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MAP-751K Consumer Request to Change Information on File (1-21-21) Download
MAP-751K (1-21-2021)(English).pdf
NYC HRA Form to use to notify HRA of change in name, address, mailing address, date of birth, SSN, and to request mail in different languages or formats for disability (Updated 12-28-2020). The MAP-751K is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages. Upon completion, it can be faxed to HRA using 917-639-0837. (Updated 2-18-2021) NOTE: The 751k is no longer used to request a change in budgeting. A new form is being issued for that and will be posted when finalized. Check for updates here https://www1.nyc.gov/assets/hra/downloads/pdf/services/health/MAP-751K.pdf (though not updated since 2/2020).
23 Feb, 2021 82 kb Downloads: 4600
Medicaid income and resource levels - 2021 Download
2021-01-12 HRA Medicaid Chart.pdf
2021 NYS Income and Resource Standards and Federal Poverty Levels (FPL)
Dated 1-12-2021
17 Jan, 2021 2.37 mb Downloads: 416544
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2020 Download
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2020. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
10 Jan, 2021 2.65 mb Downloads: 292494
HRA MAP 259d Nursing Home Discharge Alert - for Community Budgeting & Related Forms (10--2015)(with various forms updated as of 8-24-20) Download
MAP-259d-e-f-g-t Discharge Alert and Related Forms (2015-10) updated forms as of 8-24-20 (259f -648p -259t).pdf
NYC MICSA Medicaid Alert with attached forms including "Discharge Alert" 259d that nursing home physician must sign and home must submit to Medicaid to certify that a resident has a reasonable expectation to return home, which entitles resident to community budgeting (non-chronic care) - so they keep entire community Medicaid allowance rather than only $50/month. Form replaces 1159. PDF includes - Form 259f Notice of Discharge revised 2018-07-31 (now includes check-off that resident advised of Special Income Standard for those discharged from NH to MLTC) ; Form 259e (Change/Cancellation of Discharge Plan), 259g (Respite Alert), 259t (updated 5/2020) -- all forms used by nursing homes to inform HRA/MICSA of discharge plan for community budgeting or respite admission. This PDF has updated forms as of 9/23/20 from NYC MARC website.
23 Sep, 2020 1.28 mb Downloads: 65973
2020-06-22 NYS Medicaid Program Modifications COVID-19 Emergency Download
2020-06-22 NYS Medicaid program Modifications COVID-19 Emergency.pdf
23 Jun, 2020 253 kb Downloads: 806
2020-05-28 Defective Renewal Notices During COVID-19 Emergency Download
2020-05-28 Defective Renewal Notices.pdf
HRA Alert about notices sent in error to 30,000+ Medicaid recipients in NYC discontinuing Medicaid. The alert has the language of the correction notices that the consumers will receive.
31 May, 2020 78 kb Downloads: 863
2020-05-27 Updated Fax Submissions to MICSA and HCSP Download
2020-05-27 Fax Submissions to MICSA & HCSP.pdf
updates earlier fax lists (5/4/20) - allowing submission of applications and other documents by fax during COVID-19 emergency
29 May, 2020 46 kb Downloads: 1353
Using an SNT to eliminate the Medicaid spend-down Download
SNT Short Updated for Garcia v. Banks (VB).pdf
How to get Medicaid despite having "excess income" - Using a Supplemental Needs Trust to Eliminate the Spend-down for Persons who are Elderly (65+), Blind or Disabled. Written by New York Legal Assistance Group (originally from Selfhelp Community Services) updated January 2020
04 May, 2020 1.16 mb Downloads: 145292
2019-12-12 Relocation of Brooklyn CASA Office Download
2019-12-12 Relocation of Brooklyn CASA office.pdf
30 Mar, 2020 96 kb Downloads: 470
MAPDR-21 - Medicaid Managed Care Exemptions and Exclusions Download
MAPDR-21 Medicaid Managed Care Exemptions and Exclusions 9-28-2015.pdf
This documents lists which categories of beneficiaries are exempt or excluded from the requirement of joining a mainstream medicaid managed care plan. Rev'd 9/28/15
03 Jan, 2020 71 kb Downloads: 11633
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