N.Y. Comp. Codes R. & Regs. Tit. 18§ 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.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.