Medicaid Renewals/Recertifications in NYC- Medicaid can be DISCONTINUED if RENEWAL not returned - Starting April 2025

This article is for people whose Medicaid is administered by the NYC Human Resources Administration (HRA).  If your Medicaid is handled by the New York State of Health, your renewal is not covered in this article.  For those living in different counties outside NYC, whose Medicaid is administered by the Local Department of Social Services, the forms and procedures may be slightly different than NYC but the general principles are the same. 

Medicaid is authorized for one year at a time.  Approximately 3 - 4 months before the end of your authorization period, you should receive a "renewal" or "recertification" packet by mail, which includes instructions on how to complete and return the packet to HRA.  Here are tips for handling renewals, including how to obtain a copy of the renewal form if you don't receive one in the mail.

• Starting May  2025  - if  New York City recipients do not return renewals,  Medicaid is discontinued.  HRA sends a Notice of Discontinuance 10 days before the discontinuance.  When Medicaid is discontinued, so are all services -- including MLTC and home care. 

  • 20,000 NYC Medicaid recipients were sent notices that their Medicaid is STOPPING in early May 2025!  

  • The same number will likely receive notices every month from now on - if they did not return their renewal. 

• Read NYLAG's PowerPoint with tips on how to respond to the renewal to prevent cut-off of Medicaid.   Even though renewals have been sent out in NYC since 2020, discontinuances were "paused" during the Public Health Emergency,  and then for the "unwinding" period.  HRA was not allowed to discontinue Medicaid for failure to return the renewal  -- UNTIL NOW - May 2025.

• New April 2023 - NYC Medicaid renewals can be uploaded  ONLINE on  AccessHRA website  -- but documents must be submitted separately on a mobile app.    Click here for more info.

• Download sample renewal form as revised 12/2023. See the new Authorization for Verification of Resources form that you and your spouse must each sign and return with the renewal.  

IN THIS ARTICLE

1. COVID Post- PANDEMIC ALERT - RENEWALS & Discontinuances RE-STARTING WITH UNWINDING OF THE COVID PUBLIC HEALTH EMERGENCY

2. Keep track of your Medicaid authorization period so you know when to expect your Medicaid renewal

3. Obtain Your Renewal Packet if you Don't Receive it In the Mail

4.  How to Fill Out The Renewal Form  --new Authorization for Verification of Resources form that you and your spouse must each sign and return with the renewal.  

5. What to Include With Your Renewal Packet

6.  How to Send Your Renewal Packet to HRA

7. NEW IN 2023 - Upload the Renewal Online

8.  Troubleshooting Renewal Problems

2.  Keep track of your Medicaid authorization period so you know when to expect your Medicaid renewal

1. Find the starting month of your authorization period on your Medicaid acceptance letter.  The attached sample Notice of Decision on Your Medical Assistance (p. 6 of PDF) is dated July 31, 2019. Here are the key dates.

   • July 1, 2019 to June 20, 2020 - one-year authorization period.

   •  March or April 2020 - Putting aside the COVID pause -- the next renewal would have been sent during this period with a return due date of May 10, 2020. 

   • May 10, 2020 - If renewal wasn't returned by this date, on --

   • June 20, 2020 -  a notice of discontinuance is sent effective July 1, 2020. 

• Must request Fair Hearing before July 1, 2020 to prevent Medicaid from stopping on July 1st.  But under special rules until Dec. 2025,  Even if request hearing late - up til Aug. 20, 2020 - Medicaid should be restored as "Aid Continuing" back to July 1. 2025.  Download the CMS Fair Hearing e14 Waiver Approval

• JULY 1, 2020 - MEDICAID CUT OFF if did not request a Fair Hearing before that date. 

1. For another example of timing -- see the sample notices at pp. 7-8 of this PDF.  These are the notices a consumer would receive if their previous authorization period was from Sept. 1, 2018 to August 31, 2019. 

• p. 7 - Renewal Notification dated July 10, 2019 with renewal due August 10, 2019.  

• p. 8 - Notice of Decision on Your Medical Assistance dated Aug. 21, 2019 with Medicaid discontinuing effective Sept. 3, 2019.  Discontinuance is because renewal not returned by August 10, 2019. 

3. Find the date your authorization period ends in your account on the AccessHRA website. Once you log in, on the home page, click on RENEW MEDICAID button.   Here you can view your Medicaid case information including: Recert Due Date (currently named Eligibility End Date),

4. If you are enrolled in an MLTC plan, your MLTC plan should notify you of an upcoming renewal shortly before HRA mails you the renewal packet.

5. If you receive your renewal packet in the mail, don't throw out the enclosed gray return bar-coded envelope.  As explained below, you will send back the completed renewal packet in the gray envelope.   See more here about option to file the completed renewal ONLINE. 

3.  Obtain your renewal packet if you don't receive it in the mail:

1. Set up an account on the ACCESS HRA Website following this link. To set up an account, you will need to create a username, password, and select a security question. You DO NOT need an email address to set up an account. Once you create an account and log in, you may be asked to enter your date of birth and Social Security Number or CIN. Please enter this information to locate your case in HRA's system.

You will then be able to download and print your individualized renewal form. Use this personalized renewal form instead of a new Application, as your renewal packet has a unique barcode and other information that is specific to your case.

2. If you are unable to use the Access HRA website, request a copy of your renewal packet by calling HRA's automated line at 1-888-692 6116.

3. If you recently moved and have not updated your address with HRA, you will not receive your renewal, as it will be mailed to your last known address.

   • If your renewal period is coming up in the next 4 months, use Access HRA to download a copy of the renewal form (see  No. 2a above).

   • If you won't be receiving your renewal for at least 4 months, report your new address to HRA immediately.  Call the Medicaid helpline at 1-888-692-6116 to update your address or complete and fax the MAP-751K form to fax 1-917-639-0837. Download the form in English and other languages on HRA site at this link. (Form updated 3-15-2021)(Check back to see if HRA updates the form). Please make sure to keep fax confirmation.  

   • See this HRA Alert 6/30/23 which provides for protections for consumers whose renewal packets are returned by USPS.

4.   How to fill out the renewal form - See sample  12/2023  renewal form  with attachments as is being used in 2024-2025 here  

1. Click here for option to UPLOAD the renewal and supporting documents online - new April 2023.  

2. WRITE in big, clear letters on top of the form and in any white space if you get any special type of Medicaid budgeting -- such as Spousal Impoverishment, Spousal Refusal, MBI-WPD, Pooled Trust, MAGI-like,  DAC, Pickle, or Special MLTC Housing Standard. Also write in if you want  QMB (Medicare Savings Program) as well as Medicaid.  For info about these special Medicaid budgeting rules, see this article  

3. Include all household members and their information.  This includes your spouse if your spouse lives with you, and any minor dependent children (or grandchildren or other relatives) under age 18 or under 19 if in school who live with you.  Do not list your adult children, your siblings, or other roommates.

4. Make any changes to the amount of your rent, your insurance premiums, your income, and your resources.

5. If you have a Pooled Income Trust, be sure to check the box saying you are enclosing a Verification of Deposits that you obtain from your Pooled Trust organization reflecting all deposits you have made for the last year.  Many Pooled Trusts now make this document available online for download.

6. NEW IN 2023 -  Authorization for Verification of Resources - If this form is in the packet, the recipient and their spouse if they are married each must sign this form and send it back with renewal! (MAP-3179 is for applicant  and 3179a is for spouse) (pp. 7, 12-13 of PDF).  The renewal form has a new section to provide the spouse's name, date of birth, Social Security Number and address.  This is in Part 6 RESOURCES (Page 6 of the PDF).  This authorization is likely being required as HRA is belatedly implementing the Asset Verification System (AVS) required by  NYS DOH 17-ADM-02. See more about this here.

7. Financial Maintenance Form -- If your share of household expenses for rent and utilities are more than 70% of your monthly gross income, fill out the Financial Maintenance Form included in the packet to explain how you meet your expenses. (Form is page 10 of this PDF)  If someone pays one or more of your bills, write paid for by ______. You may want to include a letter from this person stating that they pay this bill on your behalf.

5.  What to include with your renewal packet.

1. If you have a Pooled Income Trust, include a current Verification of Deposits for the last year through the current month.   Ask your Trust Organization for this form.  Many Pooled Trusts now make this document available online for download.

2. Proof of payment of health insurance premiums. (Ex: Medigap, dental, vision, union/retirement, etc.).  Note: this proof may appear in your pay stub.

3. Proof of income for all of your household members, including: pension letter, letter from employer, paystubs, etc. You do not have to include a letter showing your current Social Security amount, but it is a good idea to include anyway. 

4. If you have an I.R.A., include the most recent statement that shows the amount of your Required Minimum Distribution (RMD) for the current year.  Include proof that you are taking or that you have requested regular periodic distributions. 

   • Even if you are under age 70-1/2 (or under 72 if you turned 70 on July 1, 2019 or later) and you are not required by the IRS to take distributions, Medicaid still requires that you take periodic distributions, unless you are under age 65, disabled, and working. 

5. Proof of resources -- current bank and investment account statements that you or your spouse own, even if you own them jointly with someone else. Include a statement of your burial fund account if you have one.   

6. If applicable, a copy of the signed Spousal Refusal form, if any, even if you submitted it before.  

7. If you are in an MLTC plan and have the Special Income Standard for Housing Expenses because you were in a nursing home or adult home in the past, you need to complete, sign and include this form. 

8. Include the Authorization for Verification of Resources form signed by you and your spouse if it was in the packet.

9. BEST PRACTICE TIP:  Write clearly on top of the renewal form and, if you wish, in a cover letter, if you are requesting any special budgeting (see #4.a. above).  If you include a cover letter, explain the proposed budget to demonstrate that the spend-down should be zero.  Make clear if you want the Medicare Savings Program too. 

6.  How to send your renewal packet to HRA:

1. See below here for option to UPLOAD the renewal and supporting documents online - new April 2023.

2. If returning the renewal by mail -- make two complete copies of the signed original renewal form and all attachments.  Now you have 3 sets: 

   1. Mail the original renewal packet and all required documents to HRA in the barcoded gray envelope you received in the mail.   If you downloaded the form and you do not have the return bar-coded envelope, then mail it to the address below. Make a note of when and where you mailed the bar-coded envelope.  

   2. Mail another complete copy of the renewal packet and all attachments in a separate envelope to the same address via certified mail return receipt requested so you have proof you sent it and when it was received.  Save the return receipt.

3. Keep one complete copy of the signed renewal packet and all attachments, along with the certified receipt for your records.  This will be important if you receive a letter claiming HRA never received your renewal.  See item 8 b. below.

c.    After you send your renewal packet, you can call the automated line at 1-888-692-6116 to check the status of your renewal. Have your Medicaid case number available, which can be found on the top right corner of your renewal form. Be advised it may take some time for the renewal packet to be received and processed.

7.NEW in April 2023 - FILE YOUR RENEWAL ONLINE 

1. Medicaid-only Disabled Aged and Blind (DAB) consumers can submit their Medicaid renewal online using ACCESS HRA as an alternative to returning the paper forms. (see NYC HRA ACCOUNCEMENT -- 2023-04-07 ACCESS HRA Client Portal Enhancements.

   • This includes Medicaid Excess Income or Surplus program and those that receive homecare services through a Managed Long Term Care (MLTC) plan)

2. Create an account at  https://a069-access.nyc.gov/accesshra/. You will need to create a username, password, and select a security question. You DO NOT need an email address to set up an account. Once you create an account and log in, you may be asked to enter your date of birth and Social Security Number or CIN. Please enter this information to locate your case in HRA system. 

3. TWO-STEP RENEWAL PROCESS:  (see screenshots of each step in this presentation)

   1. STEP ONE - COMPLETE AND SUBMIT ONLINE RENEWAL FORM.  On the home page of ACCESSHRA, click under MEDICAID heading on the RENEW  button.   Consumers can view their Medicaid case information including: Recert Due Date (currently named Eligibility End Date), Surplus coverage status and Surplus amount.   More information on how to file the renewal online will be posted here soon.  

• Answer questions about household, income, resources, expenses and health insurance information.  Review a summary of your answers and edit as needed
• Electronically sign and submit your completed responses before providing needed documents
• Confirmation # provided with list of documents that need to be submitted by due date (save confirmation as a PDF).

1. STEP TWO - SUBMIT DOCUMENTS via Access HRA Mobile App  

• Must submit requested documents by due date using the Access HRA Mobile App (this is the only way to submit documents). If you do not complete Step 2, the renewal will not be processed.

    see screenshots of each step above  in this presentation

4. Check Status of Renewal - by phone 1-888-692-6116 or on AccessHRA  (See  this presentation for more info - slides 36-38)​​​​​​​

8.  TROUBLESHOOTING  RENEWALS -- What if ... ????

1. You did not receive your renewal form by mail or if you recently moved?  See  here for how to print out a blank form online. 

2. You receive a Notice that your Medicaid will be discontinued for failure to renew, even though you sent in your renewal? Sometimes this happens even when you submit your renewal on time -- because the computer is programmed to send them out automatically, even if HRA has not processed it yet..  See a sample Notice of Decision on Your Medical Assistance at page 8 of this fact sheet.  On this sample notice:

   • The DATE of the notice is August 21, 2019.  
   • The missed deadline to submit the renewal was August 10, 2019. 
   • The EFFECTIVE DATE of the Medicaid case closing is Sept. 3, 2019.

• WHEN to REQUEST THE FAIR HEARING --  Normally, the State hearing agency (NYS Office of Temporary & Disability Assistance or OTDA) must RECEIVE your fair hearing request before the Effective Date of the case closing (Sept. 3, 2019 in the sample at page 8 here).  Then your Medicaid will continue until the fair hearing is held and decided.  This is called Aid Continuing.  This is usually just a short 10-day deadline after the Notice was sent.

  • ​​​​​​​​​​​​​​​​​​​​​​​​​​​​Under  a special "E14 waiver"  in the unwinding of the COVID public health emergency, OTDA will order Aid Continuing even if you miss that short 10-day deadline, as long as you request the fair hearing before the statute of limitations - which is 60 days for Medicaid discontinuance notices.  This special rule continues through December 2025.  See more here. 

• HOW TO REQUEST THE FAIR HEARING - by phone, fax, or online at https://otda.ny.gov/hearings/request/.   Mail is not recommended as it may arrive too late for you to get Aid Continuing.   Include a copy of your NOTICE, and write the date of the notice, the effective date, and the notice number on the Fair Hearing Request.  The State hearing agency OTDA will alert HRA staff to keep your case open and your coverage active.

• Find help for the hearing at https://www.lawhelpny.org/. 

• Proof that you submitted your renewal on time (or within the 30-day grace period) will be important to win the hearing.   Sometimes your advocate can help you avoid having a fair hearing altogether but you must request the hearing with Aid Continuing right away to prevent loss of Medicaid and home care services.

3. What if you are sending your renewal late?    SEND IT IN ANYWAY!  

   "If the individual returns the completed renewal ... within 90 days of the case closure for failure to  recertify, districts may use the returned renewal to reopen the   closed case and process the renewal. If eligible, coverage is  authorized back to the effective date of discontinuance for the failure  to renew. Renewals processed within this 90-day timeframe qualify for  waiver of the resource test, as described above in Waiver of Resource Test section. GIS 24 MA/07 at p. 2 / GIS 23 MA/03 at p. 7

• In NYC, even apart from the state directive giving a 90-day grace period above, you have a 30-day grace period.  HRA must accept the renewal up to 30 days after the case closing.   In the sample notice on page 8, the renewal must be received by HRA within 30 days after September 3, 2019, which is by October 3, 2019. Mail it the same way described  above or bring it to any Medicaid office so it is received within 30 days.  If it is after 30 days, you still have the 90-day grace period unde the above state directives..   See NYC Medicaid Alert, Reapplication & Renewal Grace Period July 31, 2019.

• AND if it is less than 60 days since the Notice of Discontinuance was sent by HRA, request a Fair Hearing too - along with submitting the renewal late.  Under the E14 waiver that continues through 2025, you will still get Aid Continuing. 

* * *

For questions -- contact the NYLAG Evelyn Frank Legal Resources Program:

212-613-7310 or eflrp@nylag.org  (Monday 10 AM â�� 2 PM)

Check out http://www.wnylc.com/health/​​​​​​​

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