§ 366-a. Applications for assistance; investigations; reconsideration.
1. Any person requesting medical assistance may make application
therefor by a written application to the social services official of the
county in which the applicant resides or is found or to the department
of health or its agent; a phone application; or an on-line application.
Notwithstanding any provision of law to the contrary, an in-person
interview with the applicant or with the person who made application on
his or her behalf shall not be required as part of a determination of
initial or continuing eligibility pursuant to this title.

1-a. Every person making application for medical assistance, and every
person on whose behalf an application is made, shall, if interested, be
given the New York state department of health model health care proxy
form by the person taking the application, except where doing so would
impede the immediate provision of health care services.

2. (a) Upon receipt of such application, the appropriate social
services official, or the department of health or its agent shall verify
the eligibility of such applicant. In accordance with the regulations of
the department of health, it shall be the responsibility of the
applicant to provide information and documentation necessary for the
determination of initial and ongoing eligibility for medical assistance.
If an applicant or recipient is unable to provide necessary
documentation, the social services official or the department of health
or its agent shall promptly cause an investigation to be made. Where an
investigation is necessary, sources of information other than public
records will be consulted only with permission of the applicant or
recipient. In the event that such permission is not granted by the
applicant or recipient, or necessary documentation cannot be obtained,
the social services official or the department of health or its agent
may suspend or deny medical assistance until such time as it may be
satisfied as to the applicant's or recipient's eligibility therefor.

(b) Notwithstanding the provisions of paragraph (a) of this
subdivision, an applicant or recipient may attest to the amount of his
or her accumulated resources, unless such applicant or recipient is
seeking medical assistance payment for long term care services. For
purposes of this paragraph, long term care services shall mean care,
treatment, maintenance, and services described in paragraph (b) of
subdivision 1 of section three hundred sixty-seven-f of this title, with
the exception of short term rehabilitation, as defined by the
commissioner of health.

(c) Notwithstanding the provisions of paragraph (a) of this
subdivision, an applicant or recipient providing written documentation
of income eligibility of a child for free or reduced breakfast or lunch
through the school meal program certified by the child's school shall
meet the evidentiary requirement necessary to document income.

* (d) Notwithstanding the provisions of paragraph (a) of this
subdivision, an applicant or recipient whose eligibility under this
title is determined without regard to the amount of his or her
accumulated resources may attest to the amount of interest income
generated by such resources if the amount of such interest income is
expected to be immaterial to medical assistance eligibility, as
determined by the commissioner of health. In the event there is an
inconsistency between the information reported by the applicant or
recipient and any information obtained by the commissioner of health
from other sources and such inconsistency is material to medical
assistance eligibility, the commissioner of health shall request that
the applicant or recipient provide adequate documentation to verify his
or her interest income.

* NB There are 2 par (d)'s

* (d) The commissioner of health may verify the accuracy of the
information provided by the applicant or recipient pursuant to
paragraphs (b) and (c) of this subdivision, by matching it against
information to which the commissioner of health has access, including
under subdivision eight of this section. In the event there is an
inconsistency between the information reported by the applicant or
recipient and any information obtained by the commissioner of health
from other sources and such inconsistency is material to medical
assistance eligibility, the commissioner of health shall request that
the applicant or recipient provide adequate documentation to verify his
or her resources.

* NB There are 2 par (d)'s

3. Upon the receipt of such application, and after the completion of
any investigation that shall be deemed necessary, the appropriate social
services official or the department of health or its agent shall

(a) decide whether the applicant is eligible for and should receive
medical assistance, the amount thereof and the date on which it shall
begin, which shall be the date of the application or, subject to
applicable department regulations, such earlier or later date as may be
deemed reasonable;

(b) notify the applicant in writing of the decision, and where such
applicant is found eligible, provide a tamper resistant identification
card containing a photo image of the applicant for use in securing
medical assistance under this title provided, however, that an
identification card need not contain a photo image of a person other
than an adult member of an eligible household or a single-person
eligible household. The department is not required to provide, but shall
seek practical methods for providing, a card with such picture to a
person when such person is homebound or is a resident of a residential
health care facility, or an in-patient psychiatric facility, or is
expected to remain hospitalized for an extended period. The commissioner
shall have the authority to define categories of recipients who are not
required to have a photo identification card where such card would be
limited, unnecessary or impracticable.

(c) with respect to a person determined eligible for assistance under
this title by the federal social security administration under an
agreement between the department and the secretary of health, education
and welfare pursuant to section three hundred sixty-three-b of this
title issue a medical assistance identification card which shall be
valid for periods determined by the local social services official, but
not to exceed six months.

4. Every applicant or recipient shall promptly advise the public
welfare district of any change in his financial condition or income,
number of wage earners and members in the family unit on such forms and
in such manner as the department by regulation may prescribe. In the
event that any applicant or recipient shall no longer be eligible for
medical assistance, he shall promptly return his identification card
issued pursuant to the provisions of this article to the public welfare
district.

5. (a) All continuing assistance under this title shall be
reconsidered from time to time, or as frequently as may be required by
the regulations of the department. After such further investigation as
the social services official may deem necessary or the department may
require, the assistance may be modified or withdrawn if it is found that
the recipient's circumstances have changed sufficiently to warrant such
action. The assistance may be cancelled for cause, and payment thereof
may be suspended for cause for such periods as may be deemed necessary,
subject to review by the department as provided in section twenty-two of
this chapter.

(b) The commissioner shall develop a simplified statewide
recertification form for use in redetermining eligibility under this
title. The form may include requests only for such information that is:

(i) reasonably necessary to determine continued eligibility for
medical assistance under this title; and

(ii) subject to change since the date of the recipient's initial
application.

(c) The regulations required by paragraph (a) of this subdivision
shall provide that:

(i) the redetermination of eligibility will be made based on reliable
information possessed or available to the department of health or its
agent, including information accessed from databases pursuant to
subdivision eight of this section;

(ii) if the department of health or its agent is unable to renew
eligibility based on available information, the recipient will be
requested to supply any such information as is necessary to determine
continued eligibility for medical assistance under this title; and

(iii) for persons whose medical assistance eligibility is based on
modified adjusted gross income, eligibility must be renewed at least
once every twelve months, unless the department of health or its agent
receives information about a change in a recipient's circumstances that
may affect eligibility.

* (d) An in-person interview with the recipient shall not
automatically be required as part of a redetermination of eligibility
pursuant to this subdivision unless the department of health determines
otherwise.

* NB There are 2 par (d)'s

* (d) The commissioner of health shall verify the accuracy of the
information provided by an applicant or recipient by matching it against
information to which the commissioner of health has access, including
under subdivision eight of this section. In the event the information
reported by the recipient is not reasonably compatible with any
information obtained by the commissioner of health from other sources
and such incompatibility is material to medical assistance eligibility,
the commissioner of health shall request that the recipient provide
adequate documentation to verify his or her place of residence or
income, as applicable. In addition to the documentation of residence and
income authorized by this paragraph, the commissioner of health is
authorized to periodically require a reasonable sample of recipients to
provide documentation of residence and income at recertification. The
commissioner of health shall consult with the medicaid inspector general
regarding income and residence verification practices and procedures
necessary to maintain program integrity and deter fraud and abuse.

* NB There are 2 par (d)'s

6. Notwithstanding any other provisions of this chapter or other law,
the investigations, decisions and actions required to be made or taken
by a public welfare official pursuant to this section shall be made or
taken only by the chief executive officer of the public welfare
department of a public welfare district, or by an employee of such
welfare department designated by such chief executive officer.

7. Local social services districts shall be authorized, with the
approval of the department, to station local social services employees
at federal social security offices for the purpose of providing
information and referral services relating to medical assistance to
eligible persons.

8. (a) Notwithstanding subdivisions two and five of this section,
information concerning income and resources of applicants for and
recipients of medical assistance may be verified by matching client
information with information contained in the wage reporting system
established by section one hundred seventy-one-a of the tax law and in
similar systems operating in other geographically contiguous states, by
means of an income verification performed pursuant to a memorandum of
understanding with the department of taxation and finance pursuant to
subdivision four of section one hundred seventy-one-b of the tax law,
and, to the extent required by federal law, with information contained
in the non-wage income file maintained by the United States internal
revenue service, in the beneficiary data exchange maintained by the
United States department of health and human services, and in the
unemployment insurance benefits file. Such matching shall provide for
procedures which document significant inconsistent results of matching
activities. Nothing in this section shall be construed to prohibit
activities the department reasonably believes necessary to conform with
federal requirements under section one thousand one hundred thirty-seven
of the social security act.

(b) Any verification response by the department of taxation and
finance pursuant to paragraph (a) of this subdivision shall not be a
public record and shall not be released except pursuant to this
paragraph. Information disclosed pursuant to this paragraph shall be
limited to information necessary for verification. Information so
disclosed shall be kept confidential by the party receiving such
information. Such information shall be expunged within a reasonable time
to be determined by the commissioner and the department of taxation and
finance.

9. (a) Every applicant for or recipient of medical assistance who has
dependent children shall be informed in writing at the time of
application and at the time of any action affecting his or her receipt
of such assistance of the availability of:

(i) medical assistance without cash assistance under this title;

(ii) transitional medical assistance under paragraphs (a), (b) and (c)
of subdivision four of section three hundred sixty-six of this title;

(iii) the expanded eligibility provisions for pregnant women and
children under paragraphs (m), (n), (o), (p) and (q), (s) and (t) of
subdivision four of section three hundred sixty-six of this title;

(iv) medical assistance for aged, blind or disabled persons under
subdivision one of section three hundred sixty-six of this title;

(v) family health plus under section three hundred sixty-nine-ee of
this article; and,

(vi) child health plus under title one-A of article twenty-five of the
public health law.

(b) Every applicant for or recipient of medical assistance who has no
dependent children shall be informed in writing at the time of
application and at the time of any action affecting his or her receipt
of such assistance of the availability of:

(i) medical assistance without cash assistance under this title;

(ii) the expanded eligibility provisions for pregnant women under
paragraphs (m) and (o) of subdivision four of section three hundred
sixty-six of this title;

(iii) medical assistance for aged, blind or disabled persons under
subdivision one of section three hundred sixty-six of this title; and,

(iv) family health plus under section three hundred sixty-nine-ee of
this article.

(10) As a condition for the provision of medical assistance for
nursing facility services, the application of an individual for such
assistance, including any recertification of eligibility for such
assistance, shall disclose a description of any interest the individual
or community spouse has in an annuity or similar financial instrument,
regardless of whether the annuity is irrevocable or is treated as an
asset. Such application or recertification form shall include a
statement that the state of New York becomes a remainder beneficiary
under such annuity or similar financial instrument by virtue of the
provision of such medical assistance.

11. (a) Notwithstanding any inconsistent provision of law, rule or
regulation, the commissioner of health is authorized to (i) establish
standards and procedures for express lane enrollment and renewal
implemented in accordance with section 1902(e)(13) of the federal social
security act, including but not limited to reliance on a finding made by
an express lane agency, as defined in section 1902(e)(13)(F) and (H) of
the federal social security act, to determine whether a child meets one
or more of the eligibility criteria for medical assistance; (ii) specify
such standards and procedures in the medical assistance state plan
established under title XIX of the federal social security act; and
(iii) waive any information and documentation requirements set forth in
this section necessary to implement express lane eligibility; provided,
however, information and documentation required pursuant to section one
hundred twenty-two of this chapter may not be waived.

(b) Subject to federal approval, such standards and procedures shall
specify that information and documentation regarding citizenship and
immigration status collected by an express lane agency and provided to
the commissioner for the purpose of express lane eligibility may be used
to satisfy the requirements of section one hundred twenty-two of this
chapter.

(c) Such standards and procedures shall also include a process for
determining enrollment error rates and implementing corrective actions
as required by section 1902(e)(13)(E) of the federal social security
act.

(d) For purposes of a medical assistance eligibility determination
made in accordance with this subdivision, a child shall be deemed to
satisfy the income eligibility criteria for medical assistance if an
express lane agency, as defined in section 1902(e)(13)(F) and (H) of the
federal social security act and specified in the standards and
procedures established pursuant to paragraph (a) of this subdivision,
has determined that: the child's family has income that does not exceed
a screening threshold amount, as determined by the commissioner of
health, equal to a percentage of the federal poverty line (as defined
and annually revised by the United States department of health and human
services) that exceeds by thirty percentage points the highest income
eligibility level applicable to a family of the same size under the
medical assistance program.

12. The commissioner shall develop expedited procedures for
determining medical assistance eligibility for any medical assistance
applicant with an immediate need for personal care or consumer directed
personal assistance services pursuant to paragraph (e) of subdivision
two of section three hundred sixty-five-a of this title or section three
hundred sixty-five-f of this title, respectively. Such procedures shall
require that a final eligibility determination be made within seven days
of the date of a complete medical assistance application.