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UPDATED: JANUARY 2011
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OTHER ELIGIBILITY REQUIREMENTS
DISTRICT OF FISCAL RESPONSIBILITY (DFR)
determining whether the Medicaid SSI recipient gains residence in another district following a move or remains the responsibility of the State. OMH or OPWDD will transfer a Medicaid SSI case to the new district when appropriate. • Medicaid-only recipients who move to an adult care facility in another district are the fiscal responsibility of the former district. However, if the individual becomes eligible for SSI, the SSI recipient gains residence in the new district and a Medicaid case must be opened in the new district following the closing of the Medicaid case in the former district. • SSI recipients who enter a medical facility in another district and remain eligible for SSI but for whom no SSI payment is being made (SDX Payment Status Code E01 “Eligible but no Payment”) gain residence in the new district. • SSI cash recipients who move to a medical facility in another district prior to October 20, 2008 are the fiscal responsibility of the former district. . Should the individual subsequently move and remain in receipt of SSI the district of fiscal responsibility becomes the where found district.
EXCEPTIONS TO THE “WHERE FOUND” RULE (other than SSI cash recipients/eligible’s)
NOTE: Unless one of the following exceptions applies, the “where found” district is fiscally responsible for the A/R. The burden of proof is on the “where found” district to establish that an exception applies.
Temporary Absence from Legal Residence
The local social services district where a person has his or her legal residence continues to be responsible for providing Medicaid when the person is temporarily absent from the district. A person’s legal residence, or domicile, is the principal and permanent home to which the person, wherever temporarily located, always intends to return. Districts rely on a person’s expression of intent in determining the district of legal residence, unless the person’s actions are inconsistent with the expressed intent. When a person capable of indicating intent leaves his/her district of legal residence, the person will be considered to be temporarily absent from such district if:
(MRG)