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Financial Eligibility
Sample Application for Medicaid or MSP - Disabled/Aged 65+/Blind "Non-MAGI" - Download
Medicaid Application Guide with Sample Bank Statement.pdf
Sample Medicaid application completed, with sample bank statement to show how to prove resources are within Medicaid limits
11 May, 2016 2.29 mb Downloads: 7502
Statement of NYLAG on 2016 NYS Budget Proposals to Eliminate Spousal Refusal and Reduce Spoual Impoverishment Protections Download
NYLAG Spousal Protections 2016.pdf
Statement of NYLAG on 2016 NYS Budget Proposals to Eliminate Spousal Refusal and Reduce Spoual Impoverishment Protections
04 Feb, 2016 385 kb Downloads: 1898
NYLAG Testimony on NYS Budget 2016-17 - Medicaid and Health Access Issues Download
NYLAG Health Testimony 2016-2017.pdf
Testimony of NYLAG to the New York State Legislature Joint Hearing of the Senate Finance and Assembly Ways and Means Committees - January 2016
04 Feb, 2016 480 kb Downloads: 1532
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: 7113
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: 2303
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: 7067
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: 2411
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: 2664
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: 1814
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: 5867
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