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NYLAG Comments Opposing Proposed Cap on Enrollment in the Nursing Home Transition & Diversion waiver. Download
NYLAG comments NHTD Waiver Cap Final with Attachments.pdf
Comments filed by NYLAG opposing the cap on enrollment proposed by DOH in https://health.ny.gov/facilities/long_term_care/nhtd/reference/docs/NHTDAmendmentDraft2025.PDF.
31 Jul, 2025 3.26 mb Downloads: 26
Medicaid Copyayments Download
Copayments NYS (2025-7).pdf
Fact Sheet Explaining Medicaid Copayments updated July 2025
16 Jul, 2025 397 kb Downloads: 72824
Fact Sheet on Keeping Income During and After a Temporary Nursing Home Stay Download
Fact Sheet on Keeping Income In & After Nursing Home Stays 3-21-2024 FINAL.pdf
NYLAG Fact Sheet on consumer Right to keep more income during a temporary nursing home stay, as well as after a nursing home stay if a consumer is enrolled in a Managed Long Term Care plan or for some consumers who are married.
21 Mar, 2024 816 kb Downloads: 9126
Fact Sheet & Form for Keeping SSI for 90 Days in Temporary Hospital or Nursing Home Placement Download
SSI Temporary Institutional Stay Fact Sheet and Form 2024-03 (3-11-14 VB).pdf
This fact sheet explains requirements for maintaining SSI (Supplemental Security Income) for up to 90 days during a temporary hospital or nursing home stay. The PDF also includes a new official form (2023) for requesting continuation of SSI benefits, which must be filed with the Social Security Administration within strict timelines. Note that if SSI benefits are terminated, Medicaid will also be terminated, after "Stenson" notices are mailed giving the recipient an opportunity to recertify for Medicaid without SSI. See http://www.wnylc.com/health/entry/85/
11 Mar, 2024 312 kb Downloads: 14151
Dental Implant prior auth form Download
318-7 Ciaramella exA6 dental implant form.pdf
20 Dec, 2023 515 kb Downloads: 875
Replacement Denture prior auth form Download
318-6 Ciaramella exA5 replacement denture form.pdf
20 Dec, 2023 522 kb Downloads: 707
HRA MAP 259d Nursing Home Discharge Alert - for Community Budgeting & Related Forms with various forms updated as of 3-24-2023 Download
MAP-259d-e-f-g-t Discharge Alert and Related Nursing Home Forms as of 2023-03-24 (259f -259t+ 648p).pdf
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.
25 Mar, 2023 3.04 mb Downloads: 77193
MAP-648 P SUBMISSION OF REQUEST FROM RESIDENTIAL HEALTH CARE FACILITIES (RHCF)(05/05/2022) Download
MAP-648p Submission of request from RHCF-NH 2022-05-05.pdf
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)
25 Mar, 2023 69 kb Downloads: 11583
Nassau County Physician's Request for Personal Care Aide and Orders to the Service Agency (07-2020) Download
Physician's Order Nassau County Form 517 - (2020).pdf
Form for doctor to complete to request Medicaid personal care services and CDPAP from the Nassau County DSS. Revised July 2020.
26 Aug, 2021 1.46 mb Downloads: 11992
NYLAG, MFJ & NYAIL Letter to DOH 4-13-20 re Economic Stimulus Payments for Nursing Home & Adult Home residents Download
Advocacy Ltr to DOH re economic impact payments for NH and Adult Home residents.pdf
Letter dated April 13, 2020 requesting that DOH issue guidance to Nursing Home, Adult Home & ALP administrators that the Economic Stimulus payments are exempt from being counted for Medicaid, and must be protected for the residents.
14 Apr, 2020 296 kb Downloads: 2835
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