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Medicaid
Know Your Rights: NYLAG Webinars on Medicare and Medicaid -
The Evelyn Frank Legal Resources Program conducted a five-part Continuing Legal Education Webinar program in April and May 2016 that provides tools to understand and navigate the complex world of Medicare and Medicaid in New York. The focus is on eligibility and application procedures for older...
"MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare
Medicaid eligibility rules changed significantly on January 1, 2014 for some New Yorkers as a result of the Affordable Care Act’s eligibility expansion and streamlining provisions. The expansion only applies to a population called the "MAGI" population. Generally, the new rules do NOT apply to...
Affordable Care Act --New York State Health Exchange Open Year-Round for Medicaid Applications and for Certain "Special Enrollment" categories
New York State of Health Exchange https://nystateofhealth.ny.gov/ There is year-round open enrollment for MEDICAID on the New York State of Health website. Normally, open enrollment for Qualified Health Plans is limited, but through March 31, 2021 there is a Special Enrollment Period in NYS...
Medicaid Alerts & Other Protocols published by the NYC HRA Medical Insurance and Community Services Administration (MICSA)
HRA MICSA Alerts are periodic announcements of policy, staff and office changes published by the Medical Insurance and Community Services Administration (MICSA). MICSA is the part of New York City’s Human Resource Administration (HRA) that administers HRA’s medically- related programs such as...
KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind
This Fact Sheet (updated for 2021 in Jan. 2021) is intended for New Yorkers who are age 65+ or who have disabilities, or their family members and caregivers. It explains the basic financial rules on eligibility for Medicaid in the community for this category of people, and explains how to apply...
Fundamental Changes to NY Medicaid in the 2011 State Budget
The Health Budget passed this week makes fundamental and far-reaching changes to New York’s Medicaid program, with savings reported at $2.8 billion. The proposals that were presented to the legislature in the Governor’s 30 day amendments represented a package submitted by the Medicaid Redesign...
Medicaid Managed Care Fact Sheet - Pharmacy Services
Effective October 1, 2011, Medicaid’s pharmacy benefit will be moved into the managed care benefit package. The pharmacy benefit includes all FDA approved prescription drugs, as well as some over-the-counter drugs and medical supplies. The Family Health Plus (FHP) pharmacy benefit, which is less...
Blanket Limits on Medicaid Services
An analysis of the cuts in Medicaid services enacted as part of the 2011-12 state budget, which limit access to compression stockings, prescription footwear, and enteral nutritional formula, as well as physical therapy, occupational therapy, and speech therapy. UPDATE: Court Strikes Down...
Medicaid Managed Care
Law and Regulations STATE - N.Y. Soc. Servs. L. §364-j (Amended L. 2011 Ch. 59). Regulations at 18 NYCRR 360-10. FEDERAL - 42. C.F.R Part 438 (amended extensively in 2016, with changes going into effect in NYS on rolling basis, including new appeal rules starting May 1, 2018 requiring...
Restricted Recipients
MEDICAID MANAGED CARE FACT SHEET   Restricted Recipients- the way you receive your Medicaid benefits is changing!   On August 1, 2011, Medicaid recipients who are restricted to certain providers will have to enroll in a Medicaid health plan. Before August 1, 2011, restricted...
New York Dramatically Expands Mandatory Managed Care for Medicaid Beneficiaries
Many people who used to be exempt from mandatory enrollment in Medicaid managed care have been receiving notices in summer and fall 2012 telling them that their exemption has ended, and that they now have 30 days to enroll in a managed care plan.   This type of managed care is sometimes...
"FIDA (Fully-Integrated Dual Advantage) Program for Dual Eligibles Closing Dec. 31, 2019
November 2019 Update - FIDA PROGRAM CLOSING 12/31/2019 2,520 members in the SIX FIDA plans will be assigned to a new plan for January 2020 unless they pick and enroll in a different one before December 20, 2019 WHERE IS FIDA? Most of the 2,520 dual eligibles still in FIDA plans are in NYC,...
Tools for Choosing a Medicaid Managed Long Term Care Plan
As described in this article, most adults in NYC, Westchester, Nassau and Suffolk counties who have Medicaid and Medicare, who are receiving Medicaid home attendant or housekeeping ("personal care") services through their local Medicaid "CASA" office, or long-term CHHA or adult day care services,...
Delays in Processing of Medicaid Applications - What are Your Rights and Lawsuits Challenging Delays
The Deadlines to Process Medicaid Applications in the Law Federal and state law set time limits for processing a Medicaid application. The federal Medicaid Act requires eligibility to be determined with "reasonable promptness." A determination of eligibility for Medicaid must generally be made...
Grievance and Appeal Contacts for Managed Long Term Care Plans
BEGINNING MARCH 1, 2018, members of Medicaid Managed Care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal before they may request a FAIR HEARING. This is called the "exhaustion requirement" and is...
Court Orders Lifting Restrictions in Medicaid Coverage for Compression Stockings and Orthopedic Footwear
Federal Court Orders State to Stop Restricting Coverage of Compression Stockings and Orthopedic Footwear. On July 1, 2016, a federal judge in New York issued an order enjoining state health officials from limiting coverage of orthopedic footwear and compression stockings for some state Medicaid...
Appeals & Grievances in Managed Long Term Care - "Exhaustion" of Plan Appeal Required since 2018
In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F Sept. 2020 UPDATE - NYS Dept. of Heath proposed...
New York Medicaid Expansion under the ACA ... and other 2013 budget changes
This year’s Health Budget makes significant changes to New York’s Medicaid program – expanding eligibility to 133% of the federal poverty law (FPL) and changing budgeting rules and enrollment processes for Medicaid and Child Health Plus (CHP) to conform to the Affordable Care Act. The...
Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State
Numbers tell a big part of the story of how managed care plans are doing in providing care. With mandatory enrollment in Medicaid managed care now required in every county in New York State for most people who do not have Medicare, and mandatory enrollment in Managed Long Term Care of those adults...
Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange
The Empire Justice Center published a report in May, 2013 exploring the policies that guide immigrant access to health care and making recommendations for improving immigrant access through New York's Health Insurance Exchange: New York's Exchange Portal: A Gateway to Coverage for Immigrants ...

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