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 his or her 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
(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.
SSA Employee: __________________________________________________