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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...
Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans - also Tool to Find Medicaid Providers
What types of providers are affected? Effective January 1, 2014, medical providers must be enrolled with the NY State Medicaid program in order for Medicaid to pay for services that they prescribed, ordered or referred. The rule applies to ordering, prescribing, referring and attending...
Medicaid Home-and-Community-Based Waiver Programs in New York State
Medicaid home and community-based services [HCBS] are available through waiver programs to groups of individuals who would be eligible for Medicaid if institutionalized and, but for the services, would be institutionalized in a hospital or nursing facility. Under section 1915(c) of the Social...
Medicaid Dental Benefit in NYS
Under Medicaid, dental benefits exist, but the coverage is limited. This limited coverage makes it important for advocates to understand the exceptions to different coverage limitations. By understanding the nuances of the benefit, advocates can help get their clients the coverage they need. NEWS...
Medicaid Reimbursement of Home Care and other Medical Expenses
Reimbursement in General Because Medicaid coverage can be retroactive up to three months, it is possible for a Medicaid applicant or his or her family member who paid the applicant's medical expenses to get reimbursed for some of the home care costs and other medical bills they incurred and paid...
SDOH Transitional Care Policy
Updated transitional care policy for new managed care enrollees issued May 2009.  Clarifies the responsibilities of Medicaid and Family Health Plus managed care plans for providing continuity of care, including certified home health agency care,  for new enrollees who are receiving an...
Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants
COVID-19 ALERT - See here. COVID-­19 lab testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals who are undocumented immigrants eligible only for emergency Medicaid. NEWS UPDATE March 9, 2021 - The Trump Public Charge rule has been...
Asking Medicaid to Pay for an Air Conditioner
This article explains how to get Medicaid to pay for an air conditioner. NYC also has another program to provide free air conditioners to people for whom it is medically necessary. Click here for the 2021 Cooling Assistance application.
Medicaid Copayments in New York State
This fact sheet explains which New York Medicaid recipients must pay copayments, and for which services.  It also explains the $200 CAP, which limits how much any Medicaid recipient must pay in copayments in a year to $200.  Note that for those who have both Medicare and...
Medicaid Utilization Thresholds (MUTS or UT) in New York State - Limits on Number of Services per Year
This fact sheet explains Medicaid Utilization Thresholds (MUTS or UT) in New York State - Limits on Number of certain services per year, and the "override" procedure available to increase these limits. NY Soc. Serv. L. § 365-g; 18 NYCRR Part 511. The above fact sheet has not been updated...
The Medicaid Pharmacy Benefit - For People Without Medicare - Changes Coming 2023 (delayed from 2021)
Heads Up - Changes Slated for April 2021 Delayed to April 2023 Once again, NYS is changing the way people without Medicare access prescription drugs. But the changes that were scheduled to take place in April 2021 have been delayed until April 2023, under the SFY 2021-22 budget agreement. ...
Medicaid Transportation in NYS
States are required under federal regulations (42 C.F.R. §431.53) to assure necessary transportation to Medicaid beneficiaries to and from medical services. When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary...
Medicaid Short-Term Rehabilitation Benefit
As you may know, there are three different levels of Medicaid coverage in New York State, each with different resource documentation requirements. These can be summarized as follows (see this more detailed chart): Level of Coverage: Community Coverage Without Long-Term Care Community...
Medicaid Assisted Living Programs (ALP) in NYS
INTRODUCTION The Assisted Living Program provides supportive housing and home care services to individuals who are medically eligible for placement in a nursing facility but, whose needs can be met in a less restrictive and lower cost residential setting. he operator of the assisted living...
Physical, Speech & Occupational Therapy Limits Lifted for 2021
The 2011-12 NY State budget, ] limited access to compression stockings, prescription footwear, and enteral nutritional formula, as well as physical therapy, occupational therapy, and speech therapy. Some of these limits have been repealed or made less harsh. Physical, Speech, and Occupational...
Dental and Orthodontic Services to be Included in the Medicaid Managed Care Benefit Package
Dental Services to be Included in the Medicaid Managed Care Benefit Package Effective July 2, 2012, dental services for Medicaid beneficiaries must be obtained through the member's Medicaid managed care plan, if they are in such a plan. Previously, Medicaid managed...
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...
"Ensure" and Enteral Nutritional Supplements - When does Medicaid Pay for it? 2013 Changes for Adults
Children under 21 are entitled to obtain "Ensure" or other nutritional supplements when medically necessary. However, the State has enacted laws in the last few years that restrict eligibility for nutritional supplements for adults age 21+. In 2011, the state budget law limited these "enteral...
MLTC Members in Nursing Homes for 3+ Months Being Disenrolled from MLTC Plans - 4th Batch Oct. 1, 2021
Oct. 2021 Update - Fourth "Batch" of Nursing Home Residents Disenrolled from MLTC plans in October 2021 for Long Term Nursing Home Stay "LTNHS" Total Members Disenrolled: 20,353 as of Oct. 1, 2021 for LTNHS On Oct. 1, 2021, 1,285 more MLTC members who have been in nursing homes for three or...


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