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Medicaid Managed Care
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
WHO MAY BE HIRED AS THE PERSONAL ASSISTANT? Changes effective APRIL 1, 2016 An adult who is not "legally responsible" for a Medicaid consumer's care and support may be a CDPAP assistant for that consumer. In particular, this means that a parent of...
Appeals & Grievances in Managed Long Term Care - Consumer Rights
Procedures to appeal decisions by Managed Long Term Care plans are different than those they are used to from the longtime system of requesting hearings to appeal decisions by the CASA/Medicaid offices. In March 2015 State Dept. of Health issued new Notice Templates to the MLTC plans, described...
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...
"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...
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....
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...
Medicaid Dental Benefit
Medicaid Dental Benefit 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...
Behavioral Health Carve-In
Significant changes are taking place in 2015 and 2016 in the delivery of behavioral health care in Medicaid managed care. This article will continue to be updated as information becomes available from the Department of Health. Behavioral Health Carve Outs For many years, people who are...
Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA)
Since May 2013 the NYC Medicaid Office (known as MICSA) has been located at 785 Atlantic Ave., Brooklyn, NY 11238. The Reception Unit is on the main floor of 785 Atlantic Ave.Brooklyn NY 11238. The following is a list of contact information for popular MICSA-Medicaid offices - SEE department...
Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans as of Jan. 1, 2018
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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