SI NY01730.010 Determinations of Medicaid Eligibility (RTS 403 -- 09/06)
A. Out of State Placements – General
The State of New York has been reviewing certain residency issues by using the State Data Exchange (SDX). The information on the SDX comes from the Supplemental Security Income Record (SSIRD). The cases that New York is identifying indicate that the recipient has a state and county code reflecting a residence in New York, but a mailing address outside of New York State. Since the State and County code affects Medicaid coverage and state supplementation payments, it is important that these fields accurately reflect the recipient's actual living arrangements and state of residence on the SSIRD.
When New York State identifies a case, the New York Regional Office, Center for Programs Support, reviews the referral and sends an email to the various other regional offices and field offices (in the New York Region) in order to determine why the state and county code do not reflect the same state as the mailing address.
Based upon our review of these cases, we have identified some common issues. Most cases did have the proper state and county code of residence, but lacked the proper documentation. The types of situations varied, but the ones listed below are the most common:
A change of address was input by a Teleservice Center representative and the field office had not yet interviewed the recipient who moved into their area. The new address was on the SSIRD with the previous living arrangements and state and county codes.
A parent placed a child in a facility or hospital out of their state of residence, for temporary or permanent care.
A state placed a child or an adult in a facility out of that state because the “placing” state did not have the proper facility to care for that individual.
FOs should be aware of these differences and document these cases accordingly. Special care should be taken when a child becomes age 18, see SI 00520.011 ($30 Limit) and SI 01310.115 (Deeming).
B. Documentation of Placement
Follow the National procedures in SI 01410.010 (State and County of Residence) and SI 00520.001 (Residence in an Institution).
If the placement is not by a state agency follow the instructions in POMS SI 01410.020 (Determine State of Residence).
If the child/individual is placed by a state agency, secure the name of the State agency, the name of the employee making the determination and the employee's title.
If the stay is temporary or only until a certain age, this should also be documented.
Document the information on a DROC MSOM MSSICS 022.010 and the “Remarks” Field of the SSR with the annotation – “Do Not Remove”.
For non-MSSICS cases, interviewers should use the EVID screen to document placement information. MSOM EVID 001.003, POMS GN 00301.286 and GN 00301.287.
Refer to any precedents – see SI 00520.800 (Facility Determination - SSA-8045).
C. Common Facilities Where Individuals Are Placed by New York
1. New Jersey
Andover Subacute Care and Rehab Center, Lyndhurst, NJ
Lincoln Park Care Center, Lincoln Park, NJ
Hillcrest Residential, Pittsfield, MA
Care One at Holyoke, Holyoke, MA (formerly Holyoke Rehab Center)
Judge Rotenburg Center, Canton, MA (many placements by New York)
(For additional information on this facility, see PM 03-054 dated May 16, 2003.)
Kolburne School, New Marlborough, MA
Latham School, Brewster, MA
Melmark School, Berwyn, PA
Stetson School, Barre, MA
3. New Hampshire
Easter Seals, Lancaster, NH
Lakeview Rehab Center, Effingham Falls, NH
Kids Peace Foster Care and Family Services, Orefield PA
Woods Residential School, Langhorne, PA
Fletcher Allen Health Care, Burlington VT