"Conversion" Form used in NYC by MLTC, PACE and Medicaid Advantage Plus plans to ask HRA Medicaid program to convert the Medicaid eligibility codes and allow them to enroll an individual who has been determined eligible for Medicaid into MLTC plan. Most commonly needed for people with a spend-down. They may have been found eligible for Medicaid but Medicaid is not activated until spend-down is met OR until HRA has processed this "conversion" to activate Medicaid even if spend-down is not met. Also see MLTC Frequently Asked Questions HCSP Quick Reference- REVISED 11-13-2013.pdf posted on this site

Undercare Renewal/Follow-up Transmittal

This is the cover sheet to be used for Home Care Services Program

This is the cover sheet to be used for MLTC cases

This is the cover sheet to used for MLTC NHED

This is the MLTC Provider Relations Unit cover sheet to be used

This is the cover sheet for HRA-ALP Medicaid Cover Sheet

This form is to be mailed to Home Care Services Program once a client is admitted or discharged from Assisted Living Programs

This is a list of Medicaid Offices throughout NYC's 5 boroughs, along with a list of MICSA/MAP sites with certified application counselotrs

This is the spousal refusal form for Suffolk County residents