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New York City Government
Contact list at NYC Medicaid Program (MICSA) - by Program with directors - 12/2013 Download
MICSA Contact List 12-2013.pdf
Obtained through freedom of information request by Urban Justice Center, Feb. 2014
10 Mar, 2014 50 kb Downloads: 9467
HRA Alert: Spousal Impoverishment Budgeting for MLTC Applicant/Recipients Download
Medicaid Alert Re Spousal Impv Budgeting 3-2014.pdf
Published in March 2014
05 Mar, 2014 153 kb Downloads: 3092
NYC HRA 2013 MAP INF-04 Spousal Refusal Instructions - Supplement to MAP Procedure 90-10 Download
2013 MAP INF-04 Spousal Impoverishment Correction.pdf
A community spouse is entitled to the community spouse monthly income allowance (CSMIA) even if she does a spousal refusal to contribute resources. See NYS ADM 91-ADM-33 and NYS DOH Medicaid Reference Guide at page 396. However, since mid-2012, the NYC HRA Medicaid program has violated this longstanding state rule and has denied the community spouse this income allowance if she executed a spousal refusal. Many fair hearing decisions reversed these determinations, see, e.g. FH 6208131N (3/1/2013), FH 6318971R (9/5/2013). In December 2013, the Elder Law Section of the NYS Bar Association asked HRA to cease this unlawful practice of denying this impoverishment allowance. Through a Freedom of Information request, the Bar identified some internal HRA procedures that were wrong and asked that HRA correct them. On Dec. 24, 2013, HRA issued 2013 MAP-INF 04 which correctly states that the community spouse is entitled to the CSMIA even if she does a spousal refusal, if she provides complete information regarding income and resources.
04 Mar, 2014 36 kb Downloads: 2970
MAP-628C MBI-WPD documentation checklist Download
MAP-628C MBI-WPD documentation checklist.pdf
Supplemental form to be submitted with a MBI-WPD application.
18 Feb, 2014 143 kb Downloads: 3269
MAP-101 MBI-WPD prescreening document Download
MAP-101 MBI-WPD prescreening document.pdf
Document to be submitted to HRA accompanying a MBI-WPD application.
18 Feb, 2014 76 kb Downloads: 3559
State Dept of Health and NYC HRA Medicaid program contacts Download
Medicaid phone list.pdf
NYC Medical Insurance & Community Services Administration (MICSA) CONTACT LIST
with some NYS Dept. of Health contact information
Compiled by NYLAG Evelyn Frank Legal Resources Program
14 Jan, 2014 224 kb Downloads: 53590
Letter Dec. 23, 2013 from Roy Esnard, General Counsel NYC HRA re Community Spouse Monthly Income Allowance in Spousal Refusal cases Download
Esnard Letter 2013-12-23 CSMIA.pdf
Letter in response to 12/18/2013 letter sent by NYS Bar Association Elder Law Section demanding that HRA cease illegal practice of denying Community Spouse Monthly Income Allowance to community spouses who did a Spousal Refusal
02 Jan, 2014 79 kb Downloads: 2757
NYC HRA PowePoint on New Medicaid application procedures for 2014 under Affordable Care Act Download
EIS Overview of Upcoming Changes - ACA implementation.pdf
PowerPoint was presented for certified Client Representatives who have completed a certification to be authorized submitters of Medicaid applications to HRA. However, information in this may be generally applicable.
20 Dec, 2013 3.28 mb Downloads: 1297
MAP-2161 - Spousal / Parental Refusal Form Download
MAP-2161 Spousal Refusal combined.pdf
Applicants for Medicaid in New York City can use these 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. 12/6/2011 & 3/13/2013
17 Dec, 2013 172 kb Downloads: 43593
HRA MICSA Medicaid Alert - Waiver Look-Alikes May become Exempt from Managed Care for 6 Months Download
Alert 2012-9-19 Managed Care Waiver Lookalikes Exemption.pdf
Alert 9/19/2012 The purpose of this Alert is to inform Community Based Organizations, Client
Representatives, Certified Home Health Agencies and other providers that the waiver
“look-alikes” exemption for managed care ended September 1st.

This exemption had been available for consumers who have the same characteristics and needs as
consumers enrolled in Medicaid waiver programs such as Traumatic Brain Injury,
Care at Home, Home and Community Based Services for the Developmentally
Disabled, and the Nursing Home Transition Waiver, but are not enrolled in a waiver

Such consumers may decide they now want to apply for a waiver program or
designation as developmentally disabled. Because this process may take more than
30 days, SDOH has decided to allow an exemption for up to six months for non -
dually eligible consumers who are in the process of applying for a waiver program or
designation as developmentally disabled. To qualify for this exemption, consumers
must call NY Medicaid Choice at 800-505-5678, to inform staff that they are applying
for waiver services.
09 Dec, 2013 51 kb Downloads: 3634
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