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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)...
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...
Medicaid Advantage Plus "MAP" - New "FIDE" Appeals & Hearing Process began 2020 - Healthfirst Mistake March 2021
In 2020, a new appeal and fair hearing process launched for about 10% of Managed Long Term Care members those who are in Medicaid Advantage Plus (“MAP”), which consists of a "FIDE-SNP" (Fully Integrated Dual Eligible - Special Needs Plan) that covers the Medicare services, and a Medicaid...
MLTC Members in Nursing Homes for 3+ Months Being Disenrolled from MLTC Plans
Jan. 2021 Update - More Nursing Home Residents to be Disenrolled from MLTC plans April 1, 2021, after Disenrollments on Jan. 1, 2021 On April 1, 2021, 2,008 more MLTC members who have been in nursing homes for three or more months and who have been approved for Institutional Medicaid will be...
Medicaid Renewals/Recertifications in New York City- TIPS
This article available as a fact sheet in ENGLISH and SPANISH This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration (HRA). If your Medicaid is handled by the New York State of Health – your renewal is not covered in...
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...
Medicaid Recipients to be "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare-- April 1, 2021
TRAINING ALERT - Medicare Rights Center is hosting a webinar about the changes described in this article on Wednesday, April 14, 2021 at 3:00-4:00 p.m. (EST) Register here for Webinar: Default Enrollment and Integrated Care Options for Dually Eligible New Yorkers Webinar will...
Medicare Insurance Premium Payment Program (MIPP)
Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who...
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...
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...
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...
Immigrant Eligibility for Medicaid & other Public Benefits - Public Charge Rule VACATED March 2021
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 NEWS on Public Charge - Regulations Issued by Trump Administration VACATED 3/9/21 NEWS 3/9/2021 - Just in from...
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. NEWS UPDATE March 9, 2021 - The Trump Public Charge rule has been vacated after the Biden administration...
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. NEWS UPDATE March 9, 2021 - The Trump Public Charge rule has been...
Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
NEWS UPDATE March 9, 2021 - The Trump Public Charge rule has been vacated after the Biden administration withdrew its appeal to the Supreme Court of an injunction issued by the Second Circuit and also withdrew appeal of a Seventh Circuit lawsuit. See more about this news and public charge here. ...
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...
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 eligibility for Medicaid to pay for nursing home care. At the time, and until now, nursing home care was the only Medicaid service that had a lookback and transfer penalty.See GIS 06...
Medicaid Transportation in NYS
States are required under federal regulations (42 C.F.R. §431.53) to assure necessary transportation to Medicaid beneficiaries to and from medical services. When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary...
Right to a "Home Hearing" under Varshavsky Case - Special Rights in Fair Hearings Seeking Increases in Medicaid Home Care
RIGHTS of People Who Cannot Travel to a Fair Hearing Because of Disability This article can also be downloaded as a Fact Sheet here. Individuals who, because of mental or physical disabilities, cannot travel to a fair hearing without substantial hardship or medical detriment, have rights...
Health Plan Appeal Rights in New York After the Affordable Care Act
Samuel Salganik, an attorney at Community Health Advocates, wrote this incredibly thorough article breaking down the types of appeal rights available to individuals covered by the various types of private health insurance plans in New York. This article includes coverage of the changes to patient...
Affordable Care Act --New York State Health Exchange Open Year-Round for Medicaid Applications and for Certain "Special Enrollment" categories
New York State of Health Exchange https://nystateofhealth.ny.gov/ There is year-round open enrollment for MEDICAID on the New York State of Health website. Normally, open enrollment for Qualified Health Plans is limited, but through March 31, 2021 there is a Special Enrollment Period in NYS...
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...
Appeals & Grievances in Managed Long Term Care - "Exhaustion" of Plan Appeal Required since 2018
In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F Sept. 2020 UPDATE - NYS Dept. of Heath proposed...
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 2021 in Jan. 2021) 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...


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