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Elimination of the Resource Tesr for all non SSI |Related Medicaid Consumers Download
HRA MICSA Alert Elimination of Resource Limit for Non-SSI Related Medicaid Jan 2010.pdf
22 Oct, 2010 66 kb Downloads: 1411
MAP-931 Explanation of Excess Income Program Download
MAP-931 Explanation of Excess Income Program.pdf
HRA Explanation of the Excess Income or "spend-down" or "surplus income" program. Note this is an HRA publication and advocates may disagree with interpretation of rules. See Selfhelp advocacy materials posted on this site.
13 Sep, 2010 129 kb Downloads: 4960
MAP-931A Explanation of Medicaid Pay-In Program Download
MAP-931A Optional Pay-In Program.pdf
NYC HRA Explanation of Medicaid Pay-In Program for Spend-down
13 Sep, 2010 139 kb Downloads: 5377
MAP-931B Agreement to Participate in Pay-In Program Download
MAP-931B Agreement to Participate in Pay-In Program.pdf
HRA Form for enrolling in Pay-In Program for Spend-down
13 Sep, 2010 84 kb Downloads: 3636
Medicaid Alert - Pooled Trust Submissions Download
medicaidalert HRA 4-06.pdf
Medicaid Alert issued by NYC Human Resources Administration instructing HRA staff how to process applications and renewals for consumers with pooled supplemental needs trusts. Dated April 26, 2006.
08 Sep, 2010 52 kb Downloads: 2039
NYC Medicaid Facts Alert - Pooled Trust Contributions Excluded Download
NYCMedicaidFactsAlert.pdf
Publication from NYC Human Resources Administration regarding exclusion from income budgeting of excess income contributed to a pooled supplemental needs trust (SNT). Dated May 2004.
08 Sep, 2010 53 kb Downloads: 3204
HEAP Cooling Assistance Application Locations Download
Cooling Assistance NYC.pdf
13 Jul, 2010 76 kb Downloads: 1864
Sample HRA QMB Recertification Form Download
DAB Renewal.pdf
Sample of new recertification form that specifically refers to QMB. Actual recertification form will be prepopulated with the QMB recipients information. In use as of January 2010.
11 Jun, 2010 166 kb Downloads: 37794
MAP 2050J--Home Equity Statement Download
MAP-2050J Home Equity Statement_Fillable.pdf
This form must be submitted if Medicaid applicant owns a home (or coop etc).
27 May, 2010 93 kb Downloads: 930
Map 2050J--Declaration of Income or Support Download
MAP-2050A Declaration of Income or Support.pdf
This form is used by the NYC Medicaid Program. It allows the family member or friend of a Medicaid applicant providing in-kind income or support to the applicant to document the kind of support provided, when it began, and whether it would continue. The form must be signed by the person providing support and the Medicaid applicant.
27 May, 2010 58 kb Downloads: 11770
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