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Consumer Coalition Proposed Revision - FIDA NOTICES 3-4 - 60-Dayand 30-Day Passive Enrollment Notice (5/30/14) Download
FIDA 60 day and 30 day Notices combined 04-20-2015.pdf
On May 22, 2014, DOH provided Consumer advocates with drafts of notices regarding passive enrollment in FIDA to begin fall 2014. This is the Consumer coalition's proposed revision of NOTICEs 3 and 4 (60-day and final 30-day notices before Passive Enrollment).
20 Apr, 2015 356 kb Downloads: 8010
Troubleshooting Problems Enrolling in MLTC Plans - Tips for Avoiding Delays and Medicaid Spend-down Problems Download
Troubleshooting - 4-16-15 pp.pdf
Fact sheet written by New York Legal Assistance Group Evelyn Frank Legal Resources Problem addressing common problems encountered by those trying to enroll in MLTC plans, especially where they have a spend-down OR are trying to leave a nursing home. Learn how to avoid delays in enrollment. Includes helpful forms, focused on NYC but can be adapted statewide (updated April 15, 2015)
16 Apr, 2015 2.11 mb Downloads: 26246
NY HRA HCSP MLTC Cover Sheet ("Conversion" Form) -- HCSP 3047a (1/26/2015) replaces HCSP-3022 (9/26/2013) Download
HCSP-3047a MLTC-PRU 1-26-15_150415121649.pdf
"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
15 Apr, 2015 58 kb Downloads: 7106
HSCP-3046 Home Care Services Program Cover Sheet Download
HCSP-3046 1-26-2015.pdf
This is the cover sheet to be used for Home Care Services Program
13 Apr, 2015 38 kb Downloads: 3265
HCSP 3047 MLTC Cover Sheet Download
HCSP 3047 1-26-2015.pdf
This is the cover sheet to be used for MLTC cases
13 Apr, 2015 44 kb Downloads: 3324
HSCP-3047b MLTC Nursing Home Eligibility Determination Cover Sheet Download
HCSP-3047b 1-26-2015.pdf
This is the cover sheet to used for MLTC NHED
13 Apr, 2015 55 kb Downloads: 4966
HCSP-3047a MLTC/PRU Download
HCSP-3047a MLTC-PRU 1-26-15.pdf
This is the MLTC Provider Relations Unit cover sheet to be used
13 Apr, 2015 47 kb Downloads: 3155
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: 3223
Notice of Admission/Discharge for the Assisted Living Program Download
HCSP 3027 1-26-2015.pdf
This form is to be mailed to Home Care Services Program once a client is admitted or discharged from Assisted Living Programs
13 Apr, 2015 44 kb Downloads: 3427
MAP-259H Consumer Intent to Return/Not Return Home Download
MAP-259H Intent to Return Home 2008-06-20.pdf
This form is used when a client enters a residential facility and makes a determination that he/she will either return or not return home.
13 Apr, 2015 236 kb Downloads: 4450
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