NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC
Medicaid Managed Care
Medicaid Recipients to be "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare-- April 1, 2021
.  WHAT CHANGE IS HAPPENING APRIL 1, 2021 Beginning April 1, 2021, a change is coming for New York Medicaid recipients who newly become enrolled in Medicare and become "Dual Eligibles" - someone who has both Medicare and Medicaid. Every month about 3,000 - 4,000 Medicaid recipients in New...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
A. Fact Sheets on Managed Long Term Care B. Click here for WEBINARS on LONG TERM CARE A. Fact Sheets on Managed Long Term Care BASICS Basics on Managed Long Term Care (In process of being updated - 2-2020) see also Article on Managed Long Term Care News on MLTC - updated monthly ...
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...
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...
Right to a "Home Hearing" under Varshavsky Case - Special Rights in Fair Hearings Seeking Increases in Medicaid Home Care
RIGHTS of People Who Cannot Travel to a Fair Hearing Because of Disability This article can also be downloaded as a Fact Sheet here. Individuals who, because of mental or physical disabilities, cannot travel to a fair hearing without substantial hardship or medical detriment, have rights...
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...
Managed Long Term Care
State Complaint Number for MLTC Problems - 1-866-712-7197 e-mail mltctac@health.ny.gov and put "COMPLAINT" in subject line For enrollment complaints - call NY Medicaid Choice - 1-855-886-0570 (Advocates line) 1-888-401-6582 (Consumers line) Managed Long Term Care (MLTC)...
Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled 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...
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...
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,...
When an MLTC Plan Closes - What are the Members' Rights? WARNING - Changes Coming!
Since Managed Long Term Care (MLTC) plan enrollment has been mandatory since 2013 for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some MLTC plans have either closed or reduced their service area, no longer covering certain counties or New York City....
Medicaid Advantage Plus "MAP" - New "FIDE" Appeals & Hearing Process began 2020 - Healthfirst Mistake March 2021
In 2020, a new appeal and fair hearing process launched for about 10% of Managed Long Term Care members those who are in Medicaid Advantage Plus (“MAP”), which consists of a "FIDE-SNP" (Fully Integrated Dual Eligible - Special Needs Plan) that covers the Medicare services, and a Medicaid...
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...
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,...
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...
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.
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...
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...
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...

← Prev Next
1 2


This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.