SI NY01730.105 (New York) — Medicaid Qualifying Trusts (TN 436 - 05/2013)

When an individual residing in a section 1634 State has a Medicaid trust, SSA determines if the trust is countable for SSI purposes. The existence of a Medicaid trust results in a referral to the Medicaid State agency for a Medicaid eligibility decision. See SI 01730.048 for the definition of Medicaid trusts and procedures to determine if a trust is countable for SSI purposes.

 

When a case with a trust or SLD is sent to the State, the FO must complete the MSSICS ROTH screen per MSOM MSSICS 013.011C or in the paper environment input a "Q" in the PT field of the SSR per POMS SM 01005.350 . Once the case is referred to the State, they will make a determination as to whether the recipient can receive Medicaid.

 

The FO should make a photocopy of the trust or SLD and mail it under cover of Exhibit I to the address below. The claimant should also be provided with a copy of Exhibit I for the claimant's records.

 

EX. I - (New York) Medicaid Qualifying Trust Lead

TO:     New York State Department of Health

             Office of Health Insurance Programs

             Division of Health Reform and Health Insurance Exchange Integration

             Bureau of Medicaid Enrollment and Exchange Integration

             One Commerce Plaza, Suite 826

             Albany, New York 12260

 

FROM:   _____________________________________________________

                                            (SSA Office)

                _____________________________________________________

                _____________________________________________________

NAME:  ______________________________________________________

                                         (SSI Applicant)

SSN:     ______________________________________________________

                                     (Social Security Number)

 

The above-mentioned individual filed for Supplemental Security Income on _______________.

 

_____ Attached is a copy of the trust or SLD that the person had with them when they filed at the Social Security Office.

_____ We did not enclose a copy of the trust or SLD because the

person did not have it with them when they were in the Social Security office.

(CHECK ONE)

SSA Employee:   __________________________________________________

Telephone:         __________________________________________________

Date:                 __________________________________________________