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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 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 table of contacts below is compiled from these Alerts issued by HRA: See HRA Fax/E-mail Submissions to HRA...
Sources of Legal Authority for Health Care Advocates
Public health care programs in New York State are governed by many different legal sources. Because most programs, including Medicaid, are federal in origin, governing law begins with federal statute and regulation. State statutes are often very prescriptive as well, defining key terms such as...
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 for 2022) - 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...
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. ...
Medicaid Utilization Thresholds (MUTS or UT) in NYS - Limits on Number of Services per Year to END Jul 1, 2022
GOOD NEWS - The 2022-23 NYS Budget will END the use of Utilization Thresholds for Medicaid in July 1, 2022. This fact sheet explains Medicaid Utilization Thresholds (MUTS or UT) in New York State - Limits on Number of certain services per year, and the "override" procedure available to increase...
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...
Saving Money on Prescription Drugs if You're Uninsured or Underinsured: Discount Cards and PAPs
Prescription drugs can be the most expensive healthcare cost for many people. Those who are uninsured are typically stuck with paying full retail price for prescription drugs at the pharmacy counter, which can be hundreds or thousands of dollars per month. Even those who have health insurance -...
2015 NYS Law Gives Protection from Surprise Bills and Emergency Services
The NYS Surprise Bills for Health Care Services Law went into effect in New York State March 31, 2015, protecting some consumers from "surprise bills" when services are performed by a non-participating (out-of-network) doctor at a participating hospital or ambulatory surgical center in your HMO or...
NYS Medicaid Application Form (updated 2021) for Age 65+ or Disabled or Blind - New Supp A NYC 2021
Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or form DOH-4220. Download the form at this link (As of 03-31-22, the form was last updated in August 2021). For those age 65+ or who are disabled or blind, a second form is also...
Medicare Savings Programs (MSP) in New York
March 2022 Alert Tell your State Senator and Assemblyperson and Gov. Hochul to expand income limits for MSPs - Support Senate Bill S8228/A9245 - see more here! Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualify...
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...
Income and Resource Limits for New York State Public Health Insurance Programs
1The 2022 HRA Income and Resources Level Chart was updated on March 16, 2022 and used the 2022 Federal Poverty Levels from GIS 22 MA/01 - and Attachment I issued in March 2022, which updates the previous December 2021 GIS 21 MA/25 that did not reflect the 2022 Federal Poverty Levels, which had not...
The Various Types of Medicaid Home Care in New York State
New York State has a range of Medicaid home care service programs, each oriented toward slightly different needs and sometimes to different populations. These programs are listed below, with links to detailed information posted on this site. Beginning in September 2012, for ADULTS age 21+ who...
No Surprises Act 2022 – Understanding Consumers’ Rights against Surprise Medical Bills
Starting January 1, 2022, there are new protections that prevent surprise medical bills under the federal No Surprises Act (NSA), Pub. L. No. 116-260, 134 Stat. 1182, Division BB § 109. If you have private health insurance, these new protections ban the most common types of surprise bills. If...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
A. Fact Sheets on Managed Long Term Care B. Click here for WEBINARS on LONG TERM CARE A. Fact Sheets on Managed Long Term Care BASICS Basics on Managed Long Term Care (In process of being updated - 2-2020) see also Article on Managed Long Term Care News on MLTC - updated monthly ...
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 NYC directives click here. NYS DIRECTIVES (beginning with oldest - scroll down for newer ones)...
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...
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
COVID-19 updates & Eligibility Restrictions CDPAP services are still available from MLTC and managed care plans, for people applying for "Immediate Need" services, or who are exempt from MLTC or managed care during COVID-19. People who want to register with a "Fiscal intermediary" to be paid...
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...
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)...
"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,...
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...
Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"
Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting - used for people age 65+, Disabled, or...
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 2021, the income limit is $904/mo. of income. (after subtracting $20/mo disregard) (The income limits for...


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