N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-4.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 360-4.1 - Introduction

(a) To be eligible for MA under section 360-3.3(b) of this Part as a medically needy person, or to have MA eligibility extended under some provisions of section 360-3.3(c) of this Part, a person must meet certain financial requirements. A person who meets these requirements is financially eligible for MA. This Subpart explains procedures and principles used to determine financial eligibility.

(b) How the process works.

(1) Except as provided in paragraph (2) of this subdivision, financial eligibility will be determined as follows:

(i) The size of the applicant's/recipient's MA household will be determined.

(ii) All income and resources available to the applicant/recipient during the period for which eligibility is being determined will be identified.

(iii) Certain amounts and types of income and resources will be disregarded. The remainder is the applicant's/recipient's net available income and resources.

(iv) The applicant's/recipient's net available income and resources will be compared to the eligibility standards for his/her MA household size. The applicant/recipient is financially eligible if the amounts of his/her net available income and resources do not exceed the appropriate standards. A financially eligible applicant who also meets all other eligibility requirements will be eligible to receive MA.

(v) An applicant whose net available resources are above the resource standards will be ineligible for MA until he/she incurs medical expenses equal to or greater than the excess resources.

(vi) Generally, an applicant whose net available income is above the income standard for his/her MA household size will be ineligible for MA until he/she incurs medical expenses equal to or greater than the excess income.

(2) For a pregnant woman, an infant younger than one year of age, a child at least one year of age but younger than six years of age whose household income does not exceed 133 percent of the applicable Federal poverty line set forth in section 360-4.7(b) of this Subpart, or a child born after September 30, 1983 who is at least six years of age but younger than 19 years of age and whose household income does not exceed 100 percent of the applicable Federal poverty line set forth in section 360-4.7(b) of this Subpart, financial eligibility will be determined as follows:

(i) The size of the applicant's/recipient's MA household will be determined.

(ii) All income available to the applicant/recipient during the period for which eligibility is being determined will be identified. All resources available to the applicant's/recipient's MA household are exempt from consideration.

(iii) Certain amounts and types of income will be disregarded in accordance with the provisions of section 360-4.6 of this Subpart. The remainder is the applicant's/recipient's net available income.

(iv) The applicant's/recipient's net available income will be compared to the eligibility standards or poverty lines for his/her MA household size. The applicant/recipient is financially eligible if the amounts of his/her net available income do not exceed the applicable eligibility standards or poverty lines. A financially eligible applicant who also meets all other eligibility requirements will be eligible to receive MA.

(c) This Subpart does not set forth the procedure for calculating the HR eligibility of persons whose MA eligibility depends on their being eligible for HR. As more fully explained in section 360-2.2(d)(2) of this Part, the HR eligibility of such persons generally will be determined according to Parts 352 and 370 of this Title.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-4.1