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Medicaid Renewals/Recertifications in New York City- TIPS

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Posted: 21 Jan, 2021
by Sarah Rakin (New York Legal Assistance Group)
Updated: 03 Jun, 2021
by Sarah Rakin (New York Legal Assistance Group)

This article available as a fact sheet in ENGLISH and SPANISH

This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration (HRA).  If your Medicaid is handled by the New York State of Health – your renewal is not covered in this article.  The process is different outside NYC, though the general principles are the same. 

Medicaid is authorized for one year at a time.  Approximately 3 – 4 months before the end of your “authorization period,” you should receive a renewal packet by mail, which includes instructions on how to complete and return the packet to HRA.  This process is also called “recertification.” Here are tips for handling renewals, including how to obtain a copy of the renewal form if you don’t receive one in the mail.

--  COVID PANDEMIC NOTE -

During the pandemic "Public Health Emergency," consumers will receive their renewal packets as usual, but the local districts MUST recertify Medicaid coverage for 12 months, regardless of whether the consumer fails to return to the renewal or respond to requests for information. Under GIS 20 MA/04, "Medicaid cases are being extended and individuals will not be required to renew their Medicaid eligibility during the emergency period. All active Medicaid cases with authorization and coverage dates ending in March, April, May and June will be systemically extended for 12 months." This provision has since been extended for all cases with coverage dates ending between June 2020 and July 2021 (see also GIS 20 MA/11).

Even if consumers opt to return their renewal during this period, they can "attest" to most aspects of eligibility and do not need to provide all the documents recommended below (including bank statements). 

See this article for all COVID-19 flexibilities and updates. 

1.  Keep track of your Medicaid authorization period so you know when to expect your Medicaid renewal

  1. You can find the starting month of your authorization period on your Medicaid acceptance letter.  The starting month listed in the acceptance letter will be EARLIER than the date of the notice at the top of the acceptance letter.  The attached sample Notice of Decision on Your Medical Assistance is dated July 31, 2019, and the starting month of the Medicaid authorization is July 1, 2019 (attached as Page 6 of this fact sheet).  The renewal in that case would be sent between January – March 2019. 

  2. If you are enrolled in an MLTC plan, your MLTC plan will probably notify you of an upcoming renewal shortly before HRA mails you the renewal packet.

  3. If you receive your renewal packet in the mail, don’t throw out the enclosed gray return envelope.  As explained below, you will send back the completed renewal packet in the gray envelope.

2.  Obtain your renewal packet if you don’t receive it in the mail:

  1. Set up an account on the ACCESS HRA Website following this link. To set up an account, you will need to create a username, password, and select a security question. You DO NOT need an email address to set up an account. Once you create an account and log in, you may be asked to enter your date of birth and Social Security Number or CIN. Please enter this information to locate your case in HRA’s system.

You will then be able to download and print your individualized renewal form. Use this personalized renewal form instead of a new Application, as your renewal packet has a unique barcode and other information that is specific to your case.

  1. If you are unable to use the Access HRA website, request a copy of your renewal packet by calling HRA’s automated line at 1-888-692 6116.

  2. If you recently moved and have not updated your address with HRA, you will not receive your renewal, as it will be mailed to your last known address.

    • If your renewal period is coming up in the next 4 months, use Access HRA to download a copy of the renewal form (see  No. 2a above).

    • If you won’t be receiving your renewal for at least 4 months, report your new address to HRA immediately.  Call the Medicaid helpline at 1-888-692-6116 to update your address or complete and fax the MAP-751K form to fax 1-917-639-0837. Download the form in English and other languages on HRA site at this link. (Form updated 3-15-2021)(Check back to see if HRA updates the form). Please make sure to keep fax confirmation.  

3.   How to fill out the renewal form - See sample  renewal form  is attached to this 2019 MICSA Alert

  1. WRITE in big, clear letters on top of the form and in any white space if you get any special type of Medicaid budgeting -- such as “Spousal Impoverishment,” “Spousal Refusal,” “MBI-WPD,” “Pooled Trust,” “MAGI-like,”  DAC, Pickle, or “Special MLTC Housing Standard.” Also write in if you want the Medicare Savings Program as well as Medicaid.  For info about these special Medicaid budgeting rules, see this article  

  2. Include all household members and their information.  This includes your spouse if your spouse lives with you, and any minor dependent children (or grandchildren or other relatives) under age 18 or under 19 if in school who live with you.  Do not list your adult children, your siblings, or other roommates.

  3. Make any changes, if applicable, to the amount of your rent, your insurance premiums, your income, and your resources.

  4. If you have a Pooled Income Trust, be sure to check the box saying you are enclosing a Verification of Deposits and obtain this document from your Pooled Trust organization reflecting all deposits you have made for the last year.  Many Pooled Trusts now make this document available online for download.

  5. If your share of household expenses for rent and utilities are more than 70% of your monthly gross income, fill out the Financial Maintenance Form that explains how you meet your expenses. If someone pays one or more of your bills, write “paid for by ______.”  You may want to include a letter from this person stating that they pay this bill on your behalf.

ALERT:  If family or friends help you financially, they should never give you cash.  Cash counts as income and increases your spend-down.  They may instead pay bills on your behalf, such as rent, utilities, cell phone, etc.  They must pay the bills directly to the landlord, utility company, etc.

4.  What to include with your renewal packet.

(NOTE-- Supporting documents are not required during COVID-19 pandemic- see more above)

  1. If you have a Pooled Income Trust, include a current Verification of Deposits for the last year through the current month.   Ask your Trust Organization for this form.  Many Pooled Trusts now make this document available online for download.

  2. Proof of payment of health insurance premiums. (Ex: Medigap, dental, vision, union/retirement, etc.).  Note: this proof may appear in your pay stub.

  3. Proof of income for all of your household members, including: pension letter, letter from employer, paystubs, etc. You do not have to include a letter showing your current Social Security amount, but it is a good idea to include anyway. 

  4. If you have an I.R.A., include the most recent statement that shows the amount of your Required Minimum Distribution (RMD) for the current year.  Include proof that you are taking or that you have requested regular periodic distributions. 

    • 2020 Alert - Even though no one is required by the IRS to take RMD’s in 2020 because of COVID, Medicaid still requires it, unless you are under age 65, disabled, and working.  

    • Even if you are under age 70½ (or under 72 if you turned 70 on July 1, 2019 or later) and you are not required by the IRS to take distributions, Medicaid still requires that you take periodic distributions, unless you are under age 65, disabled, and working. 
  5. Proof of resources -- current bank and investment account statements that you or your spouse own, even if you own them jointly with someone else. Include a statement of your burial fund account if you have one.   

  6. If applicable, a copy of the signed Spousal Refusal form, if any, even if you submitted it before.  

  7. If you are in an MLTC plan and have the Special Income Standard for Housing Expenses because you were in a nursing home or adult home in the past, you need to complete, sign and include this form

  8. BEST PRACTICE TIP:  Write clearly on top of the renewal form and, if you wish, in a cover letter, if you are requesting any special budgeting (see #4.a. above).  If you include a cover letter, explain the proposed budget to demonstrate that the spend-down should be zero.  Make clear if you want the Medicare Savings Program too. 

5.  How to send your renewal packet to HRA:

  1. Make two complete copies of the signed renewal form and all attachments.

  2. Mail the original renewal packet and all required documents to HRA in the barcoded gray envelope you received in the mail.   If you downloaded the form and you do not have the return bar-coded envelope, then mail it to the address below.

  3. Mail another complete copy of the renewal packet and all attachments in a separate envelope to the same address via certified mail return receipt requested so you have proof you sent it and when it was received.  Save the return receipt.

PLEASE MAIL YOUR RENEWAL TO:
Mail Renewal Program
HRA/Medicaid Assistance Program
PO BOX 329060
Brooklyn, NY 11232-9823
  1. Keep one complete copy of the signed renewal packet and all attachments, along with the certified receipt for your records.  This will be important if you receive a letter claiming HRA never received your renewal.  See item 8 b. below.
  2. After you send your renewal packet, you can call the automated line at 1-888-692-6116 to check the status of your renewal. Have your Medicaid case number available, which can be found on the top right corner of your renewal form. Be advised it may take some time for the renewal packet to be received and processed.

6.  TROUBLESHOOTING  -- What if ... ????

  1. You did not receive your renewal form by mail or if you recently moved?  See  here

  2. You receive a Notice that your Medicaid will be discontinued for failure to renew, even though you sent in your renewal? Sometimes this happens even when you submit your renewal on time -- because the computer is programmed to send them out automatically.  See a sample Notice of Decision on Your Medical Assistance at page 8 of this fact sheet.  On this sample notice:

    • The DATE of the notice is August 21, 2019.  
    • The missed deadline to submit the renewal was August 10, 2019. 
    • The EFFECTIVE DATE of the Medicaid case closing is Sept. 3, 2019.
If you receive this notice, the only way to prevent your case from closing is to request a Fair Hearing with “Aid Continuingbefore the Effective Date of the discontinuance (case closing).  In the attached sample (page 8 at this linkthis date is September 3, 2019. 

  • WHEN to REQUEST THE FAIR HEARING -- The State hearing agency (NYS Office of Temporary & Disability Assistance or OTDA) must RECEIVE your fair hearing request before the Effective Date of the case closing (Sept. 3, 2019 in the sample at page 8 here).  Then your Medicaid will continue until the fair hearing is held and decided.  This is called “Aid Continuing.” 

  • HOW TO REQUEST THE FAIR HEARING - by phone, fax, or online at https://otda.ny.gov/hearings/request/.   Mail is not recommended as it may arrive too late for you to get Aid Continuing.   Include a copy of your NOTICE, and write the date of the notice, the effective date, and the notice number on the Fair Hearing Request.  The State hearing agency OTDA will alert HRA staff to keep your case open and your coverage active.

  • Find help for the hearing at https://www.lawhelpny.org/

  • Proof that you submitted your renewal on time (or within the 30-day grace period) will be important to win the hearing.   Sometimes your advocate can help you avoid having a fair hearing altogether—but you must request the hearing with Aid Continuing right away to prevent loss of Medicaid and home care services.

  1. What if you are sending your renewal late?   In NYC, you have a 30-day grace period.  HRA must accept the renewal up to 30 days after the case closing.   In the sample notice on page 8, the renewal must be received by HRA within 30 days after September 3, 2019, which is by October 3, 2019. Mail it the same way described  above or bring it to any Medicaid office so it is received within 30 days. (But you can't -- and don't need to -- bring it to a Medicaid office during the pandemic - see note above)  If it is after 30 days, you must reapply for Medicaid.   See NYC Medicaid Alert, Reapplication & Renewal Grace Period – July 31, 2019.

WARNING:  If you received the Notice that your Medicaid will be discontinued, and if you did not send in the renewal, you must request a Fair Hearing before the case closing date to ensure your Medicaid case does not close.  You should also submit the renewal to HRA within the 30-day grace period, if there is still time.  But do not only submit the renewal even if you are in the grace period, or your Medicaid may be discontinued.  Request a Fair Hearing too!

* * *

For questions -- contact the NYLAG Evelyn Frank Legal Resources Program:

212-613-7310 or eflrp@nylag.org  (Monday, Wednesday 10 AM – 2 PM)

Check out http://www.wnylc.com/health/

This fact sheet is available online  here  in English and Spanish 

Check online for updates!

Attached files
item Renewal Fact Sheet - Spanish Version (FINAL w attachments) pdf.pdf (2.24 mb) Download
item Renewal Fact Sheet 2020 - English (w attachments) FINAL_updated 2-23-21.pdf (2.38 mb) Download
item 2021-11-05 COVID NYS Medicaid Program Modifications.pdf (263 kb) Download
item Fact Sheet on Keeping Income In & After Nursing Home Stays.pdf (497 kb) Download
item 2019-07-31 Reapplication and Renewal Grace Period.pdf (122 kb) Download
item MAP-3057E Special income housing Expenses NH-MLTC.pdf (490 kb) Download
item DAC -Pickle- 1619B Chart.pdf (128 kb) Download
item MAP-2161 + 2161a Spousal Refusal English 2018-05-11.pdf (182 kb) Download
item 2019-08-22 Elimination of MAP-2097K- with 909E Renewal Form.pdf (324 kb) Download

Also read
item Step-by-step guide to enrolling in a pooled income trust for Medicaid spend-down
item The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
item Medicare Savings Programs (MSP) in New York
item Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan
item Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"

Also listed in
folder Medicaid -> Financial Eligibility

External links
http://www.wnylc.com/health/client/images/icons/article_out.svg https://otda.ny.gov/hearings/request/
http://www.wnylc.com/health/client/images/icons/article_out.svg https://a069-access.nyc.gov/accesshra/
http://www.wnylc.com/health/client/images/icons/article_out.svg https://www1.nyc.gov/site/hra/help/health-assistance.page

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