GIS 14 MA/019:Medicaid Treatment of Temporary Assistance Intentional Program Violations

To: Local District Commissioners, Medicaid Directors

From: Judith Arnold, Director
Division of Eligibility and Marketplace Integration

Subject: Medicaid Treatment of Temporary Assistance Intentional Program Violations

Effective Date: Immediately

Contact Person: Local District Support Unit Upstate (518) 474-8887 NYC (212) 417-4500

The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) that Medicaid no longer honors Intentional Program Violations (IPVs) that have been imposed on Temporary Assistance (TA) Applicant/Recipients (A/Rs).

The definition of an IPV is as follows:

IPV - An IPV is imposed by the LDSS on an individual who is a member of a TA case and is defined as a specific period of ineligibility for TA benefits. An IPV occurs as a result of the A/R voluntarily admitting to or being found guilty of intentionally making false or misleading statements or misrepresenting, concealing or withholding facts concerning the individual's eligibility for TA, or by the A/R committing any act or engaging in conduct inconsistent with the requirements of the TA program.

Previously, Medicaid honored TA IPVs for Single Individuals and Childless Couples (S/CCs), rendering the individual(s) ineligible for Medicaid for the same period as the TA IPV. As a result of changes pursuant to the Affordable Care Act, S/CCs are part of the new Adult group. As part of the new Adult group, Medicaid eligibility is no longer contingent upon TA eligibility rules. Therefore, when a TA Safety Net individual is discontinued from TA for an IPV, Medicaid should continue pending a separate determination.

A Medicaid separate determination will continue to occur at each TA case denial due to a TA imposed IPV. Individuals who are otherwise eligible for Medicaid are to be authorized for Medicaid coverage.

The issuance of this GIS cancels the previous instructions given relating to TA IPVs and Medicaid eligibility for S/CCs outlined in 97-ADM-23 and 98 OMM/INF-02.