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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)...
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. August 2019 ALERT - On Monday August 12, 2019, the Department of...
Where to Apply for Medicaid and Medicaid Home Care in New York City
COVID-19 ALERT - Many Medicaid offices are closed during the emergency. There is one Medicaid office open in each borough where you can file an application - see this list. Or you can now FAX an application to 917-639-0732. During the COVID emergency, you do not need to submit as many...
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...
Grievance and Appeal Contacts for Managed Long Term Care Plans
BEGINNING MARCH 1, 2018, members of Medicaid Managed Care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal before they may request a FAIR HEARING. This is called the "exhaustion requirement" and is...
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 January 2020) - 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...
Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits
New: View recording of 2-part Webinar about Supplemental Needs Trusts in NYS. Click here for links to view the recordings and download the PowerPoints. This in-depth training manual or outline (updated January 2019) covers how Supplemental Needs Trusts work (both individual and pooled), when an...
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...
Legal Authorities Relating to Supplemental Needs Trusts - Federal, State, and New York City
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...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
Fact Sheets on Managed Long Term Care 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 SHEET ON Medicaid eligibility rules for Aged 65+, Disabled and Blind Individuals in...
"Ensure" and Enteral Nutritional Supplements - When does Medicaid Pay for it? 2013 Changes for Adults
Children under 21 are entitled to obtain "Ensure" or other nutritional supplements when medically necessary. However, the State has enacted laws in the last few years that restrict eligibility for nutritional supplements for adults age 21+. In 2011, the state budget law limited these "enteral...
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...
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...
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...
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...
Immigrant Eligibility for Medicaid & other Public Benefits - Public Charge Changes will begin Feb. 24, 2020 - Supreme Court Lifted Stay Jan. 2020
US Supreme Court Lifts Injunction allowing Trump Changes to "Public Charge" Rule to Go Into Effect On January 27, 2020, the United States Supreme Court lifted an injunction that had halted implementation of changes in the "Public Charge" rule, which were supposed to go into effect Oct. 15,...
Useful Websites and Phone Numbers
STATEWIDE RESOURCES ADAP (AIDS Drugs Assistance Program): 1-800-542-2437 Ayuda Legal NY: Encuentra asistencia legal gratuita en Nueva York, aprendas de sus derechos legales, obtenga información sobre las cortes, y mucho más. Centers for Medicare and Medicaid Services (CMS) (Federal...
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...
Nursing Home Residents to Be Excluded from MLTC Plans - Change Being Rolled Out Starting January 2020
.January 2020 Update - Nursing Home Residents to be Disenrolled from MLTC plans CMS has approved the request by NYS Dept. of Health to "carve out" long-term Nursing Home Care from the Managed Long Term Care (MLTC) benefit package. In this change, the State has reversed its former policy that has...
Appeals & Grievances in Managed Long Term Care - New Rules Since MAY 1, 2018
Changes in federal Medicaid managed care regulations regarding GRIEVANCES AND APPEALS became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. Download this PowerPoint presentation by NYLAG EFLRP held on April 18, 2018. Download this Fact Sheet by NYLAG EFLRP. ...
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 ) Attachment I (General Medicaid for Aged, Blind & Disabled) Attachment II (" " " Attachment III (MAGI)(Will be revised in March or April 2020 when Federal Poverty Line...
"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...
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. - There are different types and costs of Medigap policies in New York State. Rate tables for policies in the...
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...


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