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Medicaid Managed Care
 
document Applying for Medicaid Personal Care Services and CDPAP Outside NYC - 2016 Changes
New York State's Medicaid program covers personal care services and consumer-directed personal assistance services. The model for delivery of those services has, in the years since 2011, gradually transitioned from the local departments of social services, through their Medicaid programs, to...
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 Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes and Enroll in MLTC Plan
A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...
document 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...
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 Managed Long Term Care
Managed Long Term Care (MLTC) plans are insurance plans that are paid a monthly premium ("capitation") by the New York Medicaid program to approve and provide Medicaid home care and other long-term care services (listed below) to people who need long-term care because of a long-lasting health...
document KNOW YOUR RIGHTS: Managed Long Term Care and FIDA - Fact Sheets, Live and Recorded Webinars
Fact Sheets on Managed Long Term Care and FIDA. FACT SHEET 1: Basics on Managed Long Term Care FACT SHEET 2: Grievance and Appeal Rights in Managed Long Term Care (under revision from July 1, 2015 changes - see this article) FACT SHEET 3: FIDA: New Program for Dual Eligibles...
document 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...
document Patients' Rights in the Health Care System
Managed Care Bill of Rights New York State has a fairly progressive managed care bill of rights which is found in both the Public Health and Insurance laws. Disclosure. Managed care plans must tell their patients about the coverage offered, benefit packages, prior authorization rules,...
document 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,...
document New "HARP" Plans Roll out for Managed Care Members who need Behavioral Health Services - Services Start January 2016 in NYC
For many years, behavioral health services have been "carved out" of the Medicaid managed care benefit package. This means that most mental health services are accessed on a fee for service basis outside of the member's managed care plan. Posted here are the Medicaid provider billing codes for...
document Public Health Insurance Programs in New York State
These materials include an overview of public health insurance programs in New York and in-depth information on Medicaid managed care.
document KNOW YOUR RIGHTS: Medicaid Managed Care in New York State
These Fact Sheets on Medicaid Managed Care were written specially for consumers, by Medicaid Matters New York. They are dated October 2011 and will be updated in 2012 to reflect changes. Topics covered include: Included in the document attached are the following fact sheets: Know Your...
document 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...
document 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...
document 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...
document "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...
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 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 Grievance and Appeal Contacts for Managed Long Term Care Plans
Selfhelp has assembled this list of appeal and grievance contacts and policies to aid consumers and advocates in exercising their rights. The list was created using documents received in January 2013 from a FOIL request submitted to the NYS Department of Health and a review of managed long term...

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