The Medicaid Committee of the Elder Law Section of the New York State Bar Association recently demanded that the New York City Medicaid Program stop the illegal practice of failing to budget a Community Spouse Monthly Income Allowance (CSMIA) when the community spouse executed a spousal refusal. The Medicaid Committee made this demand after a number of reports that HRA was issuing illegal notices and defending them at fair hearings.

According to New York State regulation and instructions of the NYS Department of Health, New York City Human Resource Administration’s Nursing Home Eligibility Division (NHED) is supposed to budget CSMIA to meet the Minimum Monthly Maintenance Needs Allowance (MMMNA) for a community spouse who provides income and resource information, even if a spousal refusal has been submitted.

In response to the demand, Roy A. Esnard, General Counsel to NYC HRA acknowledged that HRA is required to budget CSMIA to meet the MMMNA even if a spousal refusal has been submitted. Esnard also stated that staff training will be conducted in the HRA to re-emphasize this policy, and that the cases in question will be reviewed by NHED in order to take corrective action as needed.

On January 2, 2014, the Medicaid Committee followed up with HRA, requesting that the agency provide the Medicaid Committee with copies of the directives that will be issued to Medicaid staff in the fair hearing and Nursing Home Eligibility Division, as well as to nursing homes in New York City. Hopefully the HRA will cease the illegal practice and appropriately train its staff on the correct policy and procedures it must follow.

By Eric J. Einhart, Esq. – Guest Blogger