NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC
Recent Articles
MLTC Members in Nursing Homes for 3+ Months to be Disenrolled from MLTC 8/1/20
June 2020 Update - Nursing Home Residents to be Disenrolled from MLTC plans August 1, 2020 June - July 2020 update - Beginning July 10, 2020, about 20,000 MLTC members throughout NYS who have been in nursing homes for three or more months will receive this notice telling them they will be...
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. ...
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...
Medicaid Short-Term Rehabilitation Benefit
As you may know, there are three different levels of Medicaid coverage in New York State, each with different resource documentation requirements. These can be summarized as follows (see this more detailed chart): Level of Coverage: Community Coverage Without Long-Term Care Community...
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." ...
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 nursing home coverage. There is NO transfer penalty for applying for Medicaid for inpatient or outpatient care, for Managed Long Term Care or any other home care services, for Assisted...
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...
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...
"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...
Immigrant Eligibility for Medicaid & other Public Benefits - Public Charge Changes will begin Feb. 24, 2020 - Supreme Court Lifted Stay Jan. 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 US Supreme Court Lifts Injunction allowing Trump Changes to "Public Charge" Rule to Go Into Effect On January...
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
COVID-19 updates CDPAP services are still available from MLTC and managed care plans, for people applying for "Immediate Need" services, or who are exempt from MLTC or managed care during COVID-19. People who want to register with a "Fiscal intermediary" to be paid as a CDPAP Personal Assistant...
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...
About Us
This site is made possible in part by grants from the New York State Office for Aging and the New York Community Trust. We are also grateful to Western New York Law Center for hosting the site. We are grateful to Selfhelp Community Services, which housed the Evelyn Frank Legal Resources Program...
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...
EPIC - New York's prescription drug program for seniors age 65+
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). EPIC has gone...
"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...
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...
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...


This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.