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Medicaid Renewals/Recertifications in New York City- TIPS
This article available as a fact sheet in ENGLISH and SPANISH This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration (HRA). If your Medicaid is handled by the New York State of Health – your renewal is not covered in...
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...
Income and Resource Limits for New York State Public Health Insurance Programs
NYS announced the 2021 Income and Resource levels in GIS 20 MA/13 - - 2021 Medicaid Income Levels Attachment I (General Medicaid for Aged, Blind & Disabled - non-MAGI) Attachment II non-MAGI levels Attachment III (PDF) MAGI levels for 2021 Attachment IV (PDF) MAGI levels for 2021 ...
Know Your Rights: NYLAG Webinars on Medicare and Medicaid -
The Evelyn Frank Legal Resources Program conducted a five-part Continuing Legal Education Webinar program in April and May 2016 that provides tools to understand and navigate the complex world of Medicare and Medicaid in New York. The focus is on eligibility and application procedures for older...
MLTC Members in Nursing Homes for 3+ Months Being Disenrolled from MLTC Plans
Jan. 2021 Update - More Nursing Home Residents to be Disenrolled from MLTC plans April 1, 2021, after Disenrollments on Jan. 1, 2021 On April 1, 2021, more MLTC members who have been in nursing homes for three or more months and who have been approved for Institutional Medicaid will be...
"Immediate Need" Personal Care or CDPAP - Fast-Track Application for Medicaid and Home Care - New Procedures
People who apply for Medicaid in order to obtain home care services face long delays in getting Medicaid approved and then accessing home care services from a managed long term care plan. Click here to learn about the reasons for these delays. A New York law passed in 2015 that is being...
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...
New Medicaid Application Form (2010/updated 2015) in New York State 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...
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." ...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
Fact Sheets on Managed Long Term Care New - December 2020 - Fact Sheet on Transition Rights after MLTC Plan Closes 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 FACT...
When an MLTC Plan Closes - What are the Members' Rights?
Now that enrollment in Managed Long Term Care (MLTC) plans has been mandatory for 5 years for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some of the original MLTC plans have either closed altogether, or have reduced their service area, no longer...
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...
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...
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...
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)...
Medicare Part D - Overview
The Evelyn Frank Legal Resources program has these resources for counseling Medicare beneficiaries and assisting them in accessing prescription drugs through the Medicare Part D program. NYLAG Recorded Webinar and PowerPoint presentation on Medicare Part D for the 2021 Year (for open enrollment...
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....
Pathways to Extra Help - the Part D low income subsidy and how it can help your clients
There is a special program called the Low Income Subsidy (LIS) which helps with Medicare Part D cost sharing. LIS is also known as "Extra Help." The Social Security Administration administers LIS you don't apply through your Part D plan. See Medicare Rights Center chart on Extra Help Income and...
2021 Medicare Part D Plans in NYS
The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2021 runs from October 15 through December 7, 2020. 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...
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...
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...


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