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Recent Articles
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 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...
Maintaining Community Medicaid (Non-Chronic Care) Budgeting 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 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...
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...
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...
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...
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...
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...
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...
Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans - also Tool to Find Medicaid Providers
What types of providers are affected? Effective January 1, 2014, medical providers must be enrolled with the NY State Medicaid program in order for Medicaid to pay for services that they prescribed, ordered or referred. The rule applies to ordering, prescribing, referring and attending...
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...
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...
HIPAA Forms and Health Information Access and Privacy - Overview
You have the right to privacy concerning information about your health, medical care, and how your care is paid for. This right comes from a federal law called HIPAA (Health Insurance Portability and Accountability Act). Although HIPAA regulates many other areas, the main impact it has on most...
NYS Directives on Medicaid changes under the Affordable Care Act
The New York State Department of Health (DOH) has issued additional directives outlining the new procedures for Medicaid applications and renewals under the Affordable Care Act, effective in 2014. For newest directives scroll to the bottom of this page. 1. 13 ADM-04 - Medicaid Application...
"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...
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...
Income and Resource Limits for New York State Public Health Insurance Programs
Here is the 2019 HRA Income and Resource Levels chart. This short summary chart shows that income limits have increased for the new "MAGI" category created by the Affordable Care Act, but not for the "Non-MAGI" population - the Disabled, Aged 65+ and Blind (DAB). Non-MAGI ...
2015 NYS Law Gives Protection from Surprise Bills and Emergency Services
A new New York State law went into effect March 31, 2015 that protects consumers from "surprise bills" when services are performed by a non-participating (out-of-network) doctor at a participating hospital or ambulatory surgical center in your HMO or insurer's network or when a participating...


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