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Maintaining Community Medicaid Budgeting and SSI Benefits During Temporary Nursing Home Stays
Many Medicaid recipients are admitted to nursing homes but plan to return to their homes in their community. Financially, it is important for them to maintain community Medicaid budgeting so that they can continue to pay rent, utility, and other living expenses to preserve their apartment or home...
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
October 2019 News Update on CDPAP - Lawsuit Filed Challenging Reimbursement Cuts in CDPAP On August 27, 2019, DOH updated FAQ’s about the reimbursement rate cuts for Consumer-Directed Personal Assistance (CDPAP) services that went into effect on September 1, 2019. These FAQs followed up on the...
"FIDA (Fully-Integrated Dual Advantage) Program for Dual Eligibles Closing Dec. 31, 2019
October 2019 Update - FIDA PROGRAM CLOSING 12/31/2019 2,520 members in the SIX FIDA plans will be assigned to a new plan for January 2020 unless they pick and enroll in a different one before December 20, 2019 WHERE IS FIDA? Most of the 2,520 dual eligibles still in FIDA plans are in NYC,...
2020 Medicare Part D Plans in NYS
The annual coordinated election period ("open enrollment") for Medicare Part D and Medicare Advantage plans for 2020 runs from October 15 through December 7, 2019. Every year, you should review your plan and see if it still meets your needs - whether it covers your drugs, whether costs have...
Immigrant Eligibility for Publicly Funded Health Care Benefits - CHANGES OCTOBER 15, 2019
AUGUST 2019 ALERT - Trump Administration Finalizes "Public Charge" Rule Changes - Going Into Effect Oct. 15, 2019 On Monday August 12, 2019, the Department of Homeland Security finalized a rule that dramatically expands the "public charge" immigration policy. The changes will apply only to...
Medical Records Must be Provided FREE if Needed to Support Claims for Public Benefits - New September 2017
In September 2017, a new law went into effect that requires health care providers to provide medical records at no charge, when needed to support an application, claim or appeal for a government benefit or program. Here's what the law adds to Mental Hygiene Law § 331 and NYS Public Health Law §...
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...
Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"
If you are Age 65+. Disabled, or Blind, your Medicaid eligibility is likely based on "non-MAGI" budgeting, as opposed to "MAGI" budgeting. This Fact Sheet explains the basic rules of Non-MAGI Budgeting. MAGI budgeting is used for most people under age 65 who do not receive Medicare....
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...
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...
Child Health Plus Overview
Child Health Plus Child Health Plus (CHP) is a health care program for uninsured children under the age of 19. It was previously referred to as CHP A (children’s Medicaid) and B (the State’s Child Health Insurance Program). CHP offers health care to children who are above the Medicaid...
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...
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...
Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits
This in-depth training outline (updated January 2019) covers how Supplemental Needs Trusts work (both individual and pooled), when an asset or lump sum may be deposited into an SNT. For Community Medicaid only, income may also be placed into an SNT. Explains how lump sums and SNTs affect...
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) - 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...
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...
Delays in Processing of Medicaid Applications - What are Your Rights and Lawsuits Challenging Delays
The Deadlines to Process Medicaid Applications in the Law Federal and state law set time limits for processing a Medicaid application. The federal Medicaid Act requires eligibility to be determined with "reasonable promptness." A determination of eligibility for Medicaid must generally be made...
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...
Temporary Protected Status (TPS) and Public Health Insurance
Haitian individuals and immigrants from some other countries who have applied for Temporary Protected Status (TPS) may be eligible for public health insurance in New York State. 2019 updates - The Trump administration has taken steps to end TPS status. Two courts have temporarily enjoined...
Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants
August 2019 ALERT - On Monday August 12, 2019, the Department of Homeland Security finalized a rule that dramatically expands the “public charge” immigration policy. The changes will apply only to applications that are postmarked or submitted electronically on or after October 15, 2019. ...
Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
August 2019 ALERT - On Monday August 12, 2019, the Department of Homeland Security finalized a rule that dramatically expands the “public charge” immigration policy. The changes will apply only to applications that are postmarked or submitted electronically on or after October 15, 2019. They...
The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) is a special program for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. The income...
Permanent Nursing Home Residents in NYS Required to Enroll in Medicaid Managed Care Plans or MLTC Plans - Effective since October 2015 Statewide
2018 - 2019 Update - All of the policies and procedures described in this article may be changing. 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 Medicare...
Medicaid Short-Term Rehabilitation Benefit
As you may know, there are three different levels of Medicaid coverage in New York State, each with different resource documentation requirements. These can be summarized as follows (see this more detailed chart): Level of Coverage: Community Coverage Without Long-Term Care Community...
Long Term Care Insurance
Long term care insurance is a product which, if certain conditions are met, will pay for all or a portion of, nursing home and/or home care expenses. Such policies have been marketed to individuals who do not wish to have their assets depleted should they need long term care. While such policies...


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