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NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2019
2001_to_2019_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2019. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
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19 May, 2020
3.71 mb
Downloads: 287280
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NYC HRA Medicaid Alert April 16, 2020
2020-04-16 Fax Submissions to MICSA & HCSP.pdf
HRA Alert with fax numbers for authorized submitters and providers to fax applications and other requests to various HRA Medicaid units - during the COVID-19 epidemic. The fax number posted at https://www1.nyc.gov/site/hra/locations/medicaid-locations.page for the PUBLIC to fax applications is not on this list - it is 917-639-0732
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17 Apr, 2020
172 kb
Downloads: 221
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HRA Medicaid alert 2020-04-06 Authorized Client Representatives - COVID-19 Application Submissions by E-fax
2020-04-06 MICSA Alert c-rep applicaitons e-fax.pdf
Establishes new e-Fax number for "C-Rep" Authorized client Representatives for Medicaid applications not submitted electronically by EDITS. e-Fax 917-639-0731.
Requests ONE application be submitted per fax, with cover page listing all documents attached. Says not for MLTC application submissions (unclear what this means)
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13 Apr, 2020
129 kb
Downloads: 152
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Medicaid income and resource levels - 2020
2020 HRA chart medicaid 2019-12-31.pdf
NYC HRA Form MAPDR-01
2020 NYS Income and Resource Standards and Federal Poverty Levels (FPL)
Dated 12-31-2019
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26 Feb, 2020
232 kb
Downloads: 408813
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Sample NYC Stenson Notice (revised 2015) with Renewal form (revised 2013)
MAP-909 (English) Stenson Notice (1-15-2015) with 3074 form (10-16-2013).pdf
Notice used in NYC to advise a former SSI recipient of the procedure to have continuing Medicaid eligibility determined, with Renewal form to be completed and returned (MAP 909 and MAP 3074)
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15 Jan, 2020
2.02 mb
Downloads: 5369
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MAPDR-21 - Medicaid Managed Care Exemptions and Exclusions
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
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03 Jan, 2020
71 kb
Downloads: 10437
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MAP-751K Consumer Request to Change Information on File
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)
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09 Nov, 2019
45 kb
Downloads: 3068
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Consumer Directed Personal Assistance Application - NYC HRA Home Care Services Program
M-13d - CDPAP Application (2018-04) Fill-able.pdf
From M13d, rev. 4/2018, which a NYC consumer or person directing his/her care must complete and have approved by the CASA in order to enroll in the Consumer Directed Personal Assistance Program (CDPAP). Made fill-in-able by NYLAG EFLRP.
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22 Oct, 2019
151 kb
Downloads: 3761
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NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (Bengali)
MAP-931a (Bengali) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (Bengali) to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear. Other languages now posted on this site
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24 Aug, 2019
145 kb
Downloads: 566
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MAP-931A Explanation of Medicaid Pay-In Program (English) (updated 2013-03-22)
MAP-931a (English) 2019-03-22.pdf
NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (English) to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear. Other languages now posted on this site
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24 Aug, 2019
59 kb
Downloads: 8458
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