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Immigrant Eligibility for Medicaid & other Public Benefits - Public Charge Changes BLOCKED July 29, 2020
Updated Immigrant Eligibility for Public Benefits in NYS Chart - by Empire Justice Center & NY Immigration Coalition - updated to include Public Charge Click HERE for chart Public Charge - September 22 Ruling: On September 11, the Second Circuit granted the Department of Justice’s...
Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange
The Empire Justice Center published a report in May, 2013 exploring the policies that guide immigrant access to health care and making recommendations for improving immigrant access through New York's Health Insurance Exchange: New York's Exchange Portal: A Gateway to Coverage for Immigrants ...
Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
July 29, 2020 UPDATE -- On July 29, 2020, a federal court issued a nationwide injunction blocking implementation of the Public Charge rule, both for applicants applying for a green card within the U.S. and those applying at consular offices outside the U.S. The new Public Charge rule had become...
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 2020, the income limit is $895/mo. of income. (aftersubtracting $20/mo disregard) (The income limits for...
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)...
Appeals & Grievances in Managed Long Term Care - "Exhaustion" of Plan Appeal Required since 2018
In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F Sept. 2020 UPDATE - NYS Dept. of Heath proposed...
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...
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...
NYS Hospital Financial Assistance Law -- Hospitals Must Provide Charity Care Assistance Program
Overview Charity care refers to free or low cost care provided by hospitals to uninsured or underinsured patients. New York State has provided significant state funding to hospitals for charity care since 1983, but it wasn't until 2007 that hospitals were actually required to provide charity...
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 Advantage Plus "MAP" - New "FIDE" Appeals & Hearing Process in 2020
ALERT: Medicare Rights Center is doing a WEBINAR on MAP APPEALS on SEPTEMBER 1, 2020. Register here. As if there’s not enough change, beginning January 2020, about 10% of Managed Long Term Care members now must deal with a new fair hearing process. These are people who are in Medicaid...
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...
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...
Income and Resource Limits for New York State Public Health Insurance Programs
NYS announced the 2020 Income and Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels Attachment I (General Medicaid for Aged, Blind & Disabled) Attachment II ("from...
Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants
COVID-19 ALERT - See here. COVID-­19 lab testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals who are undocumented immigrants eligible only for emergency Medicaid. July 29, 2020 UPDATE -- On July 29, 2020, a federal court issued a...
Medicare Savings Programs (MSP) in New York
Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs. There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB) Program, the...
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...
Medicare Part D - Overview (2019)
Training materials written and updated by various staff at the Evelyn Frank Legal Resources program since 2005. This outline, updated for the 2019 Part D enrollment period, which is from Oct. 15, 2018 - Dec. 7, 2018, covers the basic design of the Medicare Part D prescription drug benefit, the...
The Medicaid Pharmacy Benefit - For People Without Medicare - Changes Coming 2021
Heads Up - Changes Coming April 2021 Once again, NYS is changing the way people without Medicare access prescription drugs. Since October 2011, most people who do not have Medicare obtained their drugs throug their Medicaid managed care plan. At that time, this drug benefit was "carved into"...
Holocaust or Nazi Victim Reparations -- Effect on Medicaid, SSI and other Federally Funded and New York State Benefits
Under a 1994 federal law, (h.r. 1873 or public law 103-286), known as the Victims of Nazi Persecution Act of 1994, Holocaust compensation payments made to individuals based on their status as victims of Nazi persecution are excluded from being counted as income and resources in determining both...
Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections
Medicaid rules are different for people living in the "community" than people living in institutions. For this article, the word "institution" means nursing home care. If you live in your home, someone else's home, or an Assisted Living Program, you are considered to live in the "community." ...
Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005
The Deficit Reduction Act of 2005 (DRA, enacted in 2006, made major changes to the transfer penalty rules for eligibility for Medicaid to pay for nursing home care. At the time, and until now, nursing home care was the only Medicaid service that had a lookback and transfer penalty.See GIS 06...
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....
MLTC Members in Nursing Homes for 3+ Months to be Disenrolled from MLTC 8/1/20
July 2020 Update - Nursing Home Residents to be Disenrolled from MLTC plans August 1, 2020 July 2020 update - Beginning July 10, 2020, about 20,000 MLTC members throughout NYS who have been in nursing homes for three or more months will receive this notice telling them they will be disenrolled...
Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan
A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...


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