Page 2

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