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document 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...
document 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...
document 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...
document 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...
document Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants - Changes 2013
Enrolling in "Emergency Medicaid for undocumented immigrants and maintaining eligibility should be easier under a new 2013 policy eliminating the form physicians were previously required to fill out DOH-4471 form for the Certification of Ttreatment of an Emergency Medical Condition.(revised...
document 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 2010 Cooling Assistance application. 
document 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...
document 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...
document The Medicaid Pharmacy Benefit
Medicaid’s pharmacy benefit was moved into the Medicaid managed care benefit package in October of 2011. Before that date, people enrolled in a Medicaid managed care plan obtained all of their health care through the plan, but used their regular Medicaid card to access any drug available on the...
document Maintaining Community Medicaid (Non-Chronic Care) Budgeting During Temporary Nursing Home Stays
Many Medicaid recipients are admitted to nursing homes but plan to return to their homes in their community. Financially, it is important for them to maintain community Medicaid budgeting so that they can continue to pay rent, utility, and other living expenses to preserve their apartment or home...
document 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...
document 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...
document 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...
document 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...
document 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...
document 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...
document "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...
document Consumer Advocacy on the FIDA Demonstration - Fully Integrated Dual Advantage - Managed Care Covering Medicare and Medicaid Services Starting 2015
A new managed care Demonstration program will begin on January 1, 2015 in NYC, Long Island and Westchester, for Dual Eligibles (those receiving Medicaid and Medicare) who also need home care or nursing home care. See this article for more information about this program. This article gives links...
document New Permanent Nursing Home Residents in NYS Required to Enroll in Medicaid Managed Care Plans or MLTC Plans - Effective since October 2015 Statewide
Since February 1, 2015, there has been a new requirement for nursing home residents in New York City who became "permanent" residents after that date to enroll in Managed Long Term care (MLTC) and "mainstream" Medicaid Managed Care plans, which will now pay for and manage the nursing home care....
document Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services
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...

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