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Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
September 2018 ALERT - On Sept. 22, 2018, the Trump Administration proposed changes on the standards for deciding whether an immigrant who receives Medicaid or other government benefits is considered a "public charge" which can result in denial of Lawful Permanent Resident status (green card),...
Medicaid & MSP: Must apply for Social Security and Enroll in Medicare
Medicaid applicants and recipients can be required to pursue potentially available income, including Social Security, 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.) ...
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)...
Pathways to Extra Help - the Part D low income subsidy and how it can help your clients
There is a special program called the Low Income Subsidy (LIS) which helps with Medicare Part D cost sharing. LIS is also known as "Extra Help." The Social Security Administration administers LIS you don't apply through your Part D plan. See Medicare Rights Center chart on 2019 Extra Help...
"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...
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...
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. ...
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 Resource and Income Disregards
When determining eligibility for Medicaid in New York state, the local district determines the gross income and resources of the applicant, and then deducts certain items which may be disregarded. If any of these disregards apply to a particular applicant, then they may be eligible for Medicaid...
Income and Resource Limits for New York State Public Health Insurance Programs
Here is the 2019 HRA Income and Resource Levels chart. Please note that income limits based on the Federal Poverty Line, highlighted in green, are not yet updated- the 2018 ones are still shown. Figures highlighted in yellow are updated for 2019. This short summary chart shows that income...
Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits
This in-depth training outline (updated January 2019) covers how Supplemental Needs Trusts work (both individual and pooled), when an asset or lump sum may be deposited into an SNT. For Community Medicaid only, income may also be placed into an SNT. Explains how lump sums and SNTs affect...
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...
Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA)
Since May 2013 the NYC Medicaid Office (known as MICSA) and Home Care Services Program has been located at 785 Atlantic Ave., Brooklyn, NY 11238. The Reception Unit is on the main floor of 785 Atlantic Ave.Brooklyn NY 11238. The following is a list of contact information for popular...
"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...
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...
Immigrant Eligibility for Publicly Funded Health Care Benefits - THREATENED CHANGES SEPTEMBER 2018
Sept.23, 2018 ALERT - Trump Proposes Harsh "Public Charge" Rule Changes On Sept. 22, 2018, the the Department of Homeland Security (DHS) issued a press release and the text of the highly anticipated public charge rule. which will change the definition for deciding whether an immigrant who...
NYS Directives on Medicaid changes under the Affordable Care Act
The New York State Department of Health (DOH) has issued additional directives outlining the new procedures for Medicaid applications and renewals under the Affordable Care Act, effective in 2014. For newest directives scroll to the bottom of this page. 1. 13 ADM-04 - Medicaid Application...
Medicaid Dental Benefit in NYS
Under Medicaid, dental benefits exist, but the coverage is limited. This limited coverage makes it important for advocates to understand the exceptions to different coverage limitations. By understanding the nuances of the benefit, advocates can help get their clients the coverage they need. NEWS...
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...
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...
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 March 2018) - 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...
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...
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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