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PERSONAL EMERGENCY RESPONSE SERVICES IN CHAUTAUQUA COUNTY
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What is Medicaid? Medicaid is a program for New Yorkers who can't afford to pay for medical care.
How do I know if I qualify for Medicaid? You may be covered by Medicaid if: · * You have high medical bills. · * You receive Supplemental Security Income (SSI). · * You meet certain income, resource, age, or disability requirements.
How do I apply for Medicaid? You can apply for Medicaid in any one of the following ways: Write, phone, or go to your local department of social services. In New York City, contact the Human Resources Administration by calling (718) 557-1399. Residents of the five boroughs of New York City may call toll free at 1-877-472-8411. Pregnant women and children can apply at many clinics, hospitals, and Prenatal Care Assistance Program (PCAP) offices. Call your local department of social services to find out where you can apply. If you are in a facility operated by the New York State Office of Mental Health, contact the patient resource office. If you are in a facility certified by the New York State Office of Mental Retardation and Developmental Disabilities, contact the revenue and reimbursement office.
NYS Medicaid Buy-in Program New York State began implementing its Medicaid Buy-in Program for Working People with Disabilities on July 1, 2003. This groundbreaking program offers working people with disabilities the opportunity to keep health care coverage through Medicaid while earning more income and keeping more resources than ever before. Be a part of a community that is dedicated to ensure that every New Yorker with a psychiatric disability, who wants to work, is fully informed and supported to do so, without losing critical health care coverage!
The Need For A Medicaid Buy-In Program The Medicaid Buy-In program is designed to help those disabled persons who are not eligible for traditional Medicaid because their earnings or resources surpass the limits under SSI’s §1619(b) program. Recall that §1619(a) of the Social Security Act allows an individual to continue to receive SSI even when earned income exceeds the substantial gainful activity (SGA) level. In New York, the 2003 income limit for §1619(b) is $34,136 in wages per year. The income limit can be higher if medical expenses are high enough. Other rules governing unearned income and resources also apply. The reality facing many of these disabled persons is that too often
they are unable to obtain health insurance in the private sector that provides coverage for the services and supports that enable them to live independently and enter, remain in, or rejoin the workforce. Thus, there is a need to supplement private insurance or rely on Medicaid for necessary services and supports. For many individual SSDI and SSI recipients, the risk of losing Medicare and Medicaid coverage that is linked to their cash benefits is a risk that is an equal or greater work disincentive than the loss of cash benefits associated with working. Congress included a Medicaid Buy-In option in §4733 of the Balanced Budget Act of 1997 and when it enacted the Ticket to Work and Work Incentives Improvement Act (TWWIIA). By authorizing states to offer Medicaid Buy-In programs, these landmark pieces of legislation opened a window of opportunity for states to develop comprehensive work incentive initiatives that encourage people with disabilities to work or increase their level of work, thereby reducing or eliminating their dependency on cash assistance programs.
New York’s Medicaid Buy-In Program New York is the 27th state to implement the Medicaid Buy-In program. New York’s program is quite unique as it will establish two eligibility groups: the Basic Coverage Group and the Medical Improvement Group.
The Basic Coverage Group To be eligible for the Basic Coverage Group, an individual must have a disability that meets the medical criteria established by the Social Security Administration (SSA) but have too much income to qualify for SSI. In addition to the usual Medicaid rules, the specific requirements are: · * Disability—Certified disabled by SSA (SGA step eliminated) · * Age—Be at least 16 but not yet 65 years of age · * Work—Be engaged in paid work (includes part-time and full-time work) · * Income—Have a gross income that may be as high as $46,170 for an individual and $61,870 for a couple (as of January 1, 2003) * Resources—Have non-exempt resources that do not exceed $10,000
Every participant has the right to see their own service file. It is the right of only the participant to authorize the use of any information in their file. This authorization must be requested in writing. Access to service files shall be given to the Executive Director and the staff providing direct service. The specific written request of the participant must identify what information can be released and to whom, i.e., general and/or HIV related, drug, narcotic, or alcohol use information. No information will be released without written permission of the participant. Participants will be given a formalized appeal process in writing to remedy any unsatisfactory situations.
PARTICIPANT APPEAL PROCESS It is SILC’s policy to provide effective and acceptable means for participants to bring problems and complaints concerning their receipt of services to the appropriate persons. Participants are encouraged to settle grievances informally through discussion with staff providing services and/or using the resources of the Executive Director. If this does not remedy the situation any participant may bring up a grievance in the following manner.
Step 1 – Submit a written statement of the grievance to the Executive Director, including notes of any informal meeting and discussions. This should be done promptly. The Executive Director has the responsibility of responding to the grievance within 5 business days. If necessary, a meeting will be set up to take place no later than 3 business days from the time the grievance was first submitted to the Executive Director. The Executive Director will render a decision. Written record shall be kept of this grievance and resolution and placed in the participant's file. If the Executive Director fails to respond to the grievance, or the participant believes the decision is not acceptable, or if a solution has been reached but is not adhered to, they may proceed to Step 2.
Step 2 – Submit a written statement of the grievance to the Executive Committee, including notes of any meetings or discussions. This should be done promptly. The Executive Committee has the responsibility of responding to the grievance within 10 business days. If necessary, a meeting will be set up to take place no later than 8 business days from the time the grievance was first submitted to the Executive Committee. The Executive Committee will render a decision. Written record shall be kept of this grievance and resolution and placed in the participant's file. If the Executive Committee fails to respond to the grievance or the participant believes the decision is not acceptable, or if a solution has been reached but is not adhered to, they may proceed to Step 3.
Step 3 – Participant submits a statement of the grievance and all other pertinent materials to the Board of Directors. This should be done promptly – no later than 5 business days after the resolution of Step 2. The President shall set up a meeting with all concerned individuals and the Board of Directors to respond to the grievance 10 business days after receiving the grievance. After, due consideration of the materials and data presented the Board will render a decision in writing with copies to the Personnel Committee and the Executive Director. A copy will be maintained in the participant’s file. In all cases, the decision of the Board of Directors shall be binding. (If the grievance is with the Executive Director, the process will start with Step 3).
Step 4 – If the participant is not satisfied with the Board of Directors decision, the participant has the right to contact Joseph Tedesco, M. S. CRC, Manager, Independent Living Services, NY State Education Department at Adult Career and Continuing Education Services - Vocational Rehabilitation (ACCESS VR), at (518) 473 6829, or, by mail to Joseph Tedesco, NYSED ACCES, 89 Washington Ave., EBA 5th Floor, Room 580, Albany, NY 12234. All records and documents kept by SILC on participants are subject to review by appropriate funding sources and can be subpoenaed by courts. The rules of confidentiality are not protected by law when injury to self or others is at stake.
STATEMENT OF SELF-DIRECTION Southwestern Independent Living Center, Inc. (SILC) must assist individuals with disabilities in exercising more freedom and control over their own lives. Therefore, whenever possible, the individuals receiving services shall be instrumental in identifying needed services and the delivery of these services. Participants will be encouraged to:
1. Develop their own goals.
2. Direct delivery of services using their own abilities.
3. At all times participants should be experiencing self-advocacy.
4. SILC staff will not impose their own judgment upon the participant. I understand my rights and responsibilities as a participant of SILC services that no information is to be released to any other person outside the SILC, or agency, without my written consent and that I have the right to a grievance process. I have also been provided with phone numbers to direct any complaints regarding SILC services.
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