherwise eligible, may receive Medicaid, FHPlus or CHPlus. MRG

(other-eligibility-requirements)(page-234)Page 234#

UPDATED: NOVEMBER 2009

671

OTHER ELIGIBILITY REQUIREMENTS CITZENSHIP AND IMMIGRATION STATUS

“SPECIAL NON-IMMIGRANT”

Category 4: Special Non-Immigrants Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement Special Non-immigrants: Some categories of non-immigrant status allow the status holder to work and eventually adjust to lawful permanent residence. These categories allow the individual to apply for the adjustment to LPR status after he or she has had the non-immigrant status for a period of time. As SPECIAL NON-IMMIGRANTS, (K), (S), (T)*, and (V) visa holders are PRUCOL and are eligible for Medicaid/FHPlus/CHPlus. * Victims of Trafficking (T visas) receive benefits to the same extent as refugees (04 OMM/ADM-7). ►I-94 Arrival/Departure Record coded K3, K4, V1, V2, or V3, T*, U, or S; ►I-797 indicating the USCIS has received, taken action on or approved an application or petition; ►Postal Return Receipt addressed to the USCIS or copy of cancelled check to the USCIS and a copy of the of the enclosed documents submitted to the USCIS, or ►Correspondence to or from the USCIS, showing that the person is living in the U.S. with the knowledge and permission or acquiescence of the USCIS, and the USCIS does not contemplate enforcing the person’s departure from the U.S.

O PRUCOL*

*Except for Victims of Trafficking

NO LDSS must provide immigrants with a letter addressed to SSA for those immigrants without work authorization who met all the eligibility requirement for federal or state benefits, except for having an SSN. (08 OHIP INF- 2)

Note: Pregnant women are excluded from this requirement

MRG

(other-eligibility-requirements)(page-235)Page 235#

UPDATED: JUNE 2010

672

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS UNDOCUMENTED/ILLEGAL ALIENS

TREATMENT OF AN EMERGENCY MEDICAL CONDITION

Description: An immigrant is here illegally or is undocumented if s/he entered the United States in a manner or in a place so as to avoid inspection, or was admitted on a temporary basis (certain non-immigrants) and the period of authorized stay has expired.

Policy: Medicaid shall be provided for the care and services necessary for the treatment of emergency medical conditions to otherwise eligible illegal or undocumented aliens.

References: SSL Sect 122

131-k

Dept. Reg. 360.3.2(f)(2)

ADMs 04 ADM-7 92 ADM-10

88 ADM-47

88ADM-22

88 ADM-4

88ADM-1

GISs 10 MA/012 08 MA/009

07 MA/ 017

Interpretation: If otherwise eligible, an A/R cannot be denied Medicaid coverage for treatment of an emergency medical condition because of his/her immigration status.

The term emergency medical condition is defined as: “a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

(a) placing the patient’s health in serious jeopardy; (b) serious impairment to bodily functions; or (c) serious dysfunction of any bodily organ or part.”

Care and services related to an organ transplant procedure are not included in the federal definition of treatment for an emergency medical condition.

MRG

(other-eligibility-requirements)(page-236)Page 236#

UPDATED: JUNE 2010

673

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS UNDOCUMENTED/ILLEGAL ALIENS

TREATMENT OF AN EMERGENCY MEDICAL CONDITION

Medicaid is available for emergency services provided to undocumented/illegal or certain non-immigrants from the time that the individual is first given treatment for an emergency medical condition until such time as the medical condition requiring emergency care is no longer an emergency. If an eligible individual receives treatment for an emergency medical condition and continues to receive care after the emergency ceases, Medicaid coverage for such care is not available.

When an enrollee is eligible for Emergency Services Only, Medicaid no longer covers the costs for or the transportation to rehabilitation services (including physical, occupational and speech therapies). This is because these services do not fall under the definition of treatment of an emergency medical condition.

NOTE: Until formally notified to do otherwise, chemotherapy and radiation therapy are to be considered as emergency medical services.

Current Medicaid policy states that certain types of care provided to chronically ill persons are beyond the intent of the federal and State laws which allow Medicaid to pay for the treatment of medical emergencies. Such care includes: • alternate level of care in a hospital, • nursing facility services, and • home-care (including but not limited to, personal care services, home health services and private duty nursing).

NOTE: A women with a medically verified pregnancy is not required to document citizenship or immigration status for the duration of her pregnancy, through the last day of the month in which the 60-day postpartum period ends.

Verification: Temporary non-immigrants and undocumented aliens applying for coverage for the treatment of an emergency medical condition must complete the appropriate MEDICAID APPLICATION and sign the DOH 4471, “Certification of Treatment of Emergency Medical Condition”. MRG

(other-eligibility-requirements)(page-237)Page 237#

UPDATED: JUNE 2010

674

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS UNDOCUMENTED/ILLEGAL ALIENS

TREATMENT OF AN EMERGENCY MEDICAL CONDITION

The DOH-4471 certification form must be signed by the A/R. If the A/R is unable to sign, his or her authorized representative may sign on the behalf of the A/R. The form is not valid without the required signature of the A/R or his/her authorized representative. Signing the form authorizes the local department of social services to request information regarding the emergency medical treatment. It also gives the physician or facility permission to provide such information.

The treating physician must complete the DOH-4471 and sign and date the form. The physician must, in all cases, make the decision as to whether or not the medical treatment is for an emergency medical condition. The physician must complete the entire form, sign and date the certification and return it to the local department of social services.

The local district maintains this certification form in the applicant’s case record, the local district notifies the provider of the acceptance/denial of the application, and furnishes the provider with the individual’s CIN number when appropriate.

The DOH-4471 has space to accommodate up to four coverage periods (“FROM_____TO_____ Date(s)” of Treatment/Hospital Stay) that may be entered by the provider. A new DOH-4471 certification form must be completed, dated and signed by the A/R, or the A/R’s authorized representative, and by the treating physician and submitted for subsequent or continuing treatment of an emergency medical condition.

Each person’s “emergency” is unique and the coverage period under the definition of emergency medical condition is limited and date specific. Therefore, Medicaid coverage for the emergency care must be a specific period of time in the past (i.e., at least one day prior to the initial Medicaid application date or one day prior to the Transaction Date for recipients in need of continuing care for the treatment of the emergency medical condition).

Medicaid payment for emergency services is limited to the day treatment was initiated and the following period of time in which the necessity for emergency services exists (e.g., the date of admission through the date of discharge from the hospital).

MRG

(other-eligibility-requirements)(page-238)Page 238#

UPDATED: JUNE 2010

675

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS UNDOCUMENTED/ILLEGAL ALIENS

TREATMENT OF AN EMERGENCY MEDICAL CONDITION

The DOH-4471 form has space to accommodate up to four coverage periods (From-To Date(s) of Treatment/Hospital Stay). Each “From- To” date(s) must be entered in the Welfare Management System (WMS) as a separate coverage period, and each coverage period requires a separate Client Notification System (CMS) note (upstate). For any subsequent treatment/hospital stay or continuing treatment for an emergency medical condition, a new DOH-4471, form must be completed, dated, and signed by the A/R, or the A/R’s authorized representative, and by the treating physician.

The maximum period of time for which “emergency treatment” (coverage code “07”) may be entered from one submission of the DOH-4471 is 90 days. This can be a combination of retroactive, current, and prospective coverage. A new DOH-4471 must be obtained from a physician at least once 90 days, in order to continue the Medicaid coverage. Future (prospective) coverage may not exceed 60 days.

Category 5: Undocumented Aliens

Category

Documentation WMS ACI code

Federal Financial Participation (FFP) Social Security Number (SSN) Requirement Undocumented Aliens: (Undocumented aliens do not have the permission of the USCIS to remain in the U.S. They may have entered the United States legally but have violated the terms of their status, e.g. over-stayed a visa, or they may have entered without documents.) Undocumented aliens are unable to provide documentation of immigration status; therefore, absent any documentation they are eligible only for the treatment of an emergency medical condition. Undocumented children may be eligible for CHPlus. Undocumented pregnant women continue to be eligible for pre-natal care.

E Only eligible for treatment of an emergency medical condition

YES

NOT Required

MRG

(other-eligibility-requirements)(page-239)Page 239#

UPDATED: JANUARY 2012

676

OTHER ELIGIBILITY REQUIREMENTS

RECOVERIES

Description: Recovery is the repayment or taking back of funds expended for Medicaid.

Policy: A recovery may be made: • from the estate (including non-probate assets) of a permanently institutionalized individual of any age; • from the estate (including non-probate assets) of an individual who was 55 years of age or older when s/he received Medicaid; • from a personal injury award or settlement; • based upon a court judgment, for Medicaid incorrectly paid (including Family Health Plus); • from a legally responsible relative who fails or refuses to make his/her income and resources, as appropriate, available to the Medicaid recipient (See OTHER ELIGIBLITY REQUIREMENTS OWNERSHIP AND AVAILABILITY ); • from the sale of real property of a permanently institutionalized individual (See RESOURCES PERSONS IN MEDICAL FACILITIES TREATMENT OF REAL PROPERTY) when a lien had been placed against the real property of such person pursuant to SSL 369(2)(a)(ii); or • from a non-custodial parent who has a court order to pay cash medical support to the LDSS.

A recipient may elect to voluntarily reimburse a district for Medicaid correctly or incorrectly paid.

References: SSL Sect. 366(3)(a)

369

NYS Finance Law 18 (4&5)

General Business Law 453

Social Security Act 1917(b)

MRG

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