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UPDATED: JANUARY 2011

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OTHER ELIGIBILITY REQUIREMENTS

DISTRICT OF FISCAL RESPONSIBILITY (DFR)

For example: While visiting his sister in Essex County from another state, Mr. Smith becomes ill and cannot return to his home state. He is hospitalized in Clinton County. While in Clinton County, Mr. Smith's sister applies on his behalf for Medicaid in Essex County. If the home state does not agree that the individual is a resident of that state for Medicaid purposes, Mr. Smith is authorized for Medicaid by Essex County. Subsequently Mr. Smith is moved to a nursing facility in Franklin County. Essex County remains fiscally responsible for Mr. Smith's Medicaid.

When a person applies for Medicaid while in a district other than his/her local district of residence, the local district in which the person is found contacts the local district of residence before assuming that district will accept and process an application. The district where the A/R is found assists in processing the application as a courtesy. This acknowledgment of fiscal responsibility is confirmed and noted in the record, prior to forwarding the courtesy application. Without such an agreement, the district in which the applicant is found accepts and processes the application. If otherwise eligible, Medicaid is authorized by the district where the applicant is found. The district may then request a fair hearing to determine the district of responsibility.

All individuals who have been determined eligible for SSI cash payments by the Social Security Administration, or who are in receipt of such payments (federal benefits and/or State Supplements) are the district of fiscal responsibility of the “where found” district. The only exceptions that apply to SSI cash recipients and eligibles include:

• Children in receipt of, or eligible for, SSI cash assistance who are in the care and custody of the Commissioner of the Local Department of Social Services remain the fiscal responsibility of the Commissioner who has custody of the child. • Medicaid SSI eligible’s and recipients who are the responsibility of the Office of Mental Health (District 97/OMH) or the Office for People with Developmental Disabilities (District 98/OPWDD), who move to another district may remain the responsibility of OMH or OPWDD depending on the living arrangement of the individual. OMH and OPWDD will retain responsibility for

(MRG)