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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 Official Website on Exchange http://healthbenefitexchange.ny.gov/. Open enrollment on the New York State Health Exchange ended on 3/31/14, with an extension through April 15th to complete applications that were filed before that date. However, it is not too late to enroll for...
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 Jan.. 2018) 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 for Medicaid...
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
I – WHAT IS MEDICAID MANAGED CARE? Most, but not all Medicaid beneficiaries in New York State who do not have Medicare must now join a "mainstream" Medicaid managed care plan. Law and Regulations: N.Y. Soc. Servs. L. §364-j (Amended L. 2011 Ch. 59). Regulations at 18 NYCRR 360-10. ...
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)" - Managed Care Expansion for Dual Eligibles in NYC Metro Area - Delayed Until Jan. 2015
Fully Integrated Dual Advantage demonstration program has started: NYC and Nassau (Region I), with the first "voluntary" opt-i enrollment effective January 2015, and "passive enrollment" scheduled for those who do not OPT OUT on April 1, 2015. 2-27-2015 NEWS: Westchester & Suffolk...
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 - CHANGES COMING MAY 1, 2018
Changes in federal Medicaid managed care regulations regarding GRIEVANCES AND APPEALS will be effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. Download this PowerPoint presentation by NYLAG EFLRP held on April 18, 2018. I. What is changing May 1, 2018 - Member...
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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