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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: 53668
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: 1890
NYC HRA MICSA Alert July 3, 2018 Transition of Rosenberg Cases to NYSofHealth from HRA for SIngles-Childless Couples Download
2018-07-03 Transition of Rosenberg Determ's for MAGI S-CC to NYSofHealth.pdf
The "Rosenberg" procedure is used when public assistance cash benefits are terminated, to allow the individual to recertify and maintain Medicaid without disruption if they are still eligible. See http://www.wnylc.com/health/entry/85/. Initially this change applies to Singles and Childless Couples, and not to anyone in an MLTC plan or HARP plan. They will receive a letter from HRA telling them they must renew their Medicaid online on NYS of Health. The Alert includes the form letter.
08 Jul, 2018 94 kb Downloads: 1251
NYC HRA MICSA Alert April 9, 2018 New Asset Verification System in Nursing Home Applications Download
2018-04-09 Asset Verification System.pdf
NYC Medicaid alert announcing new Asset Verification System (AVS) that has been rolled out statewide, and started in NYC in January 2018 in Nursing Home applications only, not in Community Medicaid applications. This system applies only in "non-MAGI" cases, meaning for people age 65+, disabled, or blind. This is because MAGI cases (< 65 and not on Medicare) do not have any asset limit.
08 Jul, 2018 928 kb Downloads: 1627
NYC HRA MICSA Alert June 25, 2018 Deferring Approvals of Trusts due to Power of Attorney without authority to Create Trust Download
2018-06-25 POA Deferring Medicaid Apps - POA not auth for SNT.pdf
Directive elaborates on HRA policy first announced in a MICSA Alert July 26, 2017 (posted on this site) - which requires a Power of Attorney to include a Statutory Gift Rider, if used to establish a Supplemental Needs Trust. This new alert says HRA will defer Medicaid applications where SNT signed by a POA without authority to create and fund the trust. If applicant has capacity to execute a new POA with an SGR, Alert suggests this can be submitted. Full meaning of Alert is not clear.
08 Jul, 2018 63 kb Downloads: 1634
NYC HRA Medicaid Alert 2018-01-10 Corrected Mailing - Medicare Enrollment Download
2018-01-10- HRA MICSA ALERT REVISED Must Apply for Medicare.pdf
See http://www.wnylc.com/health/entry/185/
24 Jan, 2018 113 kb Downloads: 1558
Revised NYC HRA Notice to Medicaid Recipients Age 65+ Must Apply for Medicare (1-6-2018) Download
2018-01-06 Revised MA Notice Medicare Enrollment (Redacted).pdf
Notice sent to 5000 NYC Medicaid recipients age 65+ on Jan. 6, 2018 revoking an earlier Dec. 2017 notice and replacing it.. telling them they must apply for Medicare or risk having Medicaid discontinued. See http://www.wnylc.com/health/entry/185/
24 Jan, 2018 128 kb Downloads: 1493
NYC HRA Medicaid Form MAP 3062c Request for Time Extension - Applying for Medicare Download
MAP-3062c Request for Time Extension- Medicare App (Fill-able).pdf
New HRA form designed to request extra time to submit proof that you applied for Medicare, as newly required as a condition of obtaining or keeping Medicaid. This form is an adaptation of new Form MAP 3062c, which is for requesting extra time to submit documents generally in applications and renewals. 3062c is limited to max 30 days, while 3062c allows you to specific any number of days extension. This is a fill-able form.
24 Jan, 2018 65 kb Downloads: 1366
NYC HRA Medicaid Form MAP-3062a Request for a Time Extension (12/5/17)(fillable) Download
MAP-3062a Request for a Time Extension (12-5-17) Fillable.pdf
Used for applications, renewals, and the new requirement to apply for Medicare for those age 65+. "I am unable to provide the documentation that HRA requested at this time. I am requesting additional time past the deferral due date that HRA provided. I understand that this extra time may delay the final processing of my case which could result in an eligibility determination taking longer than the normal case processing timeframe of 30 days for a case containing a child, 45 days for a case containing adults only, or 90 days for a case based on a disability." Asks to specify if this is initial extension request or later. This is a fill-in-able form.
11 Jan, 2018 66 kb Downloads: 1836
NYC HRA Insert to Medicaid Applications and Renewals - Must Apply for Medicare (MAP 3134e) Download
MAP3134e - DAB insert renewal and apply for Medicare (1-20-17).pdf
Insert in all Medicaid renewals and applications informing people age 65+ or approaching age 65 that they must apply for Medicare. Notice does NOT say they need only apply if they meet Medicare immigration status requirements and have incomes under 120% FPL.
22 Dec, 2017 393 kb Downloads: 1380
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