HRA Medicaid Renewal Form for Disabled, Aged, & Blind (DAB) recipients - 12/6/2023 version
(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) "STOP ACT NOW" alert intended to alert consumers that this renewal MUST be returned, unlike those sent during the Public Health Emergency (MAP-3185 - 2025-01-09),
(3) Renewal form has a new section in Part 6 RESOURCES requiring authorization for HRA to verify resources using data matching - must be signeded by recipient and spouse(page 7, 12-13 of the PDF);
(4) Renewal form must be signed by both applicant and spouse (p. 15 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) Renewal instructions (pp. 15-17 of PDF)
(7) Bar coded return envelope - LAST PAGE of PDF. If you don't have this, mail it to the address on this copy CERTIFIED.

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.

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)

NYC MICSA Medicaid Alerts from 2015 and 2020 with nursing home forms updated as of 3/23/23 including "Discharge Alert" 259d that nursing home physician must sign to certify that resident has a reasonable expectation to return home, which entitles resident to community budgeting (non-chronic care) - so they keep entire community Medicaid allowance rather than only $50/month. Form replaces 1159. PDF includes - Form 259f Notice of Discharge revised 2020 (now includes check-off that resident advised of Special Income Standard for those discharged from NH to MLTC) ; Form 259e (Change/Cancellation of Discharge Plan), 259g (Respite Alert), 259t (updated 5/2020) -- PDF has updated forms as of 3/24/2023 from NYC MARC website.

Transmittal form for Nursing Home to submit to HRA: new Medicaid application, request to convert coverage from community Medicaid, upgrade coverage, or notify HRA that transfer penalty period expired. (updated 5/5/2022)

Updated 2023 using the 2022 FPLs. We hope to update it again when DOH adopts the 2023 FPLS.

This chart discusses the Medicaid Extensions/Continuations for certain special cases of SSI recipients once their SSI has been terminated. Specifically, it compares the eligibility criteria, resource/income levels, residential program requirements, spendown/NAMI contributions, reinstatement, and Medicare Buy-IN eligibility for the following groups:
A. 1619B
B. Pickle
C. DAC

2021-10-28 DARB Online Payment Option for Medicaid Excess Income Consumers - provides instructions for Online Credit Card payment to the Division of Accounts Receivable and Billing (DARB) to participate in the Medicaid Pay-In Program. Link to NYC CityPay website (https://a836-citypay.nyc.gov/) is provided. Medical bills cannot be submitted through this website.

updates earlier fax lists - allowing submission of applications and other documents by fax during COVID-19 emergency, and adds some email addresses for inquiries