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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 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"). This is a service under NYS's "State Medicaid Plan," which means that the rules described here apply whether the consumer receives it under fee-for service from...
MLTC Members in Nursing Homes for 3+ Months Being Disenrolled from MLTC Plans - 5th Batch Feb. 1, 2022
Dec. 2021 Update - Fifth "Batch" of Nursing Home Residents to be Disenrolled from MLTC plans in February 2022 for Long Term Nursing Home Stay "LTNHS" Total Members Disenrolled: 20,353 as of Oct. 1, 2021 for LTNHS On Feb. 1, 2022, more MLTC members who have been in nursing homes for three or...
Help for those who missed the annual open enrollment period for Qualified Health Plans
Do you or someone you know need health insurance? Did you miss the annual open enrollment period for enrolling in a Qualified Health Plan? (In 2021, the open enrollment period runs from Nov. 16, 2021 - Dec. 31, 2021). You may still have options to get coverage! Medicaid, Essential Plan...
Affordable Care Act --New York State Health Exchange Open Year-Round for Medicaid Applications and for Certain "Special Enrollment" categories
New York State of Health Exchange https://nystateofhealth.ny.gov/ MEDICAID Individuals eligible for Medicaid or Child Health Plus and American Indians/Alaskan Natives can enroll at any time during the year on the New York State of Health website. This is for people under age 65 who do not...
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 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 2021, the income limit is $904/mo. of income. (after subtracting $20/mo disregard) (The income limits for...
Medicaid & Medicare: Maximizing Coverage for Disabled Clients
Maximizing health coverage for DAP clients: Before and after winning the case Outline prepared by Geoffrey Hale and Cathy Roberts - updated August 2012 This outline is intended to assist Disability Advocacy Program (DAP) advocates maximize health insurance coverage for clients they...
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 2021 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric...
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"...
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...
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...
Family Health Care Decisions Act
New York’s Family Health Care Decisions Act (FHCDA)(Chapter 8 of the Laws of 2010, adding Public Health Law Ch. 29-CC and 29-CCC) allows a patient’s family member or close friend to make health care decisions for a patient who is in a hospital or nursing home, or to decisions regarding hospice...
When an MLTC Plan Closes - What are the Members' Rights? WARNING - Changes Coming!
Since Managed Long Term Care (MLTC) plan enrollment has been mandatory since 2013 for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some MLTC plans have either closed or reduced their service area, no longer covering certain counties or New York City....
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...
Physical, Speech & Occupational Therapy Limits Lifted for 2021
The 2011-12 NY State budget, ] limited access to compression stockings, prescription footwear, and enteral nutritional formula, as well as physical therapy, occupational therapy, and speech therapy. Some of these limits have been repealed or made less harsh. Physical, Speech, and Occupational...
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...
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...
2022 Medicare Part D plans in New York State
The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2022 runs from October 15 through December 7, 2021. Every year, you should review your plan options to see if your current plan still meets your needs - see more here what to look for in...
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...
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...


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