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document Income and Resource Limits for New York State Public Health Insurance Programs
Click here for NYS Medicaid Income and Resource Levels Chart for 2017 (NYC Human Resources Administration publishes chart annually based on NYS Dept. of Health figures). Chart shows income and resource limits for Medicaid and other public health insurance programs in New York State, including the...
document Medicaid Personal Care or Home Attendant Services
The Medicaid program in New York State covers a type of home care services called Personal Care services (aka PCS or "home attendant"). Covered in this article: * Law and regulations 1. What are Personal Care Services? 2. Eligibility 3. Scope of Tasks 4. How does one Obtain Personal Care...
document Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
WHO MAY BE HIRED AS THE PERSONAL ASSISTANT? Changes effective APRIL 1, 2016 An adult who is not "legally responsible" for a Medicaid consumer's care and support may be a CDPAP assistant for that consumer. In particular, this means that a parent of...
document Step-by-step guide to enrolling in a pooled income trust for Medicaid spend-down
This article is intended as a condensed road-map for using a pooled income trust to eliminate the Medicaid spend-down. This article contemplates that the individual is applying for Medicaid in order to obtain home care services. The sequence of events will be different if that is not the case. I...
document Managed Long Term Care
State Complaint Number for MLTC Problems - 1-866-712-7197 e-mail mltctac@health.ny.gov and put "COMPLAINT" in subject line For enrollment complaints - call NY Medicaid Choice - 1-855-886-0570 (Advocates line) 1-888-401-6582 (Consumers line) Managed Long Term Care (MLTC)...
document Medicaid Spend-Down
Because Medicaid is a health insurance program for the poor, one must have income and assets below a certain limit to be eligible. For a single elderly or disabled person in New York State in 2017, these limits are $825/mo. of income and $14,850 in total assets. (The income limits for people...
document Medicare Savings Programs (MSP) in New York
Funded by the State Medicaid program, Medicare Savings Programs (MSPs) help eligible individuals meet some or all of their cost-sharing obligations under Medicare. See N.Y. Soc. Serv. L. § 367-a(3)(a), (b), and (d). There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB)...
document Medicaid Assisted Living Programs (ALP) in NYS
INTRODUCTION The Assisted Living Program provides supportive housing and home care services to individuals who are medically eligible for placement in a nursing facility but, whose needs can be met in a less restrictive and lower cost residential setting. he operator of the assisted living...
document Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL Status and Procedure
2017 ALERT - As of March 5, 2017, the law explained in this article is still in effect. The Trump Administration has not changed the law on immigrant eligibility for Medicaid or other public benefits and has not changed the rules on when someone who receives Medicaid or other government benefits...
document Medicaid Certified Home Health Agency (CHHA) Services
A Certified Home Health Agency (CHHA) provides what is commonly known as “visiting nurse” services, as well as physical or occupational or speech therapy (PT/OT) in the home, "home health aide" (HHA) services, and medical supplies. The nursing visits are "part-time or intermittent " and NOT...
document List of Pooled SNTs in New York State
This is an unofficial list of non-profit organizations in New York State that offer pooled Supplemental Needs Trusts (or similar services) to people with disabilities. We do not claim that this is an exhaustive list; there may be other pooled trusts in the state of which we are unaware. In...
document Medicaid Dental Benefit
Medicaid Dental Benefit Under Medicaid, dental benefits exist, but the coverage is limited. This limited coverage makes it important for advocates to understand the exceptions to different coverage limitations. By understanding the nuances of the benefit, advocates can help get their clients...
document "FIDA (Fully-Integrated Dual Advantage)" - Managed Care Expansion for Dual Eligibles in NYC Metro Area - Delayed Until Jan. 2015
Fully Integrated Dual Advantage demonstration program has started: NYC and Nassau (Region I), with the first "voluntary" opt-i enrollment effective January 2015, and "passive enrollment" scheduled for those who do not OPT OUT on April 1, 2015. 2-27-2015 NEWS: Westchester & Suffolk...
document Medicaid Reimbursement of Home Care and other Medical Expenses
Reimbursement in General Because Medicaid coverage can be retroactive up to three months, it is possible for a Medicaid applicant or his or her family member who paid the applicant's medical expenses to get reimbursed for some of the home care costs and other medical bills they incurred and paid...
document Family Health Care Decisions Act
New York’s Family Health Care Decisions Act (FHCDA)(Chapter 8 of the Laws of 2010, adding Public Health Law Ch. 29-CC and 29-CCC) allows a patient’s family member or close friend to make health care decisions for a patient who is in a hospital or nursing home, if the patient lacks decisional...
document Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections
Medicaid rules are different for people living in the "community" than people living in institutions. For this article, the word "institution" means nursing home care. If you live in your home, someone else's home, or an Assisted Living Program, you are considered to live in the "community." ...
document Medicaid Home-and-Community-Based Waiver Programs in New York State
Medicaid home and community-based services [HCBS] are available through waiver programs to groups of individuals who would be eligible for Medicaid if institutionalized and, but for the services, would be institutionalized in a hospital or nursing facility. Under section 1915(c) of the Social...
document Where to Apply for Medicaid and Medicaid Home Care in New York City
. Changes in how people apply for and receive Medicaid personal care services occurred in September 2012, followed by major changes for how all people under age 65 applied for Medicaid in 2014, when the NY State of Health Exchange was launched to accept Medicaid applications under the Affordable...
document New Application Form (2010, updated 3/2015) Used for Medicaid, Child Health Plus and Family Health Plus in New York State
Since 2010, the New York State Department of Health has used a uniform 6-page application form to be used for Medicaid called the Access NY Application or form DOH-4220. Download the form at this link - scroll down to Application for Non-MAGI. As of October 2016, the form was last updated in...
document Medicaid Managed Care
I – WHAT IS MEDICAID MANAGED CARE? Most, but not all Medicaid beneficiaries in New York State who do not have Medicare must now join a "mainstream" Medicaid managed care plan. Law and Regulations: N.Y. Soc. Servs. L. §364-j (Amended L. 2011 Ch. 59). Regulations at 18 NYCRR...
document Applying for Medicaid Personal Care or CDPAP Services in New York City - 2016 Changes
Where and how to apply for Medicaid personal care services and Consumer Directed Personal Assistance program (CDPAP) services has drastically changed with the implementation of mandatory Managed Long Term Care in New York State under a federal waiver that was approved September 4, 2012. The...
document Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants - Changes 2013
Enrolling in "Emergency Medicaid for undocumented immigrants and maintaining eligibility should be easier under a new 2013 policy eliminating the form physicians were previously required to fill out DOH-4471 form for the Certification of Ttreatment of an Emergency Medical Condition.(revised...
document Tools for Choosing a Medicaid Managed Long Term Care Plan
As described in this article, most adults in NYC, Westchester, Nassau and Suffolk counties who have Medicaid and Medicare, who are receiving Medicaid home attendant or housekeeping ("personal care") services through their local Medicaid "CASA" office, or long-term CHHA or adult day care services,...
document Keeping Medicaid after Cash Public Assistance or SSI Benefits Are Terminated
Scenarios: Susie is 49 years old and single, with no children. She has been receiving cash public assistance and Medicaid for three years, while she appeals the denial of Social Security Disability Insurance Benefits ("SSD" or "DIB"). She finally was approved for SSD, and will start receiving...
document Air Conditioners Available to Low Income People with Medical Needs - 2014 Cooling Assistance Program
Note: Medicaid also may sometimes pay for an air conditioner. See article. HEAP-funded air conditioners are available in limited supplies to low income people in NYS who have ongoing medical conditions made worse by heat. The 2014 HEAP cooling assistance program is available from May 1, 2014...


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