SI NY01730.102 (New York) Determination Of Medicaid Eligibility

A. MEDICAID REFERRALS

The terms Medicaid and Medical Assistance (MA) are used interchangeably.

1. Immediate Medical Need

If a claimant needs medical assistance before a determination is made on his/her SSI application, refer him/her to the appropriate County Department of Social Services or, in New York City, have them call the HRA Information Line at (718) 291-1900 or toll free 1- (877) 472-8411.

Prepare the DSS-2474 in duplicate, completing all appropriate items. Make sure to check "Medical Assistance" and write "Immediate Medical Need" in "Other". Complete section III - "Initial Application Filed for SSI". Give the claimant one copy and send the other one to DSS. This applies to aged/blind and disabled individuals.

2. Non-Receipt of the Common Benefit Issuance Card (CBIC): the Medicaid Card

If an eligible individual alleges non-receipt of a Medicaid card, complete the DSS-2474. Check "Other" and note "non-receipt of Medicaid card". Complete the form in duplicate and mail the other copy to the appropriate DSS office.

3. Establishing Retroactive Medicaid Eligibility After Death

SSA must make a medical eligibility determination in blind/disability cases where the claimant dies after filing and had medical expenses (paid or unpaid). This is necessary so that the State can make a Medicaid determination. The State may contact the field office (FO) to determine if an SSI application was filed.

As a result of a court case, New York State must also reimburse the relatives of an otherwise eligible MA applicant for paid medical bills during the retroactive period.

a. Notice of Death Received

If the FO is notified by mail, associate the notice with the file and review the application to see if there were any unpaid medical expenses. If none are shown, contact the surviving spouse or other relative to learn if there are medical expenses that were incurred and are still unpaid. If there were, take action to have the Disability Determination Service (DDS) make a disability decision.

If the FO is notified in person or telephone, ask whether there were any unpaid medical expenses. Record on a report of contact (RC) the name, relationship, telephone number and whether the person is aware of any unpaid expenses. Associate this with the file. Also, review the application to see if there were any unpaid medical expenses. If there were, take action to have the DDS make a disability decision.

b. Informing the State

When a final disability determination is made, send the information to:

New York State Department of Health (DOH)
Office of Medicaid Management
Division of Consumer & Local District Relations
PO Box 118
1 Commerce Plaza
Albany, New York 12260.

The notification should be on an RC, with a copy for the file. It should contain the following:

  1. Subject: Manual Medicaid Eligibility Determination, SSI, SSI Claimant Deceased

  2. Name

  3. SSN

  4. Welfare Identification Number (if known)

  5. Title XVI disability determination

  6. Effective date of the determination

  7. Date of death

  8. Applicant's last known address

  9. Name and telephone number of the informant


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501730102NY
SI NY01730.102 - (New York) Determination Of Medicaid Eligibility - 03/13/2003
Batch run: 01/27/2009
Rev:03/13/2003