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Medicaid
MAP-751W Consumer/Provider Request to Change Information on File (3-25-21)(fill-able) Download
MAP-751W Request to Change Information (3-25-21) (fill-able)(with 3-4-22 memo where to submit).pdf
NYC HRA Form to notify HRA of corrections or changes, e.g. close case, combine case, add/remove individual, notify of death, change in immigration status, upgrade eligibility, request MSP evaluation, budgeting changes, pooled trust budgeting and add/remove third party health insurance. Per attached 3/2022 memo may be faxed to (917) 639-0837 or mailed. Note that a change in demographic information (such as name, address, phone number) should be reported in a different form: MAP-751K. The MAP-751W is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages.
24 Oct, 2022 376 kb Downloads: 4560
Supplemental Needs Trusts Outline for Advocates - Including Impact on Various Benefits of Transfers of Lump Sums into SNT's UPdated 8/2022 Download
SNT Outline 8-9-22 NYLAG FINAL.pdf
Training Outline for Advocates on Supplemental Needs Trusts (SNTs) (individual and pooled), and the effect of SNTs on various public benefit programs (updated 8/8/2022). Updated sections include Temporary/Public cash assistance, SNAP, ABLE accounts, Public Housing and Section 8, changes in procedures for submitting pooled trusts in NYC. Also heads up about 2023 increases in Medicaid income and asset limits and update about the 30-month community based lookback).
09 Aug, 2022 1.77 mb Downloads: 210503
Using an SNT to Eliminate the Medicaid spend-down - Fact Sheet (July 2022) Download
SNT Short 2022-07-05.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 Evelyn Frank Legal Resources Program, updated July 2022 with new procedures in NYC for submitting disability forms, and with 2022 figures.
04 Jul, 2022 1.21 mb Downloads: 154098
Disabled Adult Child Medicaid Extensions/Continuations Download
DAC -Pickle- 1619B Chart (OCRed).pdf
This chart discusses the Medicaid Extensions/Continuations for certain special cases of SSI recipients once their SSI has been terminated. Specifically, it compares the eligibility criteria, resource/income levels, residential program requirements, spendown/NAMI contributions, reinstatement, and Medicare Buy-IN eligibility for the following groups:
A. 1619B
B. Pickle
C. DAC
22 Mar, 2022 103 kb Downloads: 6793
Medicaid income and resource levels - 2022 (3-16-22) Download
mapdr-01 2022 nys income and resource standards and federal poverty levels (fpl) (3-16-2022).pdf
NYC HRA MAPDR-01 (3-16-2022) -- 2022 NYS Income and Resource Standards
16 Mar, 2022 267 kb Downloads: 430474
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2021 Download
2001_to_2021_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2021. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
10 Mar, 2022 3.26 mb Downloads: 297624
MAPDR-05 (12/30/2021) List of Managed Care & Managed Long Term Care Plans in NYC Download
2021-12-30 MADPR-05 Medicaid Managed Care Plan.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care
* Health and Recovery Plan Managed Care Plans (HARP)
* Managed Long Term Care (MLTC)
* Medicaid Advantage Plus (for dual eligibles, includes MLTC)
* HIV Special Needs Plans (SNP)
* Programs of All-inclusive Care for the Elderly (PACE)
* Fully Integrated Dual Advantage (FIDA) IDD

Updated February 9, 2022
09 Feb, 2022 150 kb Downloads: 58457
2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers Download
2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers.pdf
2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers - provides instructions for Online Credit Card payment to the Division of Accounts Receivable and Billing (DARB) to participate in the Medicaid Pay-In Program. Link to NYC CityPay website (https://a836-citypay.nyc.gov/) is provided. Medical bills cannot be submitted through this website.
16 Nov, 2021 124 kb Downloads: 1553
2021-08-30 Updated Fax & E-maikl Submissions to HRA Medicaid and HCSP Download
2021-08-30 Fax-e-Mail submissions to MAP - Home Care Services Preogram.pdf
updates earlier fax lists - allowing submission of applications and other documents by fax during COVID-19 emergency, and adds some email addresses for inquiries
04 Sep, 2021 152 kb Downloads: 4139
Nassau County Physician's Request for Personal Care Aide and Orders to the Service Agency (07-2020) Download
Physician's Order Nassau County Form 517 - (2020).pdf
Form for doctor to complete to request Medicaid personal care services and CDPAP from the Nassau County DSS. Revised July 2020.
26 Aug, 2021 1.46 mb Downloads: 9600
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