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Immigrant Eligibility for Medicaid & other Public Benefits - Public Charge Rule and UKRAINE Update
Updated Immigrant Eligibility for Public Benefits in NYS Chart by Empire Justice Center & NY Immigration Coalition - updated to include Public Charge 2022 NEWS - Including UKRAINIAN IMMIGRANTS UKRAINE - LINU - PUBLIC BENEFITS for DISPLACED UKRAINIANS Arriving in the US - See...
Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits
This in-depth training manual or outline (updated August 2022) 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...
Medicare Savings Programs (MSP) in New York
Heads Up - Income Limits for MSP's will increase in 2023 in NYS - see more here! 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...
"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...
When an MLTC Plan Closes - What are the Members' Rights? WARNING - Changes Now in Effect
Since Managed Long Term Care (MLTC) plan enrollment has been mandatory since 2013 for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some MLTC plans have either closed or reduced their service area, no longer covering certain counties or New York City....
Getting Help with Managed Long Term Care
Here are organizations where you can seek help for problems with Medicaid Managed Long Term Care and Medicaid Advantage Plus. Also see these KNOW YOUR RIGHTS Fact Sheets about MLTC and related topics STATEWIDE ICAN – Independent Consumer Assistance Network – ...
Requesting a New or Increased Service from a Medicaid Managed Care or MLTC
Members of Medicaid Managed Care plans, including Managed Long Term Care (MLTC) plans, have the right to request a NEW service that was not previously authorized ("prior authorization"), or an INCREASE In a service they already have ("concurrent review"), such as more hours of personal care or...
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. NYLAG 2018 Trainings on Changes: View the...
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...
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)...
COBRA - Keeping Employer Group Health Insurance After a Job Ends - Federal & New York State Protections
Here are resources on rights to continue coverage after losing one's job, under the federal "COBRA" law. FEDERAL INFO on COBRA US Dept. of Labor COBRA Webpage One-year tolling period during pandemic - extra one year to elect COBRA -- this special enrollment period extends until 60...
2022 Medicare Part D plans in New York State
The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2022 runs from October 15 through December 7, 2021. Every year, you should review your plan options to see if your current plan still meets your needs - see more here what to look for...
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...
Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services
States must have in effect a transition of care policy to ensure continued access to services during a transition from Fee for Service Medicaid (FFS) to a Managed Care plan or transition from one Managed care plan to another "when an enrollee, in the absence of continued services, would suffer...
Step-by-step guide to enrolling in a pooled income trust for Medicaid spend-down
This article is a condensed road-map for using a pooled income trust to eliminate the Medicaid spend-down. NEW June 2022 - Big Changes in NYC - See STEP TWO and STEP Three below - NEW DISABILITY forms required! DOWNLOAD OUR our longer FACT SHEET on this topic (updated July 5, 2022 to...
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. For background on Medicare and its gaps 2021 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric...
Medicaid Spend-down: NYC Medicaid Now Accepts FAXED Medical Bills
In May 2009, the NYC Medicaid Program announced a pilot program that allows consumers who must "spend down" to qualify for Medicaid to fax their medical bills each month to the Medicaid Centralized Surplus Unit. See announcement. You can download the official Spend-down fax cover sheet with the...
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...
Medicaid Disability Determinations - NYS Forms & Procedures (with updated forms Dec. 2021)
The Medicaid program has long had a procedure for determining disability for individuals who have not yet been determined disabled by the Social Security Administration.[1] This procedure is needed in order to approve pooled trusts for people age 65+ and also for other reasons described here. The...
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...
Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants
Coming later in 2022 or 2023 - Undocumented immigrants age 65+ will be eligible for full Medicaid (as opposed to only emergency Medicaid) later in 2022 or early 2023, once approved by CMS (enacted in NYS budget April 2022) COVID-19 ALERT - See here. COVID-­19 lab testing, evaluation, and...
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. What is Temporary Protected Status? TPS is a temporary immigration status granted to eligible individuals of a...
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...
Transition Rights after Enrolling in or Switching MLTC plans - 2022 Changes
This article can also be downloaded as a Fact Sheet here. If you received Medicaid personal care or Consumer-Directed Personal Assistance (CDPAP) services, and then you were required to enroll in or transfer to a different Managed Long Term Care plan, your new Plan must continue to authorize...
Medicaid Recipients to be "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare-- April 1, 2021
.  WHAT CHANGE IS HAPPENING APRIL 1, 2021 Beginning April 1, 2021, a change is coming for New York Medicaid recipients who newly become enrolled in Medicare and become "Dual Eligibles" - someone who has both Medicare and Medicaid. Every month about 3,000 - 4,000 Medicaid recipients in New...


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