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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...
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 Cost Sharing Confusion for Clients in the QMB Program
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 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 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 Immigrant Eligibility for Publicly Funded Health Care Benefits
2017 ALERT - As of March 5, 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...
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 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...
document KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind
This Fact Sheet (updated Jan.. 2017) is intended for people who are age 65+ or who have disabilities, or their family members and caregivers. It explains the basic financial rules on eligibility for Medicaid in the community for this category of people. Community Medicaid includes all hospital and...
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 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 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...
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 The Various Types of Medicaid Home Care in New York State
New York State has a range of Medicaid home care service programs, each oriented toward slightly different needs and sometimes to different populations. These programs are listed below, with links to detailed information posted on this site. Beginning in September 2012, for ADULTS age 21+ who...
document New Permanent Nursing Home Residents in NYS Required to Enroll in Medicaid Managed Care Plans or MLTC Plans - Effective since October 2015 Statewide
Since February 1, 2015, there has been a new requirement for nursing home residents in New York City who became "permanent" residents after that date to enroll in Managed Long Term care (MLTC) and "mainstream" Medicaid Managed Care plans, which will now pay for and manage the nursing home care....
document New Law Requires 7-Day Medicaid Application Approval if "Immediate Need" for Personal Care or CDPAP - Addresses Delays in Enrolling in MLTC Plans.
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...
document KNOW YOUR RIGHTS: Managed Long Term Care and FIDA - Fact Sheets, Live and Recorded Webinars
Fact Sheets on Managed Long Term Care and FIDA. FACT SHEET 1: Basics on Managed Long Term Care FACT SHEET 2: Grievance and Appeal Rights in Managed Long Term Care (under revision from July 1, 2015 changes - see this article) FACT SHEET 3: FIDA: New Program for Dual Eligibles...
document Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan - Pooled Trusts Allowed as an Option
What are Spousal Impoverishment Rules? Since 1998, a spouse of a nursing home resident on Medicaid is allowed to keep a reasonable level of income and resources to live on, while still permitting Medicaid payment for the nursing home resident's care. Congress enacted the "spousal impoverishment...
document New Application Form (2010, updated 3/2015) Used for Medicaid, Child Health Plus and Family Health Plus in New York State
Since 2010, the New York State Department of Health has used a uniform 6-page application form to be used for Medicaid called the Access NY Application or form DOH-4220. Download the form at this link - scroll down to Application for Non-MAGI. As of October 2016, the form was last updated in...
document Medicaid & MSP: Must apply for Social Security and Other Potentially Available Income - and Medicare
Medicaid applicants and recipients can be required to pursue potentially available income as a condition of receiving Medicaid, and also to apply for Medicare. (42 CFR 435.608; 18 NYCRR sec. 360-2.3 (c)(1); Medical Assistance Resource Guide [MARG] pp. 488-489.) 1. Must apply for "Potentially...
document "MAGI" Medicaid Eligibility under the Affordable Care Act - Rules for Most People Under age 65 Without Medicare
Medicaid eligibility rules changed significantly on January 1, 2014 for some New Yorkers as a result of the Affordable Care Act’s eligibility expansion and streamlining provisions. The expansion only applies to a population called the "MAGI" population. Generally, the new rules do NOT apply to...
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...


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