N.Y. Comp. Codes R. & Regs. tit. 18 § 404.1

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

Section 404.1 - Process of eligibility determination

(a)Method of determining eligibility.

The social services district must adopt methods of determining eligibility which are consistent with the objectives of the program and must respect the rights of individuals under the United States Constitution, and the Social Security Act, title IV of the Civil Rights Act of 1964, and all other relevant provisions of Federal and State law. The social services district must adopt safeguards in determining eligibility which prevent discrimination or adverse action against individuals with AIDS or an HIV infection or an HIV-related illness and individuals who have had an HIV-related test. The terms AIDS, HIV infection, HIV-related illness or HIV-related test are defined in section 360-8.1 of this Title.

(b)Provision of information to applicants.

The social services district shall:

(1) provide applicants, recipients and others who may inquire with clear and detailed information concerning social services programs, eligibility requirements, documentation requirements, and the right to a fair hearing;

(2) inform each applicant and recipient at the time of application or redetermination of his initial and continuing responsibility:

(i) to provide accurate, complete and current information on income and family composition;

(ii) to provide accurate information relating to service needs, as requested, and to notify the district of any changes in such information;

(iii) to cooperate in the verification and documentation of eligibility whenever required;

(3) inform each applicant or recipient that he has the right to accept or reject services without consequence except as specified in this Title.

(c)Application for social services.

(1) Each individual wishing to apply for social services shall be assured the opportunity to do so without delay.

(2) The application process must obtain all information, as prescribed by the department, which is necessary to establish eligibility. The required information may be obtained verbally, in writing on department approved forms, or electronically from the WMS or other department system. Information obtained verbally must be recorded by the interviewer. All information must be verified by the applicant. When an applicant for social services is currently receiving public assistance or medical assistance benefits, any relevant existing information, including, but not limited to service goals and living arrangements, which is available through the WMS or other department system, must be used to avoid a duplication of efforts in the collection of information.

(3) The application process described in this Part must be used when a person applies for services described in Article 1, 2 or 3 of Subchapter C of Chapter II of this Title.

(4) The application process may be initiated by the applicant himself or herself, his or her authorized representative, or someone acting responsibly for him or her.

(5) Except where required by Federal law or regulation, no person who applies for a social service shall be required to disclose the social security number of any person for whom the service is requested as a condition of eligibility for the service. However, nothing herein shall restrict the ability of a social services official to request that the applicant disclose the social security number of the person who will receive the service. If such a request is made, the applicant must be informed whether the disclosure is mandatory or voluntary, by what statutory or other authority such number is solicited and the uses which will be made of the social security number. A request for disclosure of the applicant's social security number may be made either orally or in writing.

(6) No person may be required to have an HIV-related test or required to disclose the results of such tests as a condition of applying for services.

(7) An applicant who requests services, in whole or in part, on the basis of AIDS or an HIV-related illness may have such condition subjected to verification by the local social services district acting in accordance with article 27-F of the Public Health Law.

(8) An application shall be required as a condition of authorization for any social service identified and defined in the district component of the comprehensive annual social services program plan except:

(i) No application is required for the provision of information and referral services, nonresidential services for victims of domestic violence and for social group services for senior citizens.

(ii) No application is required for services provided as part of a family assessment response.

(iii) Completion of an application for protective services for children is required only after investigation of a report of alleged or suspected child abuse or neglect has determined that there is some credible evidence of abuse or neglect. An application may not be completed prior to such determination.

(iv) Completion of an application for protective services for adults is required only after the investigation and assessment of a protective service for adults referral have determined that an individual meets the client characteristics for adult protective services, unless an adult who is the subject of a request for protective services for adults, the adult's authorized representative, or someone acting responsibly for such adult disagrees with the decision of the district not to accept the request as a referral for protective services for adults, as defined in section 457.1(c)(2) of this Title. In such case, the adult, the adult's authorized representative, or someone acting responsibly for such adult may apply for protective services for adults in accordance with paragraph (1) of this subdivision. If an application for protective services for adults is submitted by an adult, an adult's authorized representative, or by someone acting responsibly for such adult, the application must be accepted and a determination of eligibility or ineligibility made in accordance with subdivision (f) of this section and section 457.13 of this Title.

(9) An application must be completed at the following times:

(i) when the applicant is making an initial application for services or care;

(ii) when a reapplication is made 30 days after a services case is closed or an application for services is denied; and

(iii) when redetermining the eligibility of income-eligible recipients pursuant to 404.1(d)(2) of this Title, except those individuals specified in clause (d)(2)(ii)(b) of this section.

(10) When an income maintenance or medical assistance case is closed but social services are to be continued, information contained in the WMS concerning the recipient must be made available to enable a determination of eligibility to be made. When additional information is necessary to determine continued eligibility for social services, the social services district may require that the social services recipient submit the additional information.

(11) When a recipient of services moves to another social services district and the recipient wants to continue to receive services, information contained in WMS concerning the recipient must be made available to the district to which the recipient moved in order for the district to determine whether the recipient remains eligible for the continuation of services. When additional information is necessary to determine continued eligibility, the social services district may require that the social services recipient submit the additional information.

(d)Time period for determination of eligibility.

(1) Initial determination of programmatic and/or financial eligibility.

(i) A determination of programmatic and/or financial eligibility must be completed for all applications or reapplications for services within 30 days of the date of application, except for protective services for adults as set forth in Part 457 of this Title. The date of application for child care assistance is the date that the social services district receives the application. Eligibility for protective services for adults must be determined at the time the protective services for adults assessment services plan is completed in accordance with section 457.2(b)(4) of this Title.

(ii) Except for the provision of child care services to certain families transitioning from family assistance as set forth in section 415.2(a)(1)(iv) of this Title, and protective services for adults as set forth in Part 457 of this Title, no reimbursement will be available for the provision of services prior to the date of actual determination of programmatic and/or financial eligibility unless such determination is made within 30 days of the date of application and the individual is determined to have been programmatically and/or financially eligible when services were initiated. In no event may the date of eligibility precede the date of application except for the provision of child care to transitioning families as set forth in section 415.2(a)(1)(iv) of this Title and protective services for adults.

(2) Redetermination of programmatic and/or financial eligibility.

(i) Programmatic eligibility must be redetermined every 12 months, or 24 months for cases funded under the New York State Child Care Block Grant if the district opts in its Child and Family Services Plan to authorize child care assistance for 24 months, including State charge recipients of post-institutional service planning (PISP) who are receiving only follow-up visits as specified in paragraphs (a)(1)-(4) of section 313.2 of this Title. However, programmatic eligibility must be redetermined not less frequently than every six months for recipients of foster care services for children. The requirements regarding the periodic redetermination of programmatic eligibility as set forth in this section do not supersede or otherwise affect the requirements concerning the development, periodic review, and update and implementation of services plans or the client eligibility and monitoring activities for child care services as set forth in Part 415 if this Title or for protective services for adults as set forth in Part 457 of this Title.

(ii) Redeterminations of financial eligibility shall be made periodically, but not less frequently than:

(a) every 12 months, or 24 months for cases funded under the New York State Child Care Block Grant if the district opts in its Child and Family Services Plan to authorize child care assistance for 24 months, for an income-eligible individual in receipt of services;

(b) every 12 months for a child or minor in receipt of foster care maintenance payments;

(c) every 12 months for an individual in receipt of services whose family gross income is derived exclusively from pensions or social security benefits or SSI or a combination thereof;

(d) every 12 months for a State charge PISP recipient residing in those facilities specified in paragraphs (a)(1)-(3) of section 313.2 of this Title who is receiving only mandated follow-up visits and/or contacts.

This subparagraph does not apply to a child or minor in receipt of adoption assistance or to a recipient of social group services for senior citizens. This subparagraph also does not apply to recipients of public assistance, including Emergency Assistance to Families (EAF), or medical assistance; provided, however, that the continuing eligibility of such recipients for services must be verified every 12 months by use of an online inquiry or appropriate system production reports in those social services districts where the public assistance, medical assistance and services components of the welfare management system have been installed. In all other social services districts, verification of continuing eligibility for such recipients must occur every 12 months and must be documented in the case record and signed by the caseworker and case supervisor.

(iii) Redetermination of eligibility for social services which are made pursuant to the provisions of subparagraph (ii) of this paragraph shall not occur earlier than 30 days prior to the expiration of the periods specified in such subparagraph.

(iv) Redetermination of both financial and/or programmatic eligibility shall be made within 30 days of an indication of a change in an individual's circumstances which may render the individual ineligible or may change the degree of need for services.

(v) At the time of redetermination, current documentation shall be obtained to verify family size, categorical relationship, income, and continuing need for services, as appropriate.

(e)Documentation.

(1) General. No determination of eligibility shall be made solely on the basis of the application. Documentation of the criteria and conditions essential for eligibility shall be part of the eligibility determination process. Documentation means the collection, verification and recording of information necessary to determine eligibility.

(i) Applications for services based on income maintenance status shall be supported by documentation of the actual receipt of, or eligibility for, the income maintenance benefit or payment.

(ii) Applications for services based on income eligible status shall be supported by documentation of current family size and monthly gross income as specified in section 404.5(b) of this Part.

(iii) Applications for services based on need without regard to income shall be supported by documentation of the existence of the requisite programmatic factors except that no such documentation shall be required for the provision of information and referral.

(iv) All applications for service shall be supported by the documentation of the need for service as evidenced by an individual plan for service.

(v) If the application is filed by an applicant's authorized representative or someone acting responsibly for him, the relationship of the authorized representative or the responsible person to the applicant and the reasons for such representative filing shall be recorded.

(2) Documentation of eligibility based on income status.

(i) When an eligibility determination is based on a family's income status, the family size and the amount and source of each component of gross income as defined in section 404.5(b) of this Part shall be identified and documented prior to a determination of eligibility for social services.

(ii) Family size need not be documented beyond the information on the signed application unless there is reason to suspect that the information is not correct.

(iii) Applicants shall be required to provide documentation for all income received.

(iv) Adequate documentation of gross income can include pay stubs, business records, and/or correspondence from employers, the Social Security Administration, Veterans Administration, State employment agencies, State welfare agencies and/or providers of pensions.

(3) Recording and maintenance of records. The social services district shall maintain for each applicant or recipient a record which contains, in accordance with the requirements of Part 406 of this Title, information necessary to support an eligibility determination.

(f)Notice of eligibility determinations.

Written notice of determination of eligibility or ineligibility for service shall be sent to the applicant or recipient as follows:

(1) A notice of eligibility or ineligibility shall be sent to applicants or recipients within 15 calendar days after the determination has been made.

(2) A notice of eligibility must include information concerning the type of service to be provided, any required fee for services in accordance with section 404.6(b) of this Part, the duration of service planned, the name of the worker or unit responsible for case management and his or her telephone number, a statement regarding the continuing responsibility of the applicant or recipient to report any change in his or her status and the right of the recipient to accept or reject the service(s).

(3) A notice of ineligibility shall include information concerning specific reasons for denial or termination and department policy on which the decision is based.

(4) All notices of determination of eligibility or ineligibility must include information concerning the right of an applicant or recipient to request a fair hearing and all other information required by section 358-2.2 of this Title.

(5) Written notice of determination of eligibility or ineligibility may not be required in the following situations:

(i) where, through a face-to-face interview, a determination is made to continue eligibility; or

(ii) where, in a foster care case, the child has been surrendered by the natural parent(s) or guardian and placed under the custody of the local commissioner of social services.

(g)Provision of services.

When the service is authorized to be delivered, the social services district and the provider agency shall make provision for the delivery of the service(s) authorized within 15 calendar days after notification of eligibility.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 404.1

Amended, New York State Register October 22, 2014/Volume XXXVI, Issue 42, eff. 10/22/2014

Amended, New York State Register March 1, 2017/Volume XXXIX, Issue 09, eff. 3/1/2017

Amended New York State Register June 3, 2020/Volume XLII, Issue 22, eff. 6/3/2020

Amended New York State Register November 24, 2021/Volume XLIII, Issue 47, eff. 11/24/2021

Amended New York State Register July 12, 2023/Volume XLV, Issue 28, eff. 6/26/2023, exp. 8/24/2023 (Emergency)

Amended New York State Register July 12, 2023/Volume XLV, Issue 28, eff. 7/12/2023

Amended New York State Register June 12, 2024/Volume XLVI, Issue 24, eff. 6/12/2024