Page 41

UPDATED: JANUARY 2012

491

OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION

DENIAL

When an applicant is denied due to excess income and the applicant is ADC-related, SSI-related, a pregnant woman, or under age 21, the letter explains how excess income may be utilized to "spend down" to the Medically Needy Income level. (See INCOME MEDICALLY NEEDY INCOME LEVEL). The letter further explains local district procedures regarding the applicant's use of the excess income, including the “Optional Pay-In Program for Individuals with Excess Income.”

NOTE: 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.

If an LDSS receives a Common Application (LDSS-2921) for a child under 19 years of age who is ineligible for Medicaid due to excess income or immigration status, the “Release of Information to the Child Health Plus Program” form must be signed if an eligibility determination for Child Health Plus is desired. The LDSS must mail a copy of the application (LDSS-2921), the release form, supporting documents, a copy of the denial letter and a copy of the Medicaid budget that shows ineligibility to the Community Based Organization (CBO) in their county. If there is more than one CBO the LDSS does business with, the LDSS should select the CBO that is geographically closest to the applicant’s residence address.

If an LDSS receives a renewal or a request between renewal periods to add a child under 19 to a recipient’s Medicaid case and the child is determined ineligible based on excess income or immigration status, the LDSS must send a manual denial notice and a blank DOH-4220 and instruct the individual to apply for CHPlus.

In all instances, if the LDSS has confirmed income information through UIB, SDX or the Child Support Collection unit, such information must be forwarded with the CHPlus application.

(MRG)