|SAME AS||No Same As|
|Amd S369-ee, Soc Serv L|
|Establishes resource level requirements for the family health plus program.|
|01/07/2015||referred to health|
|01/06/2016||referred to health|
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NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A624 SPONSOR: Gantt
TITLE OF BILL: An act to amend the social services law, in relation to establishing resource level requirements for the family health plus program   PURPOSE OR GENERAL IDEA OF BILL: This bill aims to place a restriction on the eligibility requirements for the family health plus program. Specifically, certain assets held by potential recipients; applicants will not be considered upon applica- tion for the program.   SUMMARY OF SPECIFIC PROVISIONS: Section 1. Amends section 369 of the social services law, stating that medicare provided under Part A of Title XVIII of the federal social security act shall be deemed to not be an equivalent healthcare coverage under insurance or an equivalent mechanism. Amends section 369 by adding a new provision which aims to define and list all exempt resources that are not to be considered for eligibility for family health plus. Amends section 369 by adding a new provision which lists all assets and trusts that are to be considered for determining assistance under family health plus. Amends section 369 by adding a new provision that lists all asset trans- fers that are to be considered for determining assistance under family health plus.   JUSTIFICATION: Currently, most social services programs have asset cap requirements. Presently, there is no assessment of the amount of available assets that a recipient or applicant may possess within the application process. This legislation changes the nature of requirements upon which appli- cants may request for assistance from the family health plus. Personal assets, such as trusts, that have a potential for a monetary return are not to be exempt from consideration for this program. Though assets are not considered as immediate monetary income, they are, nonetheless an available resource of wealth. This legislation places a cap on the value of assets that they may have in their possession, or through a transfer. This will establish increased efficiency within the family health plus program by providing services to applicants and recipients who need it most. It will also deter applicants who seek to abuse the social services system by using a loophole that does not acknowledge available resources of wealth.   LEGISLATIVE HISTORY: 2009-2010: A.2767 2011-2012: A.995 2013-2014: A.1163   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect on the nineteenth day after it shall have become a law; provided that the commissioner is authorized to promulgate any and all rules and regulations and take any other measures necessary to implement this act on its effective date on or before such date.
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STATE OF NEW YORK ________________________________________________________________________ 624 2015-2016 Regular Sessions IN ASSEMBLY (Prefiled) January 7, 2015 ___________ Introduced by M. of A. GANTT -- read once and referred to the Committee on Health AN ACT to amend the social services law, in relation to establishing resource level requirements for the family health plus program The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (iii) of paragraph (a) of subdivision 2 of 2 section 369-ee of the social services law, as added by chapter 1 of the 3 laws of 1999 and as further amended by section 104 of part A of chapter 4 62 of the laws of 2011, is amended to read as follows: 5 (iii) does not have equivalent health care coverage under insurance or 6 equivalent mechanisms, as defined by the commissioner in consultation 7 with the superintendent of financial services; and for purposes of this 8 subparagraph, medicare provided pursuant to part A of title XVIII of the 9 federal social security act shall be deemed to not be an equivalent 10 health care coverage under insurance or an equivalent mechanism; 11 § 2. Subparagraph (iii) of paragraph (a) of subdivision 2 of section 12 369-ee of the social services law, as amended by section 68 of part C of 13 chapter 58 of the laws of 2009 and as further amended by section 104 of 14 part A of chapter 62 of the laws of 2011, is amended to read as follows: 15 (iii) does not have equivalent health care coverage under insurance or 16 equivalent mechanisms, as defined by the commissioner in consultation 17 with the superintendent of financial services; and for purposes of this 18 subparagraph, medicare provided pursuant to part A of title XVIII of the 19 federal social security act shall be deemed to not be an equivalent 20 health care coverage under insurance or an equivalent mechanism; 21 § 3. Paragraph (b) of subdivision 2 of section 369-ee of the social 22 services law, as amended by section 45-d of part C of chapter 58 of the 23 laws of 2008, and the opening paragraph as amended by section 59-c of 24 part C of chapter 58 of the laws of 2009, is amended to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02902-01-5A. 624 2 1 (b) Subject to the provisions of paragraph (d) of this subdivision, in 2 order to establish eligibility under this subdivision, which shall also 3 be determined [ without] with regard to resources, an individual shall 4 provide such documentation as is necessary and sufficient to initially, 5 and annually thereafter, determine an applicant's eligibility for cover- 6 age under this title. Such documentation shall include, but not be 7 limited to the following, if needed to verify eligibility: 8 (i) paycheck stubs; or 9 (ii) written documentation of income from all employers; or 10 (iii) other documentation of income (earned or unearned) as determined 11 by the commissioner, provided however, such documentation shall set 12 forth the source of such income; and 13 (iv) proof of identity and residence as determined by the commission- 14 er. 15 The commissioner of health may verify the accuracy of the information 16 provided by the individual pursuant to this paragraph by matching it 17 against information to which the commissioner of health has access 18 including under subdivision eight of section three hundred sixty-six-a 19 of this article. 20 § 4. Section 369-ee of the social services law is amended by adding 21 two new subdivisions 2-c and 2-d to read as follows: 22 2-c. Exempt resources. (a) The following resources shall be exempt and 23 shall not be taken into consideration in determining a person's eligi- 24 bility for medical care, services and supplies available under this 25 title: 26 (i) a homestead which is essential and appropriate to the needs of the 27 household; 28 (ii) essential personal property; 29 (iii) a burial fund, to the extent allowed as an exempt resource under 30 the cash assistance program to which the applicant is most closely 31 related; 32 (iv) savings in amounts equal to at least one-half of the income 33 amount permitted under subparagraph seven of paragraph (a) of subdivi- 34 sion two of section three hundred sixty-six of this article, provided, 35 however, that the amounts for one and two person households shall not be 36 less than the amounts permitted to be retained by households of the same 37 size in order to qualify for benefits under the federal supplemental 38 security income program; 39 (v) health insurance premiums. 40 No other resources, including federal old-age, survivors and disabili- 41 ty insurance, state disability insurance or other payroll deductions, 42 whether mandatory or optional, shall be exempt and all other resources 43 shall be taken into consideration and required to be applied toward the 44 payment or partial payment of the cost of medical care and services 45 available under this section, to the extent permitted by federal law. 46 (b) (i) In establishing standards for determining eligibility for and 47 amount of such assistance, the department of health shall take into 48 account only such resources, in accordance with federal requirements, as 49 are available to the applicant or recipient and as would not be required 50 to be disregarded or set aside for future needs, and there shall be a 51 reasonable evaluation of any such resources. The department of health 52 shall not consider the availability of an option for an accelerated 53 payment of death benefits or special surrender value pursuant to para- 54 graph one of subsection (a) of section one thousand one hundred thirteen 55 of the insurance law, or an option to enter into a viatical settlement 56 pursuant to the provisions of article seventy-eight of the insuranceA. 624 3 1 law, as an available resource in determining eligibility for an amount 2 of such assistance, provided, however, that the payment of such benefits 3 shall be considered in determining eligibility for and amount of such 4 assistance. There shall not be taken into consideration the financial 5 responsibility of any individual for any applicant or recipient of 6 assistance under this section unless such applicant or recipient is such 7 individual's spouse or such individual's child who is under twenty-one 8 years of age. In determining the eligibility of a child who is categori- 9 cally eligible as blind or disabled, as determined under regulations 10 prescribed by the social security act for medical assistance, the 11 resources of parents or spouses of parents are not considered available 12 to that child if he or she does not regularly share the common household 13 even if the child returns to the common household for periodic visits. 14 (ii) In evaluating the resources available to an applicant for or 15 recipient of medical assistance, for purposes of determining eligibility 16 for and the amount of such assistance, the department of health must 17 consider assets held in or paid from trusts created by such applicant or 18 recipient, as determined pursuant to the regulations of the department 19 of health, in accordance with the provisions of this subparagraph. 20 (A) In the case of a revocable trust created by an applicant or recip- 21 ient, as determined pursuant to regulations of the department of health 22 the trust corpus must be considered to be an available resource. 23 (B) In the case of an irrevocable trust created by an applicant or 24 recipient, as determined pursuant to regulations of the department of 25 health any portion of the trust corpus, and of the income generated by 26 the trust corpus, from which payment could be made to or for the benefit 27 of such applicant or recipient must be considered to be an available 28 resource. 29 (C) Notwithstanding the provisions of clauses (A) and (B) of this 30 subparagraph, in the case of an applicant or recipient who is disabled, 31 as such term is defined in section 1614(a)(3) of the federal social 32 security act, the department of health must not consider as available 33 resources the corpus or income of the following trusts which comply with 34 the provisions of the regulations authorized by clause (D) of this 35 subparagraph: 36 (I) a trust containing the assets of such a disabled individual which 37 was established for the benefit of the disabled individual while such 38 individual was under sixty-five years of age by a parent, grandparent, 39 legal guardian, or court of competent jurisdiction, if upon the death of 40 such individual the state will receive all amounts remaining in the 41 trust up to the total value of all medical assistance paid on behalf of 42 such individual; and 43 (II) a trust containing the assets of such a disabled individual 44 established and managed by a non-profit association which maintains 45 separate accounts for the benefit of disabled individuals, but, for 46 purposes of investment and management of trust funds, pools the 47 accounts, provided that accounts in the trust fund are established sole- 48 ly for the benefit of individuals who are disabled as such term is 49 defined in section 1614(a)(3) of the federal social security act by such 50 disabled individual, a parent, grandparent, legal guardian, or court of 51 competent jurisdiction, and to the extent that amounts remaining in the 52 individual's account are not retained by the trust upon the death of the 53 individual, the state will receive all such remaining amounts up to the 54 total value of all medical assistance paid on behalf of such individual. 55 Notwithstanding any law to the contrary, a not-for-profit corporation 56 may, in furtherance of and as an adjunct to its corporate purposes, actA. 624 4 1 as trustee of a trust for persons with disabilities established pursuant 2 to this subclause, provided that a trust company, as defined in subdivi- 3 sion seven of section one hundred-c of the banking law, acts as co-trus- 4 tee. 5 (D) The department of health shall promulgate such regulations as may 6 be necessary to carry out the provisions of this subparagraph. Such 7 regulations shall include provisions for: assuring the fulfillment of 8 fiduciary obligations of the trustee with respect to the remainder 9 interest of the department of health or state; monitoring pooled trusts; 10 applying this subdivision to legal instruments and other devices similar 11 to trusts, in accordance with applicable federal rules and regulations; 12 and establishing procedures under which the application of this subdivi- 13 sion will be waived with respect to an applicant or recipient who demon- 14 strates that such application would work an undue hardship on him or 15 her, in accordance with standards specified by the secretary of the 16 federal department of health and human services. Such regulations may 17 require notification of the department of the creation or funding of 18 such a trust for the benefit of an applicant for or recipient of medical 19 assistance; notification of the department of health of the death of a 20 beneficiary of such a trust who is a current or former recipient of 21 medical assistance; in the case of a trust, the corpus of which exceeds 22 one hundred thousand dollars, notification of the department of health 23 of transactions tending to substantially deplete the trust corpus; 24 notification of the department of health of any transactions involving 25 transfers from the trust corpus for less than fair market value; the 26 bonding of the trustee when the assets of such a trust equal or exceed 27 one million dollars, unless a court of competent jurisdiction waives 28 such requirement; and the bonding of the trustee when the assets of such 29 a trust are less than one million dollars, upon order of a court of 30 competent jurisdiction. The department of health, together with the 31 banking department, shall promulgate regulations governing the estab- 32 lishment, management and monitoring of trust established pursuant to 33 subclause (II) of clause (C) of this subparagraph in which a not-for- 34 profit corporation and a trust company serve as co-trustees. 35 (E) Notwithstanding any acts, omissions or failures to act of a trus- 36 tee of a trust which the department of health or a local social services 37 official has determined complies with the provisions of clause (C) and 38 the regulations authorized by clause (D) of this subparagraph, the 39 department must not consider the corpus or income of any such trust as 40 available resources of the applicant or recipient who is disabled, as 41 such term is defined in section 1614(a)(3) of the federal social securi- 42 ty act. The department of health's remedy for redress of any acts, omis- 43 sions or failures to act by such a trustee whose acts, omissions or 44 failures are considered by the department of health to be inconsistent 45 with the terms of the trust, contrary to applicable laws and regulations 46 of the department of health, or contrary to the fiduciary obligations of 47 the trustee shall be the commencement of an action or proceeding under 48 subdivision one of section sixty-three of the executive law to safeguard 49 or enforce the state's remainder interest in the trust, or such other 50 action or proceeding as may be lawful and appropriate as to assure 51 compliance by the trustee or to safeguard and enforce the state's 52 remainder interest in the trust. 53 2-d. Resource eligibility requirements. (a) In determining the initial 54 or continuing eligibility of any person for assistance under this 55 section, there shall be included in the amount of resources considered 56 available to such person the uncompensated value of any resource trans-A. 624 5 1 ferred, and such person shall be ineligible for such assistance for such 2 period or periods as specified in this subdivision. 3 (b) (i) A nonexempt resource shall mean any resource which if retained 4 by such person would not be exempt from consideration under the 5 provisions of subdivision two-c of this section; 6 (ii) Any transfer of a nonexempt resource made within twenty-four 7 months prior to the date of a person's application for medical assist- 8 ance shall be presumed to have been made for the purpose of qualifying 9 for such assistance; however, if such person furnishes evidence to 10 establish that the transfer was exclusively for some other purpose, the 11 uncompensated value shall not be considered available to such person in 12 determining his or her initial or continued eligibility for medical 13 assistance; 14 (iii) The uncompensated value of any such resource shall be the fair 15 market value of such resource at the time of transfer, minus the amount 16 of the compensation received by the person in exchange for the resource; 17 (iv) Excess resources shall be the total of a person's nonexempt 18 resources above twenty thousand dollars; 19 (v) Any person determined to have resources in excess of twenty thou- 20 sand dollars shall be ineligible for assistance under this section 21 pursuant to subparagraphs (vi) and (vii) of this paragraph; 22 (vi) Any person determined to have excess resources of fifteen thou- 23 sand dollars or less because of the application of this paragraph shall 24 remain ineligible for assistance under this title for a period of twen- 25 ty-four months from the date of the transfer, or until such person can 26 demonstrate that he or she has incurred medical expenses after the date 27 of transfer in the amount of such excess above otherwise allowable 28 resources, whichever period is shorter; 29 (vii) Any person determined to have excess resources of more than 30 fifteen thousand dollars because of the application of this paragraph 31 shall remain ineligible for assistance under this section for a period 32 which exceeds twenty-four months, which period shall be determined by 33 adding an additional month of ineligibility for each two thousand 34 dollars in excess of fifteen thousand dollars, or until such person can 35 demonstrate that he or she has incurred medical expenses after the date 36 of transfer in the amount of such excess above otherwise allowable 37 resources, whichever period is shorter. 38 (c) Any transfer of a resource by a person or such person's spouse for 39 less than fair market value made within or after the thirty months imme- 40 diately preceding the date of application for medical assistance under 41 this section, shall render the person ineligible for health care 42 services for a period of twenty-four months from the date of transfer, 43 which period shall be determined by adding an additional month of inel- 44 igibility for each two thousand dollars in excess of fifteen thousand 45 dollars, or until such person can demonstrate that he or she has 46 incurred medical expenses after the date of transfer in the amount of 47 such excess above allowable resources, whichever period is shorter; 48 however, a person shall not be ineligible for health care services sole- 49 ly by reason of any such transfer to the extent that: 50 (i) the resource transferred was a home and title to the home was 51 transferred to: 52 (A) the spouse of such person; or 53 (B) a child of such person who is under the age of twenty-one years or 54 certified blind or certified permanently and totally disabled, as 55 defined by section two hundred eight of this article; orA. 624 6 1 (C) a sibling of such person who has an equity interest in such home 2 and who resided in such home for a period of at least one year imme- 3 diately before the date the person applied for medical assistance pursu- 4 ant to this section; or 5 (D) a son or daughter of such person who was residing in such home for 6 a period of at least two years immediately before the date such person 7 applied for medical assistance pursuant to this section, and who 8 provided care to such person which permitted such person to reside at 9 home rather than in an institution or facility; or 10 (ii) the resource was transferred to or for the sole benefit of such 11 person's spouse, or from such person's spouse to or for the sole benefit 12 of such person, or to his or her child who is certified blind or certi- 13 fied permanently and totally disabled; or 14 (iii) a satisfactory showing is made that: 15 (A) the person or such person's spouse intended to dispose of the 16 resource either at fair market value, or for other valuable consider- 17 ation, or 18 (B) the resource was transferred exclusively for a purpose other than 19 to qualify for medical assistance; or 20 (iv) denial of eligibility would work an undue hardship, as defined by 21 the commissioner which definition shall include the inability of the 22 person or such person's spouse to retrieve the resource or to obtain 23 fair market value therefor despite his or her best efforts. 24 (d) The commissioner shall promulgate such rules and regulations as 25 may be necessary to carry out the provisions of this subdivision. 26 § 5. This act shall take effect on the ninetieth day after it shall 27 have become a law; provided however that section one of this act shall 28 remain in effect until the approval of the commissioner of health pursu- 29 ant to subdivision 4 of section 79 of part C of chapter 58 of the laws 30 of 2005, when upon such date the provisions of section two of this act 31 shall take effect; and provided further that the commissioner of health 32 is authorized to promulgate any and all rules and regulations and take 33 any other measures necessary to implement this act on its effective date 34 on or before such date.