Benefit Update

May 2008

• Family Health Plus Premium Assistance Program
• Medicaid Presumptive Eligibility for Children
• Changes in the Medicare Savings Program
• Iraqi and Afghan Special Immigrants Eligibility for Public Benefits
• Law Passed Prohibiting Discrimination in Housing Based on Source of Income
• Stimulus Payment Update
• More than One in Every 100 Adults in America is in Jail or Prison

Benefit Update Archives

Family Health Plus Premium Assistance Program

A new benefit, Family Health Plus Premium Assistance, is now available to low income NYS residents. This benefit allows individuals who have access to health insurance from their employer to receive cost savings through the Family Health Plus program. If eligible for Premium Assistance the State will pay for:

• The employee's share of his/her employer's medical insurance premium
• The employee's deductible, coinsurance and any co-payment amounts under their employer's plan that exceed those currently required by Family Health Plus
• Services and supplies covered by Family Health Plus that are not covered by the employer's plan

Individuals who are enrolled into the Family Health Plus Premium Assistance Program will receive a Medical Assistance Benefit card; this will be in addition to the plan card from their employer's health plan.

When medical benefits and services are covered by the employer's plan, individuals should use their employer's plan. In such instances individuals are encouraged to use providers that are also enrolled in Medicaid, which will allow deductibles, coinsurance and co-payments to be paid through the eMedNY system. In instances where a non-Medicaid provider is used, reimbursement of co-pays, deductibles and coinsurance will be made to the enrollee upon submission of documentation to NYC Medicaid's Client Reimbursement Unit that such costs were paid. Details of reimbursement procedures will be included in the acceptance notice. When medical benefits and services are not covered by the employer's health plan, the individual should use his/her Medicaid card with an enrolled Medicaid provider.

Eligibility for the Premiums Assistance Program will be completed as part of the initial application process (in NYC, current recipients, upon renewal, will remain in FHPlus for now). To be eligible individuals and couples must meet the income and resources guidelines of the FHPlus program. In addition, the employer's health plan must be both qualified and cost effective. At the time of application the individual will be asked if s/he has access to employer sponsored health insurance. If yes, the individual will be asked to provide documentation about the available sponsored health insurance coverage. The local district will make a determination whether the employer's plan is both cost-effective and qualified.

If the local district determines the employer's plan is both qualified and cost effective, and the FHPlus applicant is currently enrolled in the employer sponsored health insurance plan, the district must enroll the individual into the FHPlus Premium Assistance Program. If the applicant or recipient is not currently enrolled in the employer sponsored health insurance, s/he must enroll in the employer sponsored health insurance at the time s/he meets the requirements of the employer's enrollment procedures, that is, after meeting any waiting period requirements or waiting for an open enrollment period.

If the local district determines the plan is not qualified and/or not cost effective, and the FHPlus applicant is not enrolled in an employer sponsored health plan, s/he will be allowed to enroll into a FHPlus plan. However, if the applicant is currently enrolled in an employer sponsored health plan that is neither qualified and/or cost effective, the applicant will not be eligible for either the FHPlus Premium Assistance program or for enrollment into a FHPlus plan.

Medicaid Presumptive Eligibility for Children

As of February 2008 certain "qualified entities" (QE's) are able to screen children up to age 19 for Medicaid eligibility, and if it appears the child is Medicaid eligible based on their age and income, will be able to enroll the child into Medicaid immediately before a full Medicaid determination has been made. This is known as presumptive eligibility. Parents/guardians will also be able to file an application for ongoing Medicaid at the QE when their children are screened as presumptively eligible.

Parents/guardians will be able to attest to basic eligibility information including the child's citizenship/immigration status, identity, residency, household size and composition, and income. A presumptively eligible child will be able to receive Medicaid coverage from any Medicaid provider for a limited amount of time for all Medicaid covered care and services and supplies until the Medicaid eligibility decision is made. If the child applicant screens eligible for presumptive eligibility, the "Access NY Health Care Application" must be completed and signed by the applicant/representative, which will be submitted to Medicaid for presumptive eligibility.

The QE should then assist the household in compiling the necessary documentation to determine ongoing eligibility. The completed application package must be compiled by the QE and submitted to the HRA within 21 days from the date of initial screening (or within a reasonable extended timeframe, if the applicant is making a good-faith effort to secure necessary documentation). Upon receipt of the package, Medicaid will make a determination of ongoing Medicaid eligibility. For children ineligible for ongoing Medicaid, the period of presumptive eligibility will be authorized only from the date of initial screening to 10 days after the date the local districts makes the final determination on the application.

Children screened eligible for presumptive eligibility may receive one presumptive authorization period in a 12 month period. Children who are ineligible for Medicaid PE should be referred to a facilitated enroller for a determination of CHP B eligibility.

Changes in the Medicare Savings Program

Effective April 1, 2008 there is no longer a resource test for any of the Medicare Savings Programs. This applies to both applicants and recipients at renewal. Similar to the QI-1 program, financial eligibility for a QMB or SLIMB is now based only on an applicant's income.

In addition, there is a new initiative that eliminates the need for consumers applying for the Medicare Savings Program (MSP) only to complete a face-to-face interview. Although MSP applicants still may apply in person at any of the Medical Assistance Program Community offices, they have the choice to complete the process by mail. Applicants who are seeking MSP-only coverage should apply using the one page DOH-4328, Medicare Savings Program Application. To request an MSP application kit be mailed to the consumer's residence, call the HRA Infoline at 1-877-472-8411 or order the kit online at https://a069-webapps1.nyc.gov/phips/menu.cfm.

To apply by mail, a consumer should complete, sign and date the DOH-4328, Medicare Savings Program Application, answer all questions and attach need documentation, (included in the application packet is the Medicare Savings Program Documentation Guide detailing acceptable proofs of documentation), and return the completed application and photocopies of the required proofs (not the originals) in the business reply envelope provided in the application kit.

Iraqi and Afghan Special Immigrants Eligibility for Public Benefits

Iraqi and Afghan immigrants who are granted special immigrant visas (SIV) and their families are eligible for federally funded Medicaid, Family Assistance and Food Stamps (if all other eligibility criteria of the respective programs are met) for a limited amount of time after their date of entry into the U.S. Afghan or Iraqi nationals granted SIV generally are interpreters and/or translators who performed work for the U.S. Armed Forces. The limited period of time is effective as follows:

• December 26, 2007, for Afghan special immigrant visa holders and continues for 6 months from the date they entered into the U.S. as a special immigrant
• January 28, 2008, for Iraqi special immigrant visa holders and continues for eight months from the date they entered into the U.S. as a special immigrant

Eligibility under this special provision cannot be granted for those immigrants who entered the U.S. prior to these dates, although they may be eligible for any of the remaining 6/8 month time periods, depending on their date of entry into the U.S. At the end of the 6/8 month time period (and for those immigrants who entered prior to the above dates) these immigrants may qualify for NYS Medicaid coverage under PRUCOL provisions and/or the Safety Net Assistance Program.

Law Passed Prohibiting Discrimination in Housing Based on Source of Income

On March 26, 2008 the New York City Council voted to override Mayor Bloomberg's veto of anti-discrimination legislation that prohibits landlords from discriminating against tenants based on lawful source of rent payment including Section 8, the Work Advantage Programs or any other public assistance. The law takes effect immediately, making it illegal for certain landlords to discriminate against Section 8 voucher holders in particular.

The law applies to all landlords who own at least one building with five or more rental units. This means that it does not apply to small property owners. The law makes it a violation of the New York City Human Rights Law to refuse to rent to someone because they have a voucher or any other public assistance. It also is illegal for landlords placing ads in newspapers or websites to specify that they will not accept vouchers or other government programs.

If a landlord refuses to rent to someone who has a Section 8 voucher, that person can file a complaint with the New York City Human Rights Commission, or s/he can bring a lawsuit against the landlord.

To file a complaint call the NYC Human Rights Commission at (212) 306-7450 or any of their community service centers, in order to make an appointment to file a complaint. Once an appointment is made a staff member will meet with the complainant who must be ready to provide specifics such as: the name and address of the landlord, the specific things he was told which led him to believe he was being discriminated against, and the date the discrimination occurred. The Commission will conduct a hearing and determine whether there was discrimination. The Commission can then direct the landlord to rent to the complainant, issue a fine or direct the landlord to pay damages.

If the person being discriminated against and wants to file a lawsuit, s/he can contact the legal services or legal aid office (go to www.lawhelp.org ) or s/he can contact the Anti-Discrimination Center at 212-346-7600.

Stimulus Payment Update

For those unable to keep up with the news on the economic stimulus payments here are a few updates you might have missed:

• The creation of an on-line calculator on IRS.gov helps taxpayers, who have prepared a 2007 tax return, determine if they are eligible for the economic stimulus payment and if so how much may be eligible to receive.
• A payment schedule (see below), also on the IRS site, gives an approximate date the payment should be sent. The schedule is different for those who have requested to receive their refund by direct deposit on their 2007 income tax refunds. All others will receive their economic stimulus payment in the form of a paper check.

If individuals owe the government back taxes or other debts such as back child support or students loans some or all of the stimulus payment maybe recouped. In those cases the IRS will send a letter to the taxpayer explaining the offset.

The stimulus payment will not affect individuals in receipt of a needs based public benefits programs such as public assistance, food stamp, Medicaid or Supplemental Security Income (SSI). The payment will not count as income in the month it is received and will not count as a resource (asset) for 60 days after the month in which it was received.

More than One in Every 100 Adults in America is in Jail or Prison

At the start of 2008, 2,319,258 adults were held in American prisons or jails, or one in every 99.1 men and women according to a new report One in 100: Behind Bars in America 2008 released by the Pew Center on the States' Public Safety Performance Project. A close examination of the most recent U.S. Department of Justice data (2006) found "that while one in 30 men between the ages of 20 and 34 is behind bars, the figure is one in nine for black males in that age group. Men were roughly 13 times more likely to be incarcerated, and found that the female population was expanding. For black women in their mid- to late-30s, the incarceration rate also has hit the one-in-100 mark. In addition, one in every 53 adults in their 20s is behind bars; the rate for those over 55 is one in 837". To view the full report click here.