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UPDATED: JANUARY 2012
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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)