Medicaid Alerts & Other Protocols published by the NYC HRA Medical Insurance and Community Services Administration (MICSA)

HRA MICSA Alerts are periodic announcements of policy, staff and office changes published by the Medical Insurance and Community Services Administration (MICSA). MICSA is the part of New York City’s Human Resource Administration (HRA) that administers HRA’s medically- related programs such as the Medical Assistance Program (MAP). MAP determines which New Yorkers are eligible for Medicaid and Family Health Plus. MICSA also administers the Home Care Services Program (HCSP). HCSP CASA's administer NYC'S home care programs for Medicaid eligible elderly and disabled New Yorkers.

When policy changes occur within MICSA’s programs considered important enough to be of concern to Home Care Providers, Home Health agencies, hospitals, and other community based organizations, MICSA sends out an announcement of the changes known as a Medicaid Alert. These announcements are sent out to community based organizations periodically throughout the year.

Medicaid Alerts may be useful by advocates in verifying policy changes to frontline Medicaid workers. We have compiled ones that are pertinent as of November 2010. They are organized in 3 general categories:

Medicaid Eligibility & Procedures - include applications, renewals, verification of citizenship/immigration status, etc.
Medicaid Home Care
Medicaid/CASA Office Relocations & Staff

Within each category, they are listed chronologically with a KEY TOPIC for ease in finding pertinent directives.

Please email us to provide any other HRA Medicaid directives that might be helpful to others..

MEDICAID ELIGIBILITY AND PROCEDURES

DATE TOPIC TITLE

2018

2018-07-28 Special Income Standard for Housing Expenses for Individuals Discharged from a Nursing Facility and
who Enroll into the MLTC Program - update on previous policy. See this article

2018-07-03 "Rosenberg" Medicaid Determinations after Public Assistance Discontinued - Shifted to NYS of Health

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 more here. Initially this change applies to Singles and Childless Couples, and not to anyone in an MLTC plan or HARP plan. Those affected will receive a letter from HRA telling them they must renew their Medicaid online on NYS of Health. The Alert includes the form letter.

2018-06-25 Pooled Trusts (SNT) Deferral of SNT's Submitted with Invalid Power Of Attorney.

Elaborates on earlier Alert of 2017-07-26 -- Powers of Attorney (POA) and Statutory Gift Rider required for Pooled Trusts. This directive says if an SNT is submitted that is signed with a POA without authority to establish a trust, it will be deferred, with opportunity for applicant to execute a new POA, presuming capacity to do so. It is unclear if the approval will be retroactive to initial submission of SNT.

2018-04-26 Pooled Trusts (SNT) Disability Form Completion when Submitting Pooled Trusts over age 65

Reminder to submit completed LDSS-1151 (revised 6/2012) with pooled trusts for those over age 65, or under 65 if they are not receiving SSD/SSI benefits. Implies that must complete Work History section even if work done more than 15 years ago, but don't have to enter physical demands of job if more than 15 years ago. Says should not cross out entire work section even if no work done in last 15 years.

2018-04-09 Nursing Home Applications - Asset Verification System (AVS) -

NYC rolling out Asset Verification System (AVS) that has been rolled out statewide. So far in NYC used 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.

2017

2017-12-13 Applications/Eligibility Requirements Medicare Enrollment Required. See this article for more info.

2017-12-04 Applications Application Dates and Deferral Timeframes - Changes deadline for applicants to respond
to a "deferral" or request by local DSS for additional documents to support application.
Everyone gets 15 calendar days to respond, except for nursing home applicants (5-year
lookback) get 21 calendar days. Consumer may request an extension by submitting new
form MAP-3062a manually to the department where they submitted application.
Decision granting or denying extension will be on form MAP-3062b (sample attached to the Alert.

2017-07-26 Pooled Trusts Powers of Attorney and Statutory Gift Rider - Requires that POA's executed after Sept. 1,
2009 must include a Statutory Gift Rider in order for agent to establish a pooled trust.

2017-05-11 Renewals Revised Disabled, Aged, Blind (DAB) Renewal Form and On-line Reprints of DAB on www.nyc.gov/accessnyc.

2017-04-26 Transportation New Contractor for NYC Medicaid transportation - LogistiCare - (formerly MAS - Medical Answering Services LLC) Has contact info.

2016

2016-12-15 Changes in Medicaid Coverage for Temporary Non-Immigrants Temporary Non-Immigrants

2016-09-23 Medicaid Applications & Personal Immediate Need Applications - Personal Care and CDPAP
Care & CDPAP Procedure and Transmittal Form HCSP 3052

2016-04-04 HIPAA Release MAP-751d Authorization for Disclosure of Health Information replaced by
OCA Form No. 960 - Authorization for Release of Health Information Pursuant to HIPAA Download Alert here.

2015

2015-10-28 Nursing Home & Managed Care Nursing Home Transition into Managed Care: Forms & PDF Training Material (lists new forms which are attached in PDF including:

MAP 259d - Discharge Alert for Non-Chronic Care Budget (Community Budgeting)(10-2015 revised)
MAP 259e (Change in Discharge Plan)
MAP 259f (Discharge Notice)
MAP 259g (Respite care)
MAP-259t - Request to Convert Case
MAP-2159 Notification of Change or Correction to File from nursing facility
MAP-2150i Notice of Permanent Placement - Medicaid Managed Care
MAP2159W Permanent Placement Disenrollment Request
MAP-648p - Submission of Request from RHCF - Residential Health Care Facility
NOTE - references PowerPoint which is not attached but posted here)

2015-10-26 Nursing Home & Managed Care - MICSA/NHED Submission Protocol for Transition of Nursing Home Benefit into Medicaid Managed Care

2015-08-31 Spend-Down/ Surplus NYC MICSA Alerts 8/31/15 & 5/18/15 re Payment of Surplus Bills or Pay-in by Third Parties with accompanying form MAP-3107a Attestation of Use of Recipient Funds to pay Surplus

2015-06-15 Nursing Home MAP-648 P Nursing Home Medicaid Transmittal

2015-06-03 MA Eligibility-MAGI Treatment of Income of a Dependent under MAGI-Like Budgeting. Implements NYS DOH GIS GIS 15 MA/008 - Treatment of Income of Dependents Under MAGI-like Rules PDF

2015-06-02 Nursing Home Policy Change for the Start Date of the Transfer of Assets Look Back Period

2015-03-10 MA Eligibility Newborn Processing Update

2015-04-27 MA Eligibility MAPDR-01 2014 NYS Medicaid Income & Resource Standards with Federal Poverty

Levels (new version includes MAGI as well as NON-MAGI income levels)

2015-04-03 Nursing Home Transition of Long Term Nursing Home Benefit into Medicaid Managed Care

2015-03-31 Nursing Home Nursing Home Eligibility Division Expedited Renewal Protocol

2015-03-10 Transition Exchange to LDSS Consumers with Medicaid on Exchange Needing Enrollment into MLTC or

HIV SNP

2015-03-10 MA Eligibility Automated Newborn Processing on WMS

2015-02-20 MA Eligibility Reinstatement of Suspended Medicaid Coverage for Formerly Incarcerated Individuals

2015-02-03 MA Eligibility Medicaid Recipients Transferred at Renewal from NYS of Health to Local Dept. of Soc. Services

Procedure for transitioning people from expanded "MAGI" Medicaid generally for people under 65 who do not have Medicare -- when they turn 65 or become enrolled in Medicare, they must transfer to Non-MAGI Medicaid, using a stricter income and resource test. The procedure provides some coverage to fill the gap during the transition. It implements State DOH 14-LCM-02 PDF (Dec. 2014) with Attachments to State DOH LCM:

Attachment I -Renewal form notice language and Medicaid Renewal Form
Attachment II - Statewide Provider IDs (Medicaid managed care plans)
Attachment III - Recipient Referral Information - Data Elements

2015-01-26 MLTC CASA Fact Sheet

2015-01-05 MA Eligibility Consumers Transition from NYSOH to WMS update

2014

2014-12-09 MA Eligibility 8 Helpful Hints for Accurate Completion of the Medical Request for Home Care (M11Q)

2014-10-24 MA Eligibility MAGI Consumers Long Term Eligibility Rules

2014-09-26 MA Procedures Incorrect Stenson Notices to Some (2500) SSI Consumers

2014-08-26 MA Eligibility HRA MAP Form 3097 Request for Budgeting Recipients with Excess Income Who May

Be MAGI Eligible (PDF includes FORM 3097)

2014-06-10 MA Procedures Submission of Medicaid Application Reconsideration and Reapplication Requests - cites

to Request for Reconsideration Form MAP3069b (click here) and 3069c (unavailable)

2014-06-11 MA Eligibility Consumers with Medicaid Coverage on the NYSOH (Marketplace) whose Coverage Must be Transitioned to WMS

2013

2013-12-24 Nursing Home Budgeting 2013 MAP-INF 04: Spousal Refusal Instructions - Supplement to MAP

Spousal Impoverishment Procedure 90-10 (community spouse entitled to spousal impoverishment monthly income allowance (CSMIA) even if does spousal refusal as to assets) (revised per Esnard letter)

2013-12-24 MA Eligibility Important Changes in Medicaid Application Submissions-MAGI & Non-MAGI

2013-12-20 MA Eligibility Substantial Home Equity (Nursing Home and Community-Based LTC)

2013-12-16 MLTC Spousal Impoverishment & Transfer of Assets for Certain Individuals Enrolled in MLTC

2013-12-13 Transportation Public Transportation Reimbursement Change

2013-11-13 MLTC FAQ - procedures for MLTC plans to enroll members who have a spend-down.

References Form HCSP-3022 known as MLTC Conversion Form (9/26/2013)

2013-10-1 Health Exchange NYS Health Benefit Exchange Opens October 1, 2013

2013-8-13 MLTC Disenrolled Housekeeping Case Consumers (MLTC)

2013-5-6 Office Relocation PHASE V-Relocation of MICSA 34th Street Offices to Brooklyn

2013-5-1 Office Relocation SPECIAL TBI & NHTD-Relocation fo MICSA 34th Street Office to Brooklyn

2013-4-30 Office Relocation PHASE IV-Relocation of MICSA 34th Street Offices to Brookyn

2013-4-24 Office Relocation PHASE II-III-Relocation of MICSA 34th Street Offices to Brooklyn

2013-4-18 LTHHCP\Lombardi Mandatory Enrollment of LTHHCP Consumers in Managed Care

2013-4-16 Office Relocation PHASE I-Relocation of MICSA 34th Street Offices to Brooklyn

2013-4-3 Office Relocation Relocation of MICSA 34th Street Offices to Brooklyn

2013-3-05 MA Eligibility Social Security Verification--No Proof of SSA Income Required at Applications or Renewals

2013-2-19 MLTC Special Income Standard for Housing Expenses for Individuals Discharged from NH to MLTC

MAP-3057E Special Income Standard for Housing Expenses Form, which must be completed and filed with HRA to ensure the proper budgeting of the case

2013-2-14 MLTC MLTC Submissions of Nursing Home Enrollments

MLTC FORM ** References Form HCSP-3022 known as MLTC Conversion Form (9/26/2013)

2013-1-24 Pooled Trusts Medical Evidence Gathering for Adult Disability Determinations

2012

2012-12-28 Transportation

Medicaid Transportation Management for Mainstream Medicaid Managed Care

2012-11-13 PAY-IN Spend-Down UPDATE: Temporary Relocation of DARB Unit that Processes Pay-In Program Payments (amends 2012-11-09 Alert)

2012-11-02 Hurricane Relief Medicaid Coverage - Hurricane Sandy

2012-10-26 Home Care, Managed Care Consumer-Directed Personal Assistance Program (CDPAP) and Managed Care

CDPAP must be accessed through Medicaid managed care plans effective 11/1/12 for those enrolled in these plans (people with Medicaid but not Medicare statewide), or through Managed Long Term Care plans, for people who have Medicaid and Medicare in NYC

2012-09-21 Renewals RENEWAL STATUS INFORMATION FOR MEDICAID CONSUMERS (status of renewal available

for calling HRA Helpline 1-888-692-6116

2012-09-19 Managed Care Ending Managed Care Exemption for "Waiver Look-Alikes" - but allowing 6-month exemption for

people not in but applying for a waiver

2012-09-06 Managed Long Term Care Mandatory Enrollment into Managed Long Term Care

2012-07-03 Managed Long Term Care Mandatory Enrollment into Managed Long Term Care

2012-03-27 Managed Care MAPDR-21 Medicaid Managed Care Exemptions and Exclusions

2011

2011-12-30 MANUAL MAILING - Discontinued Manual Mailing of Medicaid Alerts

2011-05-03 RENEWALS - Expansion of Attestation of Income, Resources, and Residence for SSI-related (DAB) Renewals

Announces expansion of ability to "attest," rather than verify with documentation, certain eligibility criteria during the annual renewals for Medicaid for "DAB" population - Disabled, Aged 65+, Blind. May attest to income, resources, and change of residency. This includes those receiving Community-Based Long-Term Care Services, which is new.

2011-03-16 MEDICAID FAIR HEARINGS Relocation of Fair Hearing and Conference Unit to 111 Livingston St.,Brooklyn

2010

2010-07-02 APPLICATIONS Financial Maintenance Requirements for Medicaid and Family Health Plus

2010-07-01 APPLICATIONS Revisions to Health Insurance Application 4220 and Access NY Supplement A

2010-06-30 CITIZENSHIP PROOF Puerto Rican Birth Certificates

2010-06-08- UNDOCUMENTED IMMIGRANTS - EMERGENCY MEDICAID

DOH 4471 Certification of Treatment of an Emergency Medical Condition Replaces MAP 2151

2010-04-26 APPLICATIONS Elimination of the Face to Face Interview for Medicaid Family Health Plus applicants

2010-02-26 UNDOCUMENTED IMMIGRANTS Temporary Protected Status for Undocumented Haitian Immigrants

2010-01 2010 INCOME LEVELS Medicaid Income and Resource Levels 2010

2010-01 MEDICARE SAVINGS PROGRAM Disregard of Income Placed in Pooled Trust when Applying for MSP Program

2010-01 RESOURCE LEVELS Elimination of Resource Limit for Non-SSI Related Medicaid

2008

2008-11-03 APPLICATIONS Change of Submission Location for Client Reps

2008-06-10 ELIGIBILITY NYC Eliminates Drug and Alcohol Screening

2008-06-10 RESOURCE LEVELS Resource Level Raised to $13,050

2008-04-08 RECERTIFICATIONS Mail Renewal 30 Day Grace Period

2008-04-08 APPLICATIONS MSP Applications Done Now by Mail

2008-04-08 APPLICATIONS Elimination of the Resource Test for MSP Program

2006

2006-10-06 RECERTIFICATIONS Introduction of MAP-909E DAB Mail Renewal Form

2006-04-26 POOLED TRUSTS Instructions for Submitting Supplemental Needs Trusts

2005

2005-07-07 POOLED TRUSTS Disability Determinations for Individuals with a Pooled Trust

2004

2004-06-21 BURIAL ACCOUNTS Irrevocable Pre-Need Funeral Agreements and Burial Funds

2004-05 POOLED TRUSTS Supplemental Needs Trusts Excluded from Medicaid Eligibility Budgeting

2001

2001-05-30 NURSING HOMES Nursing Home Expedited Discharge Program

MEDICAID HOME CARE - NOTE - not updated since 2012 - see above section

DATE TOPIC TITLE

2012

2012-10-26 Home Care, Managed Care Consumer-Directed Personal Assistance Program (CDPAP) and Managed Care

CDPAP must be accessed through Medicaid managed care plans effective 11/1/12 for those enrolled in these plans (people with Medicaid but not Medicare statewide), or through Managed Long Term Care plans, for people who have Medicaid and Medicare in NYC)

2012-09-19 Managed Care Ending Managed Care Exemption for "Waiver Look-Alikes" - but allowing 6-month exemption for

people not in but applying for a waiver (this affects some Medicaid personal care recipients receiving CASA home care who in summer/fall 2012 are receiving notices that their exemption from managed care has ended and they must join a mainstream managed care plan

2012-09-06 Managed Long Term Care Mandatory Enrollment into Managed Long Term Care

2012-07-03 Managed Long Term Care Mandatory Enrollment into Managed Long Term Care

2011

2011-05-02 CASA III Relocated Merger of CASA III with CASA V

2011-03-16 Home Care Fair Hearings Relocation of Fair Hearing and Conference Unit to 111 Livingston St.,Brooklyn

2010

2010-08-25 Applications Relocation and New Address of Central Intake Office to Submit M11Q

2009

2009-11-05 APPLICATIONS Revised MIIQ for Home Care

2008

2008-04 RECERTIFICATIONS Mail Renewal 30 Day Grace Period