New York Health Access - Other Services

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	Expanded Medicaid Dental Benefits - Effective 1/31/24 New York’s Medicaid program includes limited dental benefits. The coverage has been expanded beginning on January 31, 2024 as the result of the settlement of the Ciaramella v. McDonald case (originally Ciaramella v. Zucker). This article will go over general Medicaid dental rules and common...


	What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS By the Legal Aid Society Thanks to a settlement secured by Legal Aid in Ciaramella v. McDonald many more New Yorkers will be eligible for additional dental procedures under Medicaid by early 2024. What dental services does the settlement impact? Root canals, crowns, dental implants, and...


	Previous Medicaid Dental Benefit in NYS (Rules Effective for Services Requested Through 1/30/24) New York’s Medicaid program includes limited dental benefits. The coverage was expanded beginning on January 31, 2024 as the result of the settlement of the Ciaramella v. McDonald case (originally Ciaramella v. Zucker). This article explains Medicaid dental rules in effect until January 31,...


	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...


	Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans - also Tool to Find Medicaid Providers What types of providers are affected? Effective January 1, 2014, medical providers must be enrolled with the NY State Medicaid program in order for Medicaid to pay for services that they prescribed, ordered or referred. The rule applies to ordering, prescribing, referring and attending...


	Medicaid Home-and-Community-Based Waiver Programs in New York State Medicaid home and community-based services [HCBS] are available through waiver programs to groups of individuals who would be eligible for Medicaid if institutionalized and, but for the services, would be institutionalized in a hospital or nursing facility. Under section 1915(c) of the Social...


	Medicaid Reimbursement of Home Care and other Medical Expenses Reimbursement in General Because Medicaid coverage can be retroactive up to three months, it is possible for a Medicaid applicant or his or her family member who paid the applicant's medical expenses to get reimbursed for some of the home care costs and other medical bills they incurred and paid...


	Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services NOTE: This article is about consumer rights when a Medicaid recipient "transitions" to or from a Managed Care plan. For information about care related to gender transitions, see Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care. What is a Transition...


	Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants & Changes for Age 65+ NEWS ALERT: January 1, 2024 - Undocumented immigrants age 65+ became eligible for full Medicaid (as opposed to only Emergency Medicaid). See this article to learn how this expansion is being implemented, and Download the official Fact Sheet - New Health Insurance Option for...


	Asking Medicaid to Pay for an Air Conditioner This article explains how to get Medicaid to pay for an air conditioner. NYC also has another program to provide free air conditioners to people for whom it is medically necessary. Click here for the 2022 Cooling Assistance application.


	Medicaid Copayments in New York State This fact sheet explains which New York Medicaid recipients must pay copayments, and for which services. It also explains the $200 CAP, which limits how much any Medicaid recipient must pay in copayments in a year to $200. Note that for those who have both Medicare and...


	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...


	The Medicaid Pharmacy Benefit - For People Without Medicare - NYRx Implemented April 1, 2023 Once again, in April 2023, NYS changed the way people without Medicare access prescription drugs. These are people in "mainstream" Medicaid managed care plans, including HARP and HIV-SNP plans. These changes were delayed from 2021, but are in effect as of April 1, 2023. These were enacted under...


	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...


	Medicaid Short-Term Rehabilitation Benefit As you may know, there are three different levels of Medicaid coverage in New York State, each with different resource documentation requirements. These can be summarized as follows (see this more detailed chart): Level of Coverage: Community Coverage Without Long-Term Care Community...


	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...


	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...


	Dental and Orthodontic Services to be Included in the Medicaid Managed Care Benefit Package Know Your Rights: What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS (2024) Dental Services to be Included in the Medicaid Managed Care Benefit Package Effective July 2, 2012, dental services for Medicaid beneficiaries must be obtained through the member's...


	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...


	"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...

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