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NYC Medicaid Alert 6-30-2022 - Change in Submissions to HRA for Disability Determination for Pooled Trusts & MBI-WPD (revises 5/31/22 Alert) Download
2022-6-30 MA Alert Disability Determination by New York State Medicaid.pdf
Eff. June 1, 2022, submissions to HRA to approve a Pooled Trust or MBI-WPD no longer need to include the disability forms (DOH-5141, DOH-5143, Authorization MAO-751e, AIDS report form MAP 252F. Instead, once the pooled trust is filed with HRA, HRA will route it to NYS DOH Disabilitiy Review Team, which will then request MAP 3177 Disability Determination Request from the consumer. Unclear if other documentation will be required but likely - stay tuned look for updates at http://www.wnylc.com/health/entry/44/ (This revises the Alert issued May 31, 2022
01 Jul, 2022 148 kb Downloads: 665
2022-0-5-13 New York Independent Assessor Download
2022-05-13 New York Independent Assessor.pdf
Beginning May 16, 2022, any adult 18 and older seeking fee for service (FFS) Personal Care Services (PCS) and/or Consumer Directed Personal Care Services (CDPAS) for the first time or seeking initial MLTC plan eligibility must be referred to the New York Independent Assessor (NYIA) for their Community Health Assessment (CHA) and Clinical Appointment (CA). This change does not include the Immediate Needs process at this time. NYIA will conduct independent assessments, provide independent practitioner orders, and perform independent reviews of high needs cases for PCS and CDPAS. The NYIA will also take over the work currently done by the Conflict Free Evaluation and Enrollment Center (CFEEC) to assess individuals for MLTC plan eligibility.
23 May, 2022 93 kb Downloads: 250
DOH-5130 Form Download
DOH form 5130_updated 9-2021.pdf
Per MICSA Alert dated 03-24-2022, if an older version than the revised DOH 4220 form - Access NY Health Care Application (updated as of 9-2021) is submitted, DOH 5130 (and OHIP-0112) has to be submitted.
31 Mar, 2022 23 kb Downloads: 226
Revised DOH-4220, Access NY Health Care Application (updated 8-2021) Download
DOH form 4220_updated 8-2021.pdf
This is the statewide DOH-4220 Medicaid Application form used to apply for non-MAGI Medicaid (updated 8/2021 but HRA just announced this change in an Alert dated 03-24-2022).
31 Mar, 2022 619 kb Downloads: 212
MICSA Alert re Revised DOH-4220, Access NY Health Care Application Download
2022-03-24 Revised DOH-4220 Access NY Health Care Application.pdf
The statewide DOH-4220 Medicaid Application form used to apply for non-MAGI Medicaid has been updated (dated 8/2021 but HRA just announced this change in this alert). If an applicant submits an older version of the form, the agency will continue to accept it and not require the applicant to complete the newer application form. However, copies of the OHIP-0112 and DOH-5130 would need to be sent with the older application. It has reminder that as of March 1, 2022, the DOH-5178A will be the only Supplement A accepted with the DOH-4220 application.
31 Mar, 2022 136 kb Downloads: 244
Medicaid income and resource levels - 2022 (3-16-22) Download
mapdr-01 2022 nys income and resource standards and federal poverty levels (fpl) (3-16-2022).pdf
NYC HRA MAPDR-01 (3-16-2022) -- 2022 NYS Income and Resource Standards
16 Mar, 2022 267 kb Downloads: 428836
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2021 Download
2001_to_2021_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2021. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
10 Mar, 2022 3.26 mb Downloads: 297183
2022-02-04 Changes to the LDSS-3183 Provider or MLTC Plan and Recipient Letter Download
2022-02-04 Changes to LDSS-3183 Provider or MLTC Plan & Recipient Letter.pdf
A Medicaid Recipient who submits medical bills from a Provider to meet the spenddown will receive an OHIP-3183 “Provider/Recipient Letter” indicating which medical expenses are the responsibility of the Recipient (and which the Provider should not bill to Medicaid). When the Recipient is enrolled with a Managed Long Term Care Plan (MLTC), the Recipient and the MLTC will receive an OHIP-0128 “MLTC/Recipient Letter” indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). These forms replace the LDSS-3183 form.
17 Feb, 2022 810 kb Downloads: 675
Contact List - Medicaid Managed Care Organizations in NYC Download
2021-12-30 MADPR-05 Medicaid Managed Care Plan.pdf
Contact List - Medicaid Managed Care Organizations in NYC (updated 12-30-2021)
09 Feb, 2022 150 kb Downloads: 1145
MAPDR-05 (12/30/2021) List of Managed Care & Managed Long Term Care Plans in NYC Download
2021-12-30 MADPR-05 Medicaid Managed Care Plan.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care
* Health and Recovery Plan Managed Care Plans (HARP)
* Managed Long Term Care (MLTC)
* Medicaid Advantage Plus (for dual eligibles, includes MLTC)
* HIV Special Needs Plans (SNP)
* Programs of All-inclusive Care for the Elderly (PACE)
* Fully Integrated Dual Advantage (FIDA) IDD

Updated February 9, 2022
09 Feb, 2022 150 kb Downloads: 57916
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