360-3.3 Who is eligible for MA. Generally, an applicant is eligible for MA if he/she
meets the conditions listed in section 360-3.2 of this Part and belongs to one of the
groups listed below:
(a) Persons who are categorically needy. An applicant is categorically
needy if:
(1) he/she is eligible for or receiving HR; or
(2) he/she is eligible for or receiving ADC; or
(3) he/she is eligible for or receiving SSI
and/or State supplementary payments; or
(4) he/she is a child receiving foster care
maintenance payments under Title IV-E of the Social Security Act and living in the State;
(5) he/she is a child living in the State on
whose behalf an adoption assistance agreement is in effect under Title IV-E of the Social
Security Act, whether or not adoption assistance payments are provided for under the
agreement or are being made pursuant to Title IV-E; or
(6) he/she is an adopted child under age 21
provided that:
(i) there is a legally
executed adoption assistance agreement in place between an authorized agency and the
adoptive parents (other than an adoption assistance agreement subject to the provisions of
Title IV-E of the Social Security Act);
(ii) the child has a
special need for medical or rehabilitative care that would have precluded placement with
adoptive parents unless MA were provided to the child; and
(iii) the child was in
receipt of MA in the three-month period prior to the adoption agreement being entered
into, or the child would have been eligible for MA during such period if only the child's
own income and resources were considered in determining eligibility.
(b) Persons who are medically needy. An applicant/recipient is
medically needy if his/her net available income and resources do not meet the cost of
necessary medical care and services available under the MA program, as determined in
accordance with Subpart 360-4 of this Part, and he/she is:
(1) a person 65 years of age or older;
(2) a person who is certified blind or
certified disabled;
(3) a person under 21 years of age, or under 22
years of age and receiving inpatient psychiatric services which he/she began receiving
before reaching age 21;
(4) a pregnant woman;
(5) a person ineligible for ADC solely because
his or her income and/or resources are above the amounts allowed for ADC eligibility. This
category includes: parents or other relatives listed in section 369.1(b) of this Title who
are living with and caring for a child under the age of 21 who is deprived of parental
support; and persons who otherwise would be eligible for a continuation of an ADC grant
pursuant to section 369.3(d)(1) of this Title;
(6) the spouse of a cash assistance recipient
who is living with the recipient, who is essential to the recipient's welfare, and whose
needs are included in determining the amount of the recipient's cash payment;
(7) a federally non-participating (FNP) person
who is a parent of a dependent child under 21 years of age and who is ineligible for
public assistance solely because his/her income and/or resources are above the amounts
allowed for public assistance eligibility, provided that the child is living with such
parent or is temporarily absent from the parent's household. An FNP person does not meet
the categorical eligibility requirements for ADC or SSI; or
(8) a person who resides in a
department-approved private facility which is funded through voluntary contributions and
which provides for all maintenance and personal needs, provided that such person has no
income or resources or that such person's income and resources are applied toward the cost
of maintenance in the facility. If such person is federally non-participating, he/she will
be required to comply with the requirements of subdivision (5) of section 131 of the
Social Services Law.
(c) Persons whose MA eligibility is extended. Certain persons will
continue to receive MA benefits for a specified period of time after ceasing to be
categorically needy or medically needy.
(1) (i) A family which
becomes ineligible for ADC or HR will remain eligible for MA for an extended MA coverage
period of six calendar months following the month of ADC or HR ineligibility if:
(a) the family became ineligible for ADC or HR on or after April 1, 1990;
(b) the family was eligible for ADC or HR in at least three of the six months immediately
preceding the first month of ADC or HR ineligibility; and
(c) the family became ineligible for ADC or HR due to the caretaker relative's hours of
employment or income from employment, or the loss of the $30 plus one-third of the
remainder earned income disregard or the $30 earned income disregard, as provided in
section 352.20 of this Title; and
(d) the family continues to have a dependent child.
(ii) When notifying a
family of its ineligibility for ADC or HR for the reasons described in subparagraph (i)(c)
of this paragraph, social services districts must give the family adequate notice of its
rights to an extended MA coverage period under this paragraph, including notice of the
reporting requirements for the additional extended MA coverage period under paragraph (2)
of this subdivision and the circumstances described in subparagraph (iii) of this
paragraph.
(iii) Social services
districts also must give the families receiving MA under this paragraph adequate notice of
the option for an additional extended MA coverage period in both the third and sixth
months of the extended MA coverage period.
(iv) Upon adequate
notice to the family, the extended MA coverage period under this paragraph must be
terminated at the end of:
(a) the first month in which the family ceases to include a dependent child; or
(b) the month in which the department determines that a family member fraudulently
received ADC or HR in any of the six months prior to the extended MA coverage period.
(2) (i) A family which
received MA for the full six-month extended MA coverage period provided for under
paragraph (1) of this subdivision may be eligible for an additional extended MA coverage
period of six calendar months. In order to be eligible for the additional extended MA
coverage period, the family must have submitted the first report required under
subparagraph (ii) of this paragraph, or have good cause for failing to meet the reporting
requirement.
(ii) A family must
report to the social services district the family's gross monthly earnings and the
family's costs for child care, which were necessary for the employment of the caretaker
relative. These reports must include earnings and costs for each of the three preceding
months. The reports must be submitted no later than the 21st day of the fourth month of
the extended MA coverage period and no later than the 21st day of the first and fourth
months of the additional extended MA coverage period.
(iii) Social services
districts must give families receiving MA coverage under this paragraph adequate notice of
the reporting requirements of subparagraph (ii) of this paragraph in the third month of
the additional extended MA coverage period.
(iv) Upon adequate
notice to the family, the additional extended MA coverage period under this paragraph must
be terminated at the end of:
(a) the first month in which the family ceases to include a dependent child;
(b) the month in which the department determines that a family member fraudulently
received ADC or HR in any of the six months prior to the extended MA coverage period;
(c) the first or fourth month of the additional extended MA coverage period if the family
fails, without good cause, to meet the reporting requirements set forth in subparagraph
(ii) of this paragraph in either the first or fourth month of the additional extended MA
coverage period;
(d) the first or fourth month of the additional extended MA coverage period if the
caretaker relative had no earnings in one or more of the previous three months, unless the
lack of earnings was due to an involuntary loss of employment, illness, or other good
cause; or
(e) the first or fourth month of the additional extended MA coverage period if the
family's average gross monthly earnings during the previous three months, less the cost of
child care necessary for the employment of the caretaker relative, exceed 185 percent of
the federal income official poverty line applicable to the family's size.
(3) A household which becomes ineligible for
ADC due to the collection or increased collection of child or spousal support will remain
eligible for MA for four calendar months beginning with the first month of ADC
ineligibility if the family was eligible for ADC in at least three of the six months
immediately preceding the first month of ADC ineligibility.
(4) Repealed April, 1996.
(5) A woman receiving MA on any day of her
pregnancy remains eligible for MA for at least 60 days beginning on the last day of her
pregnancy. Her eligibility will continue until the last day of the month in which the 60th
day occurs, regardless of any change in her household's income.
(6) A child whose mother was eligible for and
receiving MA on the date of the child's birth will be eligible for MA for up to one year
from the date of birth so long as:
(i) the mother remains,
or if pregnant, would remain eligible for MA; and
(ii) the child is a
member of the woman's household.
(7) A person who becomes ineligible for SSI
because he/she is no longer certified blind or certified disabled will remain eligible for
MA for two months following the month in which the blindness or disability ends, provided
the person continues to meet the financial eligibility requirements in Subpart 360-4 of
this Part.
(8) Any certified blind or certified disabled
person who is a qualified severely impaired individual will continue to be eligible for MA
despite earnings that demonstrate his or her ability to engage in substantial gainful
activity under the SSI program. A person is a qualified severely impaired individual if:
(i) he/she was eligible
for MA and received SSI benefits, State supplementary payments, or benefits under section
1619(a) of the Social Security Act in the month preceding the first month in which the
provisions of this paragraph are applied; and
(ii) the Social
Security Administration has determined that:
(a) the person continues to be blind or to have a disabling physical or mental impairment;
(b) the person continues to meet all other requirements for SSI eligibility except for
earnings;
(c) the lack of MA coverage would seriously inhibit the person's ability to continue or to
obtain employment; and
(d) the person's earnings are insufficient to provide a reasonable equivalent of the SSI,
MA, and publicly-funded attendant care benefits that would be available to the person if
he/she were not employed.
(9) A person 60 years of age or older who
applies for and receives early widow's or widower's insurance benefits under section
202(e) or (f) of the Social Security Act, or receives other benefits under section 202 of
such Act but is eligible for widow's or widower's insurance benefits, and who becomes
ineligible for SSI or State supplementary payments as a result of receiving such benefits,
will remain eligible for MA so long as:
(i) he/she would be
eligible for SSI or State supplementary payments if he/she were not receiving such
benefits; and
(ii) he/she is not
entitled to Medicare Part A hospital insurance benefits.
(10) A person who was receiving both SSI and
Social Security benefits at any time after April, 1977 and who subsequently became
ineligible for SSI will be eligible for MA if:
(i) the person is
currently eligible for and receiving Social Security benefits; and
(ii) the person would
be eligible for SSI if Social Security cost-of-living increases received by the person and
his/her spouse since the last month in which the person received both Social Security and
SSI benefits were not counted as income.
(11) A person who was eligible for MA in
December, 1973 as a blind or disabled individual will remain eligible for MA so long as:
(i) the person still
meets the December, 1973 criteria for blindness or disability; and
(ii) the person meets
all other current requirements for MA eligibility.
(12) A person eligible for MA in December, 1973
as an essential spouse of a recipient of aid to the aged, blind, or disabled (AABD)
remains eligible for MA so long as:
(i) the aged, blind or
disabled individual still meets the December, 1973 eligibility requirements for AABD; and
(ii) the person remains
the spouse of the aged, blind or disabled individual.
(13) A person who was an inpatient in an
institution participating in the MA program for all or any part of December, 1973 and who:
(i) would have been
eligible to receive AABD except for being such an inpatient; or
(ii) was considered to
be eligible for AABD, for the purpose of determining MA eligibility, on the basis of
needing care in such an institution, remains eligible for MA so long as he/she continues
to be in need of inpatient care.
(14) A person who was entitled to Social
Security benefits and was eligible for or receiving cash assistance under ADC or AABD in
August, 1972 will have his/her MA eligibility determined without regard to the October,
1972 Social Security increase. This provision also applies to a person who would have been
eligible for ADC or AABD during August, 1972 if he/she had not been in a medical
institution or intermediate care facility.
15) A person age 18 or older who was receiving
SSI or State supplementary payments on the basis of blindness or disability which began
before he or she reached the age of 22, and who on or after July 1, 1987 lost elgibility
for SSI benefits because he or she became entitled to child's insurance benefits under 42
U.S.C. 402(d) (also known as Disabled Adult Child's benefits) or to an increase in the
amount of such benefits, remains elgible for MA so long as he or she would be elgible for
SSI benefits in the absense of such child's insurance benefits or the increase in such
benefits.
(16) An infant who is receiving medically
necessary in-patient care and services on his or her first birthday and who is eligible
for MA because his or her household's income does not exceed 185 percent of the applicable
poverty line set forth in subdivision (b) of section 360-4.7 of this Part will remain
eligible for such in-patient care and services until the end of his or her in-patient
stay.
(17) A child who is receiving medically
necessary in-patient care and services on his or her sixth birthday and who is eligible
for MA because his or her household's income does not exceed 133 percent of the applicable
federal poverty line set forth in section 360-4.7(b) of this Part will remain eligible for
such in-patient care and services until the end of his or her in- patient stay.
(18) A child who is receiving medically
necessary in-patient care and services on his or her 19th birthday and who is eligible for
MA because his or her household's income does not exceed 100 percent of the applicable
federal poverty line set forth in section 360-4.7(b) of this Part will remain eligible for
such in-patient care and services until the end of his or her in- patient stay.