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Medicaid
Using an SNT to eliminate the Medicaid spend-down Download
SNT Short (new logo).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
13 Feb, 2020 469 kb Downloads: 136381
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: 10095
MAP-751K Consumer Request to Change Information on File Download
MAP-751K - Consumer request to change info on file (2018-05-14) English.pdf
NYC HRA Form to use any time notifying HRA of change or requesting a change in budgeting. Use for requesting Special Income Disregard for Housing, Spousal Impoverishment budgeting, Pooled Trust budgeting, etc. (5/14/2018)
09 Nov, 2019 45 kb Downloads: 2641
Disabled Adult Child Medicaid Extensions/Continuations Download
DAC -Pickle- 1619B Chart.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
09 Sep, 2019 128 kb Downloads: 4430
HRA MAP 259d Nursing Home Discharge Alert - for Community Budgeting & Related Forms (10--2015)(with various forms updated as of 8-24-19) Download
MAP-259d-e-f-g-t Discharge Alert and Related Forms (2015-10) updated forms as of 8-24-19 (259f -648p.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 ($859+ $20 disregard in 2019) 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 (Chang/Cancellation of Discharge Plan), and 259g (Respite Alert) -- 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 8-24-19 from NYC MARC website.
24 Aug, 2019 1.27 mb Downloads: 62097
2019-07-31 Reapplication and Renewal Grace Periods Download
2019-07-31 Reapplication and Renewal Grace Period.pdf
21 Aug, 2019 122 kb Downloads: 445
2019-06-04 MICSA Alert Regarding May 2019 Eligibility Renewal Packets Download
2019-06-04 renewal packets.pdf
18 Jun, 2019 77 kb Downloads: 652
Statewide list of MLTC-MAP-PACE plans by County with Enrollment April 2019 Download
Statewide and NYC MLTC plan list with enrollment 4-2019.pdf
Statewide Contact list of MLTC-MAP-PACE plans by County is at http://www.health.ny.gov/health_care/managed_care/mltc/mltcplans.htm. This list by county is updated with April. 2019 enrollment data
NYC list is last pages.
29 May, 2019 1.08 mb Downloads: 26640
Medicaid income and resource levels - 2019 Download
2019 Income and Resource Levels - 2019-04-04.pdf
NYC HRA Form MAPDR-01
2019 NYS Income and Resource Standards and Federal Poverty Levels (FPL)
Dated 04-04-2019
01 May, 2019 368 kb Downloads: 406072
MAP-751E Authorization to Release Medical Information.pdf Download
12 Apr, 2019 479 kb Downloads: 1528
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