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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 - CHANGES COMING MAY 1, 2018
Changes in federal Medicaid managed care regulations regarding GRIEVANCES AND APPEALS will be effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. Download this PowerPoint presentation by NYLAG EFLRP held on April 18, 2018. Download this Fact Sheet by NYLAG EFLRP. ...
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
July 2018 Update - All of the policies and procedures described in this article will be changing soon, as the result of the NYS Budget enacted in April 2018. This budget reverses the MLTC expansion to include nursing home care that is described in this article. Once implemented, adults with...
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 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...
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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