GIS 11 MA/016: Clarification of the Financial Maintenance Policy

To: Local District Commissioners, Medicaid Directors

From: Judith Arnold, Director Division of Coverage and Enrollment

Subject: Clarification of the Financial Maintenance Policy

Effective Date: Immediately

Contact Person: Local District Support Unit - Upstate (518) 474-8887, New York City (212) 417-4500

The purpose of this General Information System (GIS) message is to provide local departments of social services (LDSS) with clarification of the financial maintenance policy in 10 OHIP/ADM-6, "Standardized Financial Maintenance Requirements for Medicaid Applicants/Recipients."

When calculating the household income to be used in the financial maintenance assessment, all known income of the applying members' household, including income of any non-applying legally responsible relatives (LRRs), must be counted. This includes income exempt from the MA budget. For example, an applying 17-year old is a full time student and has wages from a part time job. Although the wages are exempt from the household income for Medicaid eligibility, the wages must be included in the income for the financial maintenance assessment. Likewise, if a non-applying child is in the household, any income the child may have, such as child support, is included in the financial maintenance calculation.

Also, it has been brought to the Department of Health's (DOH's) attention that some LDSS are sending out the Financial Maintenance form (DOH-4443) for every application and renewal received. Local departments of social services are reminded that the DOH-4443 must be sent to an applicant/recipient (A/R) only after the financial maintenance assessment is completed and it has been determined that the A/R's share of the monthly housing expenses are in excess of: 70% of the A/R's gross monthly income if living in Bronx, Kings, Manhattan, Nassau, Putnam, Queens, Richmond, Suffolk or Westchester counties; or 60% if living in any other county. When an A/R's household expenses do not exceed the standard guidelines, the DOH-4443 must not be sent to the A/R.

Please direct any questions to the Local District Support Unit at 518-474-8887 Upstate and 212-417-4500 for NYC.