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Medicaid
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2024 Download
2001_to_2024_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2024. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
07 Mar, 2025 3.77 mb Downloads: 301860
Medicaid income and resource levels - 2025 (2-14-2025) Download
MAPDR-01 Feb 26 2025.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).
26 Feb, 2025 2.13 mb Downloads: 450569
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: 9888
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: 9852
Using an SNT to Eliminate the Medicaid spend-down - Fact Sheet (May 2024) Download
SNT Short 2024-05-02 FINAL.pdf
How to get Medicaid despite having "excess income" - Using a Supplemental Needs Trust to Eliminate the Spend-down for Persons who are Elderly (65+), Blind or Disabled. Written by New York Legal Assistance Group Evelyn Frank Legal Resources Program, updated May 2024 with new procedures in NYC for submitting disability forms, and with 2024 figures.
02 May, 2024 450 kb Downloads: 167334
MAP-2161 and MAP 2161a Spousal / Parental Refusal Form (2023) (ENGLISH) Download
MAP-2161 (2023-03) + MAP-2161a (2023-11) Combined ENGLISH.pdf
Applicants for Medicaid in New York City can use this "APPLICANT/RECIPIENT DECLARATION CONCERNING THE LEGALLY
RESPONSIBLE RELATIVE’S INCOME/RESOURCES" forms to indicate the refusal of their legally responsible relative to make available their income or resources for the cost of necessary medical care and services, i.e. "spousal/parental refusal." Since 2018, includes language to request accommodation of disability in reading notice. Instructions explain whi h form to use - MAP-2161 or 2161a - don't need both. Both attached in same PDF. Other languages availaable of MAP-2161 at https://www.nyc.gov/site/hra/help/health-assistance.page
20 Mar, 2024 329 kb Downloads: 68025
2023-12-28 Contact Information Update for the Medical Assistance Program's Third-Party Health Insurance Unit Download
2023-12-28 Contact Information Update for the Medical Assistance.pdf
06 Feb, 2024 136 kb Downloads: 561
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: 217751
MAPDR-05 (08/04/2022) List of Managed Care & Managed Long Term Care Plans in NYC Download
2022-08-04 MAPDR-05 Medicaid Managed Care Plans NYC.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care
* Health and Recovery Plan Managed Care Plans (HARP)
* Managed Long Term Care (MLTC)
* Medicaid Advantage Plus (for dual eligibles, includes MLTC)
* HIV Special Needs Plans (SNP)
* Programs of All-inclusive Care for the Elderly (PACE)
* Fully Integrated Dual Advantage (FIDA) IDD

Updated August 4, 2022 (current on HRA site as of 5/31/23)
31 May, 2023 129 kb Downloads: 62188
MAP-909E DAB Renewal Form Redacted (2022-01-04) Download
MAP-909e DAB Renewal (2022-01-04) Redacted Sample with 2023 ACT NOW insert.pdf
HRA Medicaid Renewal Form being sent in 2023 to Disabled, Aged, & Blind (DAB) recipients in the "unwinding" of the Public Health Emergency. Note that the packet contains
(1) a 2-page Renewal Notification letter with the deadline to return the renewal, which is always the 10th of the 2nd month after the notification,
(2) "ACT NOW" alert intended to alert consumers that this renewal MUST be returned, unlike those sent during the Public Health Emergency (MAP-3185 - 2023-01-19),
(3) Renewal form has a new section in Part 6 RESOURCES requiring authorization for HRA to verify resources using data matching (page 6 of the PDF);
(4) Renewal form must be signed by both applicant and spouse (p. 9 of PDF)
(5) Financial Maintenance form - not new - only required if housing costs are more than 70% gross monthly income (p. 10 of PDF);
(6) NEW: Authorization for Verification of Resources - Recipient and Spouse each must sign this and send back with renewal!
(MAP-3179 and 3179a) (pp. 11-13 of PDF)
(7) Renewal instructions (pp. 14-16 of PDF)
31 May, 2023 2.17 mb Downloads: 15682
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