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UPDATED: JANUARY 2012

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OTHER ELIGIBILITY REQUIREMENTS

FINANCIAL MAINTENANCE

Description: Financial maintenance refers to the manner in which the A/R meets basic needs and non-medical expenses. The local district evaluates the completeness and consistency of the A/R’s statements regarding financial circumstances.

Policy: If monthly housing expenses exceed 60/70 percent, as appropriate, of the A/R’s monthly income, the A/R must provide further information on specific monthly living expenses and an explanation as to how the expenses are being met. If the LDSS determines that based on information provided by the A/R that there are discrepancies in the A/R’s statements or other evidence the LDSS has that raises questions regarding the validity or reasonableness of the A/R’s statements, further information may be required.

NOTE: This does not apply to A/Rs who are applying for or are in receipt of Family Planning Benefit Program or MSP only. Financial maintenance does not apply to child-only cases or to A/R’s subject to post-eligibility treatment of income.

References: SSL Sect.

366-a.4

Dept. Reg.

360-2.2

360-2.3(c)

ADM

10 OHIP/ADM-6

INFs

10 OHIP/INF-1

GISs

11 MA/016

Interpretation: Local social services districts are responsible for determining what percentage of an A/R’s income is being spent on housing expenses. When an A/R reports on the ACCESS NY Health Care application (DOH-4220), the DSS-2921 or the Medicaid, Family Health Plus and/or Family Planning Benefit Program Renewal (Recertification) form that his/her share of monthly housing expenses is in excess of: 70% of the A/R’s gross monthly income if living in Bronx, Kings, Manhattan, Nassau, Putnam, Queens, Richmond, Suffolk and Westchester counties; or 60% if living in any other county, the LDSS must pursue further information to evaluate how he/she is meeting basic living expenses. Monthly living expenses include: cable, phone, heat, electricity, food, transportation, credit card payments etc.

(MRG)