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Financial Eligibility
NYC MICSA Alerts 8/31/15 & 5/18/15 re Payment of Surplus Bills or Pay-in by Third Parties Download
2015-08-31 Mailing of Notices to Excess Income Consumers re 3rd party payment of surplus.pdf
Both Alerts in one PDF with accompanying Form MAP-3107A Attestation of Use of Recipient Funds
22 Nov, 2015 506 kb Downloads: 4216
NYC HRA Medicaid MICSA Alert June 3, 2015 - Treatment of Income of Dependents for MAGI-Like Budgeting Download
2015-06-03 Treatment of Income of a Dependent under MAGI-Like Budgeting Rules.pdf
Implements NYS DOH GIS 15 MA-08 which clarified that child dependents' Social Security or other income should not be counted in MAGI-like budgeting, which local districts must do when a person eligible under the MAGI category needs long term car and some other instances, for which eligibility must be processed by the local district rather than the Exchange.
22 Nov, 2015 207 kb Downloads: 1011
MAP-648 P SUBMISSION OF REQUEST FROM RESIDENTIAL HEALTH CARE FACILITIES (RHCF) Download
MAP-648P NH MA Transmittal 6-2015.pdf
Transmittal form used by HRA Medicaid where the Nursing Home provides HRA with streamlined information about the applicant and the applicant's request for Nursing Home Medicaid coverage.
18 Jun, 2015 147 kb Downloads: 4199
Pre-Paying for Burial – Tip for Qualifying for Medicaid despite “Excess Resources” Download
Funeral Agreement Fact Sheet.2 (6-16-2015).pdf
This advocacy memo from NYLAG explains the rules regarding treatment of pre-paid funeral agreements for burial arrangements for Medicaid eligibility for people age 65+, blind, or disabled.
16 Jun, 2015 582 kb Downloads: 148811
Policy Change for the Start Date of the Transfer of Assets Look Back Period Download
2015-06-02 Policy Change for the Start Date of the Transfer of Assets Look Back Period.pdf
Effectively immediately, the review of assets is limited to the 60-month period immediately preceding the month of institutionalization and application for Medicaid.

For Medicaid recipients who are institutionalized for long-term nursing home care or receiving more than 29 days of rehabilitation services, the look-back period consists of the 60 months preceding the month of institutionalization.
02 Jun, 2015 308 kb Downloads: 1152
Newborn Processing Update Download
2015-05-06 Newborn Processing Update.pdf
Update advised that all newborns born in 2015 submitted via the NYS automated system have been determined processed either automatically or manually
06 May, 2015 191 kb Downloads: 1366
HCSP 3026 ALP Medicaid Cover Sheet Download
HCSP-3026 HCSP Cover Sheet for ALP-MLTC 1-26-2015.pdf
This is the cover sheet for HRA-ALP Medicaid Cover Sheet
13 Apr, 2015 44 kb Downloads: 768
Spousal Refusal Form - Suffolk County Download
Spousal Refusal Form - suffolk county.doc
This is the spousal refusal form for Suffolk County residents
13 Apr, 2015 25 kb Downloads: 2382
15-INF-03 Informational Letter Personal Needs Allowance in Non-Medical & Medical Facilities Download
15-INF-03 Informational Letter Personal Needs Allowance in Non-Medical and Medical Facilities.pdf
This informational letter provides social services districts with updated charts that represent the monthly Personal Needs Allowance, PNAs, for residents of non-medical facilities the PNAs in medical facilities.
13 Apr, 2015 302 kb Downloads: 532
MAP-909E DAB Renewal Redacted Download
MAP-909E DAB Renewal (8-2011) redacted.pdf
This is a redacted form that can act as a guide as for Disabled, Aged, & Blind client renewals.
13 Apr, 2015 1.88 mb Downloads: 1553
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