N.Y. Social Services Law § 366-i: Long-term care financing demonstration program

§ 366-i. Long-term care financing demonstration program. 1.

Notwithstanding any inconsistent provision of sections three hundred

sixty-six or three hundred sixty-six-c of this title, or any other

provision of law, the commissioner of health is authorized to develop

the long-term care financing demonstration program, an alternative

program for the establishment of eligibility under the medical

assistance program for up to five thousand persons.

2. The provisions of this section shall not take effect unless all

necessary approvals under federal law and regulation have been obtained

to receive federal financial participation in the costs of health care

services provided to persons determined to be eligible for medical

assistance pursuant to this section.

3. Defined private contribution. Upon being determined eligible for

the demonstration, a person shall disclose his or her household's

resources and income to the local social services district, or an entity

acting on behalf of such district pursuant to subdivision five of this

section, and shall enter into an agreement with such district or entity.

The agreement shall require the person to apply a defined private

contribution toward the cost of institutional or non-institutional

long-term care, as defined by the commissioner in regulations. Such

regulations shall provide for two levels of contribution: (a) a level

that would permit a full medical assistance resource exemption pursuant

to paragraph (a) of subdivision four of this section; and (b) a level or

levels that would permit a medical assistance resource exemption that is

equivalent to the value of the contribution pursuant to paragraph (b) of

subdivision four of this section.

4. Medical assistance eligibility. Upon completion of the defined

private contribution required by such agreement, the person may apply

for medical assistance under this title and, if otherwise eligible,

shall be eligible for such assistance either: (a) in the case of an

individual who opts for a contribution level under paragraph (a) of

subdivision three of this section, without regard to otherwise

applicable resource requirements of this title; or (b) in the case of an

individual who opts for a contribution level under paragraph (b) of

subdivision three of this section, without regard to an amount of

resources that is equivalent to the value of the contribution. In either

case, eligibility for medical assistance under this title shall, with

respect to the amount of resources that are exempt from consideration

under this subdivision, be without regard to the lien and estate

recovery provisions of section three hundred sixty-nine of this title;

provided, however, that nothing herein shall prevent the imposition of a

lien or recovery against property of an individual on account of medical

assistance incorrectly paid.

5. The commissioner is authorized to enter into a contract with a

private entity to assist in the administration of the demonstration

program established by this section. Such a contract may include,

without limitation, assistance in the development of the criteria for

the defined private contribution, drafting of the defined contribution

agreement, accepting and processing applications for demonstration

participation under this section, and accepting and processing

applications for medical assistance for demonstration participants.

Notwithstanding any inconsistent provision of sections one hundred

twelve and one hundred sixty-three of the state finance law, or section

one hundred forty-two of the economic development law, or any other law,

the commissioner is authorized to enter into a contract under this

subdivision without a competitive bid or request for proposal process.

6. If the commissioner exercises his or her authority to implement a

demonstration program under this section he or she shall submit a report

to the governor, president pro tem of the senate and speaker of the

assembly by the first day of November, two thousand fifteen, on the

implementation of this section. Such report shall include a statement as

to the extent to which individuals have opted to participate in the

demonstration, an analysis of the impact of the demonstration on medical

assistance program long-term care costs, any recommendations for

legislative action, and such other matters as may be pertinent.