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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...
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...
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...
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 for 2020 in Dec. 2019) is intended for New Yorkers 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, and explains how to apply...
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...
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...
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 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...
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...
Overview - Supplemental Needs Trusts
Supplemental Needs Trusts (SNTs) are legal tools used to help disabled people keep more of their income or assets without losing their public benefits. See fact sheet in SPANISH. SNTs were originally invented to allow parents of children with developmental disabilities to provide for them...
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...
"FIDA (Fully-Integrated Dual Advantage) Program for Dual Eligibles Closing Dec. 31, 2019
November 2019 Update - FIDA PROGRAM CLOSING 12/31/2019 2,520 members in the SIX FIDA plans will be assigned to a new plan for January 2020 unless they pick and enroll in a different one before December 20, 2019 WHERE IS FIDA? Most of the 2,520 dual eligibles still in FIDA plans are in NYC,...
Temporary Protected Status (TPS) and Public Health Insurance
Haitian individuals and immigrants from some other countries who have applied for Temporary Protected Status (TPS) may be eligible for public health insurance in New York State. 2019 updates - The Trump administration has taken steps to end TPS status. Two courts have temporarily enjoined...
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 - new Requirement to Request Plan Appeal Before a Fair Hearing Caregivers' Fact Sheet on FIDA (English) (Spanish...
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...
Immigrant Eligibility for Publicly Funded Health Care Benefits - COURTS BLOCK CHANGES scheduled for OCTOBER 15, 2019
Courts Block Trump Changes to "Public Charge" Rule From Going Into Effect Oct. 15, 2019 In the days leading up to October 15, 2019, when the Department of Homeland Security's final "public charge" rule was scheduled to go into effect, eight federal courts issued "preliminary injunctions" barring...
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
October 2019 News Update on CDPAP - Lawsuit Filed Challenging Reimbursement Cuts in CDPAP Click here for main article following this news update On October 11, 2019, the Albany County Supreme Court enjoined NYS DOH from implementing a new reimbursement methodology for Consumer-Directed Personal...
2020 Medicare Part D Plans in NYS
The annual coordinated election period ("open enrollment") for Medicare Part D and Medicare Advantage plans for 2020 runs from October 15 through December 7, 2019. Every year, you should review your plan and see if it still meets your needs - whether it covers your drugs, whether costs have...
Medical Records Must be Provided FREE if Needed to Support Claims for Public Benefits - New September 2017
In September 2017, a new law went into effect that requires health care providers to provide medical records at no charge, when needed to support an application, claim or appeal for a government benefit or program. Here's what the law adds to Mental Hygiene Law § 331 and NYS Public Health Law §...
Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"
If you are Age 65+. Disabled, or Blind, your Medicaid eligibility is likely based on "non-MAGI" budgeting, as opposed to "MAGI" budgeting. This Fact Sheet explains the basic rules of Non-MAGI Budgeting. MAGI budgeting is used for most people under age 65 who do not receive Medicare....
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...


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