NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC
Recent Articles
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...
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"). WARNING: MAJOR CHANGES in Personal Care Eligibility and Assessment were ENACTED IN STATE LAW APRIL 2020 that will be implemented in Oct. 2020 or after. Read...
Medigap (Medicare Supplemental) Policies and Rates in New York State - with Rate Tables for the Current Year
Medigap (aka Medicare supplemental insurance) policies are sold by private health insurance companies to cover some of the "gaps" in expenses not covered under original Medicare. For background on Medicare and its gaps 2020 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric...
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)...
Right to a "Home Hearing" under Varshavsky Case - Special Rights in Fair Hearings Seeking Increases in Medicaid Home Care
RIGHTS of People Who Cannot Travel to a Fair Hearing Because of Disability This article can also be downloaded as a Fact Sheet here. Individuals who, because of mental or physical disabilities, cannot travel to a fair hearing without substantial hardship or medical detriment, have rights...
Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"
Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting - used for people age 65+, Disabled, or...
Applying for Medicaid Personal Care or CDPAP Services in New York City - 2021 Changes
Jan. 2021 UPDATE: As of Jan. 1, 2021, people age 65+, disabled or blind applying for Medicaid in NYC MUST include "Supplement A" with their applications using a NEW version of the form. This is required even for applicants who are not seeking community-based long term care services such as...
Applying for Medicaid Personal Care Services and CDPAP Outside NYC - 2016 Changes
New York State's Medicaid program covers personal care services and consumer-directed personal assistance services. The model for delivery of those services has, in the years since 2011, gradually transitioned from the local departments of social services, through their Medicaid programs, to...
"Qualified Medicare Beneficiaries" (QMB) - Protections against "Balance Billing"
THE PROBLEM: Meet Joe, whose Doctor has Billed him for the Medicare Coinsurance Joe Client is disabled and has SSD, Medicaid and Qualified Medicare Beneficiary (QMB). His health care is covered by Medicare, and Medicaid and the QMB program pick up his Medicare cost-sharing obligations. Under...
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. ...
Medicaid Disability Determinations - NYS Forms & Procedures (with updated forms August 2021)
August 2021 news alert - See new Disability Form and new HIPPA form required! 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...
Income and Resource Limits for New York State Public Health Insurance Programs
NYS updated the 2021 levels with GIS 21 MA/06 -with the 2021 Federal Poverty Levels (April 2021) Attachment I ( MAGI & non-MAGI limits for Aged, Blind & Disabled - non-MAGI) Attachment II non-MAGI levels Attachment III (PDF) MAGI levels for 2021 Attachment IV (PDF) MAGI levels...
Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
NEWS UPDATE March 9, 2021 - The Trump Public Charge rule has been vacated after the Biden administration withdrew its appeal to the Supreme Court of an injunction issued by the Second Circuit and also withdrew appeal of a Seventh Circuit lawsuit. See more about this news and public charge here. ...
Medicaid Advantage Plus "MAP" - New "FIDE" Appeals & Hearing Process began 2020 - Healthfirst Mistake March 2021
In 2020, a new appeal and fair hearing process launched for about 10% of Managed Long Term Care members those who are in Medicaid Advantage Plus (“MAP”), which consists of a "FIDE-SNP" (Fully Integrated Dual Eligible - Special Needs Plan) that covers the Medicare services, and a Medicaid...
Health Plan Appeal Rights in New York After the Affordable Care Act
Samuel Salganik, an attorney at Community Health Advocates of the Community Services Society (CSS) wrote this incredibly thorough article breaking down the types of appeal rights available to individuals covered by the various types of private health insurance plans in New York. This article...
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...
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 2021) - See SPANISH TRANSLATION. 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...
Legal Authorities Relating to Supplemental Needs Trusts - Federal, State, and New York City
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...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
A. Fact Sheets on Managed Long Term Care B. Click here for WEBINARS on LONG TERM CARE A. Fact Sheets on Managed Long Term Care BASICS Basics on Managed Long Term Care (In process of being updated - 2-2020) see also Article on Managed Long Term Care News on MLTC - updated monthly ...
Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA)
Since May 2013 the NYC Medicaid Office (known as MICSA) and Home Care Services Program has been located at 785 Atlantic Ave., Brooklyn, NY 11238. The Reception Unit is on the main floor of 785 Atlantic Ave.Brooklyn NY 11238. The following is a list of contact information for popular...
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...
The Medicaid Pharmacy Benefit - For People Without Medicare - Changes Coming 2023 (delayed from 2021)
Heads Up - Changes Slated for April 2021 Delayed to April 2023 Once again, NYS is changing the way people without Medicare access prescription drugs. But the changes that were scheduled to take place in April 2021 have been delayed until April 2023, under the SFY 2021-22 budget agreement. ...
Medicare Insurance Premium Payment Program (MIPP)
Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who...
NYS Medicaid Application Form (updated 2015) for Age 65+ or Disabled or Blind - New Supp A NYC 2021
Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or form DOH-4220. Download the form at this link (As of January 2021, the form was last updated in March 2015). For those age 65+ or who are disabled or blind, a second form is...
Medicaid Recipients to be "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare-- April 1, 2021
.  WHAT CHANGE IS HAPPENING APRIL 1, 2021 Beginning April 1, 2021, a change is coming for New York Medicaid recipients who newly become enrolled in Medicare and become "Dual Eligibles" - someone who has both Medicare and Medicaid. Every month about 3,000 - 4,000 Medicaid recipients in New...


This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.