Page 36
UPDATED: JUNE 2010
486
OTHER ELIGIBILITY REQUIREMENTS
DECISION AND NOTIFICATION
Description: A decision on an application, reapplication, or recertification is a determination that the applicant is either eligible or ineligible for Medicaid. Policy: A decision as to the A/R's eligibility is made within specified time periods for each new application, reapplication and recertification. Upon reaching a decision, a written notification of acceptance, denial, withdrawal, discontinuance, reduction or change in the spenddown calculation is sent to the applicant.
The Notice of Intent sent to Temporary Assistance A/Rs who have also applied for Medicaid contains a separate statement concerning Medicaid eligibility. Where the reason for denying the TA case is also a valid reason for denying Medicaid, it is stated separately in the Notice of Intent.
New SSI beneficiaries will receive a letter from New York State informing them that they are automatically eligible for Medicaid. This letter also requests the A/R to supply information concerning third party health insurance, and information on paid or incurred medical bills for the three months prior to the month of application.
References: SSL Sect. 366
366-a
Dept. Reg. 358-3.3
358-4.1
360-2.4
360-2.5
360-2.8
360-2.9
ADMs 10 OHIP/ADM-4
89 ADM-21
82 ADM-5
Interpretation: A determination of eligibility is made within a 45-day time period. A determination of eligibility for persons eligible under the poverty based programs (pregnant women and children under age 19) is completed within 30 days. The only exception to this are cases awaiting a disability determination. A 90-day time limit is applied to situations when a disability determination is being
(MRG)