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MAP-751W Consumer/Provider Request to Change Information on File (11-25-2024)(fill-able) Download
MAP-751W Request to Change Information (Doc required) (11-25-2024).pdf
NYC HRA Form to notify HRA of corrections or changes, e.g. close case, combine case, add/remove individual, notify of death, change in immigration status, upgrade eligibility, request MSP evaluation, budgeting changes, pooled trust budgeting and add/remove third party health insurance. may be faxed to Fax 1-917-646-0837 per August 2024 Medicaid Alert http://www.wnylc.com/health/download/738/. Note that a change in demographic information (such as name, address, phone number) should be reported in a different form: MAP-751K. The 2018 version of the MAP-751W is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages - but has not yet been updated to the 2024 version as of 1/23/25.
20 Feb, 2025 186 kb Downloads: 9773
Currency Conversion Worksheet for Holocaust Reparations Download
Reparation worksheet.xls (1-2025).xlsx
Use this worksheet to convert lifetime total amount received in Holocaust reparations / restitution from foreign currencies (Deutschmarks and Euros) into U.S. Dollars. This is for purposes of taking advantage of the exemption of saved reparations payments from the resource test for Federally-funded means-tested benefits, like Medicaid and Supplemental Security Income. Updated monthly.
18 Feb, 2025 148 kb Downloads: 9064
Medicaid income and resource levels - 2025 (2-14-2025) Download
MAPDR-01 02.14.2025 - 2025 Financial Levels for Medicaid and Related Program Eligibility.pdf
NYC HRA MAPDR-01 (updated 02-14-2025) -- Although this was issued in Feb. 2025, almost all the figures are in yellow which means that they are still the 2024 figures. The 2025 figures can only be calculated after NYS Dept. of Health issues the 2025 Federal Poverty Levels (FPL) later in February or March (even though the FPLs were announced by the federal govt).
17 Feb, 2025 251 kb Downloads: 450127
HRA-MAP 931Y E-Fax Medical Bills Cover Sheet (2018) Download
MAP-931Y_E-Fax_Medical_Bills 2018-4-27.pdf
HRA Medicaid Fax Cover Sheet to Fax medical bills to meet spend-down (2018)
29 Jan, 2025 80 kb Downloads: 25568
MAP-751K Consumer Request to Change Information on File (12-14-2023)(fill-able) Download
MAP-751k consumer-provider request to change info on file (English) (2023-12-14).pdf
NYC HRA Form to use to notify HRA of change in name, address, mailing address, date of birth, SSN, and to request mail in different languages or formats for disability (Updated 12-14-2023). The MAP-751K is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages. Fax to HRA MAP Undercare 1-917-646-0837 per Medicaid Alert 8/2024 http://www.wnylc.com/health/download/738/. NOTE: The 751k is no longer used to request a change in budgeting. For that, use new form MAP-751W posted at the same webpage as above for the 751K (but updated form not posted there - use http://health.wnylc.com/download/770/
24 Jan, 2025 111 kb Downloads: 9819
Most downloaded
Medicaid income and resource levels - 2025 (2-14-2025) Download
MAPDR-01 02.14.2025 - 2025 Financial Levels for Medicaid and Related Program Eligibility.pdf
NYC HRA MAPDR-01 (updated 02-14-2025) -- Although this was issued in Feb. 2025, almost all the figures are in yellow which means that they are still the 2024 figures. The 2025 figures can only be calculated after NYS Dept. of Health issues the 2025 Federal Poverty Levels (FPL) later in February or March (even though the FPLs were announced by the federal govt).
17 Feb, 2025 251 kb Downloads: 450127
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2023 Download
2001_to_2023_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2023. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
11 Mar, 2024 3.52 mb Downloads: 301721
Medicaid Eligibility in 2014 Download
Understanding MAGI & the Marketplace.pdf
Training provides framework for understanding the changes to Medicaid effective 2014, including: new categories, new income levels, new budgeting and new benefits.
15 Nov, 2013 1.56 mb Downloads: 271891
Supplemental Needs Trusts Outline for Advocates - Including Impact on Various Benefits of Transfers of Lump Sums into SNT's UPdated 6/2023 Download
SNT Outline 2023-06.pdf
Training Outline for Advocates on Supplemental Needs Trusts (SNTs) (individual and pooled), and the effect of SNTs on various public benefit programs (updated 6/30/2023). Updated sections include Temporary/Public cash assistance, SNAP, ABLE accounts, Public Housing and Section 8, changes in procedures for submitting pooled trusts in NYC. Also heads up about 2023 increases in Medicaid income and asset limits and update about the 30-month community based lookback).
01 Jul, 2023 1.3 mb Downloads: 217656
Directory of MICSA (NYC Medicaid) Contacts - August 2013 Download
MICSA Directory (08-06-13).pdf
NYC Medicaid office moved from 330 West 34th Street to 785 Atlantic Avenue, Brooklyn NY 11238 in May 2013. Contact numbers at that office listed in this document.
15 Aug, 2013 3.07 mb Downloads: 206461

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