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MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Russian) 2019-03-2 Download
MAP-931a (Russian) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Russian) 2019-03-22 updated 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.
24 Aug, 2019 140 kb Downloads: 178
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Spanish) 2019-03-22 Download
MAP-931a (Spanish) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Spanish) 2019-03-22 updated 2019-03 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.
24 Aug, 2019 66 kb Downloads: 175
Medicaid income and resource levels - 2019 Download
2019 Income and Resource Levels - 2019-04-04.pdf
NYC HRA Form MAPDR-01
2019 NYS Income and Resource Standards and Federal Poverty Levels (FPL)
Dated 04-04-2019
01 May, 2019 368 kb Downloads: 402036
Transitioning of MAGI-like Medicaid Cases from DSS/HRA Medicaid to NYSOH Download
2019-02-18 Transitioning of MAGI-like Medicaid Cases from DSS.HRA Medicaid to NYSOH.pdf
Since the New York State of Health was introduced in 2014, it has been responsible for all MAGI Medicaid cases. However, there were many Medicaid consumers with MAGI-like budgeting who were found eligible before January 1st, 2014. Their cases have remained with HRA until they could be transitioned. Those consumers will now be transitioned in two phases: one in June 2018 and one in April 2019. The alert details which groups of MAGI-like recipients will and will not be transitioned. Some groups that are excluded from the transition are consumers with the Medicare Savings Program and consumers who are 64 years of age.
01 Mar, 2019 58 kb Downloads: 651
MAPDR-05 (02/20/2018) List of Managed Care & Managed Long Term Care Plans in NYC Download
2019-02-05 MAPDR-05 Managed Care Plan Lists with ID Numbers.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)
* Medicaid Advantage (for dual eligibles)
* 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)

Updated February 20, 2018
20 Feb, 2019 104 kb Downloads: 46462
HRA Medicaid Alert 12/18/18 - Change in Email address to send HRA Office of Legal Affairs Draft SNTs for Review Download
2018-12-18 Referrals of Draft SNTs to Office of Legal Affairs (OLA) Change of Email address.pdf
This change is only where to submit DRAFT trusts. It does not affect how to submit EXECUTED supplemental needs trusts and pooled trusts, which is to submit them to the Medicaid office processing the Medicaid case (Home Care Services Program if seeking or has home care or MLTC). See more about where to submit executed trusts at http://www.wnylc.com/health/entry/44/.
02 Jan, 2019 176 kb Downloads: 882
NYC Medicaid Alert: 12/31/18 - HRA Contacts in Medicaid and Home Care Services Programs Download
2018-12-31 HRA Medicaid & HCSP Contacts for Authorized Submitters and CBO's.pdf
Listing of contacts in Medicaid and Home Care Services Programs, intended for use by Hospitals, Authorized Client
Representatives, Providers, Certified Home Health Agencies (CHHA’s), Community Based Organizations
(CBO’s) and other entities
02 Jan, 2019 93 kb Downloads: 2462
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2018 Download
2001_to_2018_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2018. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
02 Jan, 2019 3.24 mb Downloads: 282949
MAP-2161 and MAP 2161a Spousal / Parental Refusal Form (2018-05-11) (ENGLISH) Download
MAP-2161 + 2161a Spousal Refusal English 2018-05-11.pdf
Applicants for Medicaid in New York City can use this "APPLICANT/RECIPIENT DECLARATION CONCERNING THE LEGALLY
RESPONSIBLE RELATIVE’S INCOME/RESOURCES" forms to indicate the refusal of their legally responsible relative to make available their income or resources for the cost of necessary medical care and services, i.e. "spousal/parental refusal." Rev. 5/11/2018 to include language to request accommodation of disability in reading notice. NOTE: Use MAP2161 if applicant is indicating spouse's or parent's refusal and 2161a for refusing spouse or parent to indicate refusal. Can submit either form - don't need both. Both attached in same PDF.
24 Aug, 2018 182 kb Downloads: 53135
NYC HRA MICSA Alert 4/26/18 -Disability Form Completion when Submitting Pooled Trusts Download
2018-04-26 Disability Form completion for Pooled Trust Submission.pdf
Reminder to Submit Completed LDSS-1151 with work history to Approve Pooled Trust - for people age 65+. This Alert is unclear re whether must include history even if no work done in last 15 years. It says don't need to explain physical requirements of job unless done in last 15 years, but unclear if must still list jobs done more than 15 years ago.
12 Jul, 2018 148 kb Downloads: 1762
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