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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...
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...
"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...
Advocate's Outline on Supplemental Needs Trusts
This in-depth training outline (updated January 2018) covers how Supplemental Needs Trusts work (both individual and pooled). Explains how they affect eligibility for SSI, Medicaid, and many different public benefits. The 2018 edition includes information on ABLE accounts as a possible alternative...
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...
Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans as of Jan. 1, 2018
What types of providers are affected? Effective January 1, 2014, medical providers must be enrolled with the NY State Medicaid program in order for Medicaid to pay for services that they prescribed, ordered or referred. The rule applies to ordering, prescribing, referring and attending...
Income and Resource Limits for New York State Public Health Insurance Programs
Here is the 2018 HRA Income and Resource Levels chart. The green highlighted figures are updated for 2018. The yellow highlighted figures are for MAGI Medicaid and other Medicaid programs for which eligibility is based on the Federal Poverty Line, for which 2018 levels will not be announced until...
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...
Medicaid & MSP: Must apply for Social Security and Enroll in 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 Medicare - New...
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) 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 provide written notice in plain language...
Legal Authorities Relating to Supplemental Needs Trusts
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...
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...
"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 - 2016 Changes
Where and how to apply for Medicaid personal care services and Consumer Directed Personal Assistance program (CDPAP) services has drastically changed with the implementation of mandatory Managed Long Term Care in New York State under a federal waiver that was approved September 4, 2012. The...
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...
Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan - Pooled Trusts Allowed as an Option
A. 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...
Holocaust or Nazi Victim Reparations -- Effect on Medicaid, SSI and other Federally Funded and New York State Benefits
Under a 1994 federal law, (h.r. 1873 or public law 103-286), known as the Victims of Nazi Persecution Act of 1994, Holocaust compensation payments made to individuals based on their status as victims of Nazi persecution are excluded from being counted as income and resources in determining both...
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...
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)...
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...
2018 Medicare Part D and Medicare Advantage Plans - NYS
The annual coordinated election period ("open enrollment") for Medicare Part D and Medicare Advantage plans for 2018 runs from October 15 through December 7, 2017. CMS has released the 2018 landscape of Part D and Medicare Advantage plans. Here are the lists of plans for New York State: ...
Medicaid Personal Care or Home Attendant Services
The Medicaid program in New York State covers a type of home care services called Personal Care services (aka PCS or "home attendant"). Covered in this article: * Law and regulations 1. What are Personal Care Services? 2. Eligibility 3. Scope of Tasks 4. How does one Obtain Personal Care...
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...
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)...
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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