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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: 3352
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: 53010
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: 2621
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: 1123
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: 41714
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: 3485
NYC HRA: MLTC Frequently Asked Questions (HCSP Quick-Reference-03 revised 11/13/2013) Download
MLTC Frequently Asked Questions HCSP Quick Reference- REVISED 11-13-2013.pdf
FAQ clarifying issues that pose barriers to enrollment into MLTC plans. Many of these problems stem from "coding" problems - eligibility codes in the Medicaid "eMedNy" system. This FAQ explains that some codes may appear to say the individual is not eligible for Medicaid or for MLTC -- but THEY DO NOT MEAN THAT! And plan should submit "conversion package" to HRA to activate Medicaid and allow enrollment.
15 Nov, 2013 178 kb Downloads: 3277
MAPDR-21 - Medicaid Managed Care Exemptions and Exclusions Download
MAPDR-21 Medicaid Managed Care Exemptions and Exclusions.pdf
This documents lists which categories of beneficiaries are exempt or excluded from the requirement of joining a mainstream medicaid managed care plan. Rev'd 9/23/13
27 Sep, 2013 55 kb Downloads: 7978
CASA Directory Updated 9-18-13 Download
Medicaid Alert CASA List 9-18-13.pdf
CASA field offices have been consolidated. There is one CASA office per borough.
23 Sep, 2013 70 kb Downloads: 3371
NYC HRA MICSA Alert - MLTC Submissions of Nursing Home Enrollments - Feb.14, 2013 Download
Medicaid Alert 2-2013 NH to MLTC.pdf
Special procedure for MLTC plans to submit "conversion" package to NYC HRA Medicaid program, to enroll residents of nursing homes who want to enroll in an MLTC plan in order to return to the community.

In all MLTC enrollments, the conversion package is a set of forms that HRA needs in order to make the necessary entries into the Medicaid eligibility and billing system, so that the enrollment takes effect on the 1st of the following month, and so the MLTC Plan is paid its capitation rate. Once in MLTC, the member will not be able to access Medicaid services in the MLTC service package outside the MLTC Plan's network.

For nursing home residents, the "conversion" is more complicated. HRA not only has to enter the codes described above but also has to remove the codes that applied because of the residence in the nursing home. For many years, nursing home residents have encountered delays in lifting the nursing home "code" from their eligibility, so that they could now access community-based home care and other medical services. The conversion package must include:

(1) The HCSP-3022 (Medicaid Cover Sheet) - This is the conversion form.. A copy is or will be posted on this website.
(2) Completed Nursing Home discharge Alert (MAP-259D)(posted at http://www.wnylc.com/health/download/132) and see article at http://www.wnylc.com/health/entry/117/ )
(3) A copy of the signed enrollment form
(4) A copy of the MAP-3057 (Special Income Standard) form, if applicable (posted at http://www.wnylc.com/health/download/398/) and described in http://www.wnylc.com/health/entry/114/ - last link in Table of Contents
05 Sep, 2013 284 kb Downloads: 945
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