New York Health Access

Medicaid

	Know Your Rights: NYLAG Webinars on Medicare and Medicaid - The Evelyn Frank Legal Resources Program conducted a five-part Continuing Legal Education Webinar program in April and May 2016 that provides tools to understand and navigate the complex world of Medicare and Medicaid in New York. The focus is on eligibility and application procedures for older...


	"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...


	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/ MEDICAID Individuals eligible for Medicaid or Child Health Plus and American Indians/Alaskan Natives can enroll at any time during the year on the New York State of Health website. This is for people under age 65 who do not...


	Medicaid Alerts & Other Protocols published by the NYC HRA Medicaid Program HRA Medicaid Alerts are periodic announcements of policy, staff and office changes published by the HRA Medicaid Progarm (formerly called the "Medical Insurance and Community Services Administration (MICSA)". The Medicaid Program is the part of New York City’s Human Resource Administration...


	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 02/20/2024 with 2024 figures) explains Medicaid eligibility for New Yorkers who are age 65+ or who have disabilities. It explains the basic financial rules on eligibility for Medicaid in the community for this category of people, and explains how to apply for Medicaid if...


	Fundamental Changes to NY Medicaid in the 2011 State Budget The Health Budget passed this week makes fundamental and far-reaching changes to New York’s Medicaid program, with savings reported at $2.8 billion. The proposals that were presented to the legislature in the Governor’s 30 day amendments represented a package submitted by the Medicaid Redesign...


	Physical, Speech & Occupational Therapy Limits Lifted for 2021 The 2011-12 NY State budget, ] limited access to compression stockings, prescription footwear, and enteral nutritional formula, as well as physical therapy, occupational therapy, and speech therapy. Some of these limits have been repealed or made less harsh. Physical, Speech, and Occupational...


	Medicaid Managed Care IN THIS ARTICLE * Complaints - Where to File *Law & Regulations 1 - What is Managed Care? 2 - Mandatory Enrollment for Most People with Medicaid - and LOCK-IN 3 - Who is Exempt or Excluded from Enroling in Managed Care 4 - Enrolling and Disenrolling in Managed Care 5 - List of plans in...


	Restricted Recipients MEDICAID MANAGED CARE FACT SHEET Restricted Recipients- the way you receive your Medicaid benefits is changing! On August 1, 2011, Medicaid recipients who are restricted to certain providers will have to enroll in a Medicaid health plan. Before August 1, 2011, restricted...


	New York Dramatically Expands Mandatory Managed Care for Medicaid Beneficiaries Many people who used to be exempt from mandatory enrollment in Medicaid managed care have been receiving notices in summer and fall 2012 telling them that their exemption has ended, and that they now have 30 days to enroll in a managed care plan. This type of managed care is sometimes called...


	Tools for Choosing a Medicaid Managed Long Term Care Plan As described in this article, most adults in NYS who have Medicaid and Medicare, who need Medicaid personal care or CDPAP services or long-term CHHA or adult day care services, must select and enroll in a managed long term care plan, or a PACE or Medicaid Advantage Plus plan. Starting in May 2022...


	Delays in Processing of Medicaid Applications - What are Your Rights and Lawsuits Challenging Delays The Deadlines to Process Medicaid Applications in the Law Federal and state law set time limits for processing a Medicaid application. The federal Medicaid Act requires eligibility to be determined with "reasonable promptness." A determination of eligibility for Medicaid must generally be made...


	Grievance and Appeal Contacts for Managed Long Term Care Plans SINCE 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 when they receive an Initial Adverse Determination denying or...


	Court Orders Lifting Restrictions in Medicaid Coverage for Compression Stockings and Orthopedic Footwear Federal Court Orders State to Stop Restricting Coverage of Compression Stockings and Orthopedic Footwear. On July 1, 2016, a federal judge in New York issued an order enjoining state health officials from limiting coverage of orthopedic footwear and compression stockings for some state Medicaid...


	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...


	New York Medicaid Expansion Know Your Rights: What You Need to Know About NYS Medicaid Expansion in 2023 This year’s Health Budget makes significant changes to New York’s Medicaid program – expanding eligibility to 133% of the federal poverty law (FPL) and changing budgeting rules and enrollment processes for...


	Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State Numbers tell a big part of the story of how managed care plans are doing in providing care. With mandatory enrollment in Medicaid managed care now required in every county in New York State for most people who do not have Medicare, and mandatory enrollment in Managed Long Term Care of those adults...


	Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange The Empire Justice Center published a report in May, 2013 exploring the policies that guide immigrant access to health care and making recommendations for improving immigrant access through New York's Health Insurance Exchange: New York's Exchange Portal: A Gateway to Coverage for Immigrants ...


	"Ensure" and Enteral Nutritional Supplements - When does Medicaid Pay for it? 2013 Changes for Adults Children under 21 are entitled to obtain "Ensure" or other nutritional supplements when medically necessary. However, the State has enacted laws in the last few years that restrict eligibility for nutritional supplements for adults age 21+. In 2011, the state budget law limited these "enteral...


	Annual Open Enrollment Period for Qualified Health Plans Begins November 16, 2023 The annual open enrollment period for Qualified Health Plans on the New York State of Health exchange starts November 16, 2023. Go to the New York State of Health website to look at plan options and enroll. You must enroll by December 15, 2023 for coverage starting January 1, 2024. Even if you...

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