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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)...
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...
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...
Medicaid Disability Determinations - NYS Forms & Procedures (with updated forms July 2012)
The Medicaid program has long had a procedure for determining disability for individuals who have not yet been determined disabled by the Social Security Administration.[1] There are different reasons for determining disability. The procedure is primarily used for Medicaid recipients between...
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...
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...
"MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare
Medicaid eligibility rules changed significantly on January 1, 2014 for some New Yorkers as a result of the Affordable Care Act’s eligibility expansion and streamlining provisions. The expansion only applies to a population called the "MAGI" population. Generally, the new rules do NOT apply to...
Useful Websites and Phone Numbers
STATEWIDE RESOURCES ADAP (AIDS Drugs Assistance Program): 1-800-542-2437 Ayuda Legal NY: Encuentra asistencia legal gratuita en Nueva York, aprendas de sus derechos legales, obtenga información sobre las cortes, y mucho más. Centers for Medicare and Medicaid Services (CMS) (Federal...
Medicaid Managed Care
Law and Regulations STATE - N.Y. Soc. Servs. L. §364-j (Amended L. 2011 Ch. 59). Regulations at 18 NYCRR 360-10. FEDERAL - 42. C.F.R Part 438 (amended extensively in 2016, with changes going into effect in NYS on rolling basis, including new appeal rules starting May 1, 2018 requiring...
Pathways to Extra Help - the Part D low income subsidy and how it can help your clients
There is a special program called the Low Income Subsidy (LIS) which helps with Medicare Part D cost sharing. LIS is also known as "Extra Help." The Social Security Administration administers LIS you don't apply through your Part D plan. See Medicare Rights Center chart on 2018 Extra Help...
The Medicaid Pharmacy Benefit
Medicaid’s pharmacy benefit was moved into the Medicaid managed care benefit package in October of 2011. Before that date, people enrolled in a Medicaid managed care plan obtained all of their health care through the plan, but used their regular Medicaid card to access any drug available on the...
Legal Authorities Relating to Supplemental Needs Trusts
There is a confusing patchwork of Federal and State laws and regulatory guidance governing the use of Supplemental Needs Trusts in the Medicaid context. This article is intended to collect some of these authorities in one place. One of the prerequisites for using a Supplemental Needs Trust is...
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...
When an MLTC Plan Closes - What are the Members' Rights?
Now that enrollment in Managed Long Term Care (MLTC) plans has been mandatory for 5 years for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some of the original MLTC plans have either closed altogether, or have reduced their service area, no longer...
New Permanent Nursing Home Residents in NYS Required to Enroll in Medicaid Managed Care Plans or MLTC Plans - Effective since October 2015 Statewide
July 2018 Update - All of the policies and procedures described in this article will be changing soon, as the result of the NYS Budget enacted in April 2018. This budget reverses the MLTC expansion to include nursing home care that is described in this article. Once implemented, adults with...
How to use a pooled SNT to eliminate the Medicaid spend-down.
This Fact Sheet explains how to use a Pooled Supplemental Needs Trust to eliminate the Medicaid spend-down (updated March 2018) N. Y. Social Services Law § 366, subd. 5 (f) - Law enacted Dec. 18, 2017 - NEW LAW enacted that requires the State Dept. of Health to provide written notice in plain...
Know Your Rights: NYLAG Webinars on Medicare and Medicaid -
The Evelyn Frank Legal Resources Program conducted a five-part Continuing Legal Education Webinar program in April and May 2016 that provides tools to understand and navigate the complex world of Medicare and Medicaid in New York. The focus is on eligibility and application procedures for older...
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...
About Us
This site is made possible in part by grants from the New York State Office for Aging and the New York Community Trust. We are also grateful to Western New York Law Center for hosting the site. We are grateful to Selfhelp Community Services, which housed the Evelyn Frank Legal Resources Program...
CASA Contact List - NYC
The NYC Medicaid Home Care Services Program, which is part of the NYC Human Resources Administration Medical Insurance Community Services Administration (MICSA), also known as the Medicaid program, formerly was responsible for administration in NYC for three types of Medicaid "personal care"...
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...
Grievance and Appeal Contacts for Managed Long Term Care Plans
BEGINNING MARCH 1, 2018, members of Medicaid Managed Care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal before they may request a FAIR HEARING. This is called the "exhaustion requirement" and is...
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)...
Appeals & Grievances in Managed Long Term Care - CHANGES COMING MAY 1, 2018
Changes in federal Medicaid managed care regulations regarding GRIEVANCES AND APPEALS will be effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. Download this PowerPoint presentation by NYLAG EFLRP held on April 18, 2018. Download this Fact Sheet by NYLAG EFLRP. ...
Medicaid & MSP: Must apply for Social Security and Enroll in Medicare
Medicaid applicants and recipients can be required to pursue potentially available income, including Social Security, as a condition of receiving Medicaid, and also to apply for Medicare. (42 CFR 435.608; 18 NYCRR sec. 360-2.3 (c)(1); Medical Assistance Resource Guide [MARG] pp. 488-489.) ...


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