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Financial maintenance requirements at application and renewal

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Posted: 05 May, 2010
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Updated: 28 Sep, 2011
by Valerie Bogart (New York Legal Assistance Group)
 In September, 2011, NYS Department of Health (DOH) clarified the administrative directive 10ADM-06 Standardized Financial Maintenance Requirements for Medicaid Applicants/Recipients,  which in June, 2010,  established a standardized methodology by which local social services districts and facilitated enrollers (FEs) should assess how certain Medicaid/Family Health Plus applicants and recipients are meeting their living expenses.  The 2011 clarification is GIS 11MA016 - Clarification of the Financial Maintenance Policy.
The policy directive 10-ADM-06 indicates that that financial maintenance should be explored if an applicant/recipient’s monthly housing costs (rent, mortgage and/or property taxes) exceed a certain threshold relative to the household's income. The threshold is 70% in New York City, Long Island, and Westchester and Putnam counties and 60% in the rest of the state.
The policy becomes effective June 1, 2010.   When it was first introduced in June 2010:
  • The bad news was that the policy institutionalizes a procedure that will make it more difficult for some clients to access Medicaid and Family Health Plus -- especially the very poorest clients, and others with very high housing costs relative to their income.  At application and recertification, individuals whose housing costs exceed the threshold will be asked to fill out a financial maintenance statement (the DOH-4443)  and given at least 10 days to respond.  If the applicant/recipient fails to respond, the case can be closed or denied.   If the person responds, but the statement shows that expenses exceed their income, the DSS “must require” the person to explain the discrepancy, per the ADM.  If the person “cannot explain how he/she is paying for monthly expenses … [the] application/renewal may be denied/discontinued for failure to provide this requested information.”  (p. 5 of the ADM)
  • The good news was that there would be a clear standard now, and one uniform financial maintenance statement -- apparently districts and FEs were using different standards and various forms.  Also, DSS cannot require households to provide verification of their expenses.  And the policy doesn’t apply to Medicare Savings Program (MSP) applicants/recipients using the shortened MSP application form.
In September 2011, DOH issued GIS 11MA016 - Clarification of the Financial Maintenance Policy.  It appears some districts may have been "abusing the process" by requiring everyone to go through the process. The GIS clarifies treatment of income of non-household members and reminds districts to only seek additional information where the "percentages are satisfied."   

This article was authored by the Empire Justice Center and updated by Selfhelp Community Services, with information provided by Jim Murphy, Legal Services of Central New York, Inc. 

Empire Justice Center

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