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document Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA)
Since May 2013 the NYC Medicaid Office (known as MICSA) has been located at 785 Atlantic Ave., Brooklyn, NY 11238. The Reception Unit is on the main floor of 785 Atlantic Ave.Brooklyn NY 11238. The following is a list of contact information for popular MICSA-Medicaid offices - SEE department...
document Appeals & Grievances in Managed Long Term Care - Consumer Rights
Procedures to appeal decisions by Managed Long Term Care plans are different than those they are used to from the longtime system of requesting hearings to appeal decisions by the CASA/Medicaid offices. In March 2015 State Dept. of Health issued new Notice Templates to the MLTC plans, described...
document Medicare Savings Programs (MSP) in New York
Funded by the State Medicaid program, Medicare Savings Programs (MSPs) help eligible individuals meet some or all of their cost-sharing obligations under Medicare. See N.Y. Soc. Serv. L. § 367-a(3)(a), (b), and (d). There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB)...
document Medicaid Transportation in NYS
States are required under federal regulations (42 C.F.R. §431.53) to assure necessary transportation to Medicaid beneficiaries to and from medical services. When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary...
document How to use a pooled SNT to eliminate the Medicaid spend-down.
This memo explains how to use a Pooled Supplemental Needs Trust to eliminate the Medicaid spend-down (updated July 2017) Note that new State forms (486T and 1151) were released in October 2012 for proving disability, as needed for approval of a Supplemental Needs Trust. See this article for...
document 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...
document 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...
document "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 lives only on SSI and SSD. His health care is covered by Medicare, and Medicaid’s Qualified Medicare Beneficiary (QMB) program picks up his Medicare cost-sharing obligations. Under...
document Medicaid Dental Benefit
Medicaid Dental Benefit Under Medicaid, dental benefits exist, but the coverage is limited. This limited coverage makes it important for advocates to understand the exceptions to different coverage limitations. By understanding the nuances of the benefit, advocates can help get their clients...
document Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
WHO MAY BE HIRED AS THE PERSONAL ASSISTANT? Changes effective APRIL 1, 2016 An adult who is not "legally responsible" for a Medicaid consumer's care and support may be a CDPAP assistant for that consumer. In particular, this means that a parent of...
document 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...
document 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...
document 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)...
document 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...
document Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL Status and Procedure
2017 ALERT - As of March 5, 2017, the law explained in this article is still in effect. The Trump Administration has not changed the law on immigrant eligibility for Medicaid or other public benefits and has not changed the rules on when someone who receives Medicaid or other government benefits...
document Court Orders Lifting Restrictions in Medicaid Coverage for Compression Stockings and Orthopedic Footwear
Federal Court Orders State to Stop Restricting Coverage of Compression Stockings and Orthopedic Footwear. On July 1, 2016, a federal judge in New York issued an order enjoining state health officials from limiting coverage of orthopedic footwear and compression stockings for some state Medicaid...
document HIPAA Forms and Health Information 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...
document Immigrant Eligibility for Publicly Funded Health Care Benefits
2017 ALERT - As of May 3, 2017, the Trump Administration has not changed the law on immigrant eligibility for Medicaid or other public benefits and has not changed the rules on when someone who receives Medicaid or other government benefits is considered a "public charge" or is at risk of removal...
document Income and Resource Limits for New York State Public Health Insurance Programs
Click here for NYS Medicaid Income and Resource Levels Chart for 2017 (NYC Human Resources Administration publishes chart annually based on NYS Dept. of Health figures). Chart shows income and resource limits for Medicaid and other public health insurance programs in New York State, including the...
document 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...
document Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes and Enroll 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...
document 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...
document 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...
document Help for those who missed the first open enrollment period
Do you or someone you know need health insurance? Did you miss the open enrollment period? You may still have options to get coverage! Medicaid, Essential Plan and Child Health Plus enrollment is year-round! If you have experienced certain life events, you may qualify for a special enrollment...
document What you need to know about EPIC - New York's prescription drug program for seniors
New York has a State Pharmaceutical Assistance Program (SPAP) to help low- to moderate-income older adults age 65+ pay for prescription drugs. The Elderly Pharmaceutical Insurance Coverage (EPIC) program is administered by the New York State Department of Health (NYSDOH). It's easy to apply...


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