DOH provided Consumer advocates with drafts of notices regarding passive enrollment in FIDA to begin fall 2014.

DOH provided Consumer advocates with drafts of notices regarding passive enrollment in FIDA to begin fall 2014.

Practical Guide on getting Medicaid to reimburse for home care expenses incurred during the 3-month retroactive period, and during the pendency of the application, in New York City. Includes citations to pertinent case law and regulations.

HRA MICSA Alert 12-13-13 explains new procedure from public transportation reimbursement.

MICSA Alert 10-1-13 explaining the opening of the NYS health benefit exchange and some basic eligibility criteria.

Special procedure for MLTC plans to submit "conversion" package to NYC HRA Medicaid program, to enroll residents of nursing homes who want to enroll in an MLTC plan in order to return to the community.

In all MLTC enrollments, the conversion package is a set of forms that HRA needs in order to make the necessary entries into the Medicaid eligibility and billing system, so that the enrollment takes effect on the 1st of the following month, and so the MLTC Plan is paid its capitation rate. Once in MLTC, the member will not be able to access Medicaid services in the MLTC service package outside the MLTC Plan's network.

For nursing home residents, the "conversion" is more complicated. HRA not only has to enter the codes described above but also has to remove the codes that applied because of the residence in the nursing home. For many years, nursing home residents have encountered delays in lifting the nursing home "code" from their eligibility, so that they could now access community-based home care and other medical services. The conversion package must include:

(1) The HCSP-3022 (Medicaid Cover Sheet) - This is the conversion form.. A copy is or will be posted on this website.
(2) Completed Nursing Home discharge Alert (MAP-259D)(posted at http://www.wnylc.com/health/download/132) and see article at http://www.wnylc.com/health/entry/117/ )
(3) A copy of the signed enrollment form
(4) A copy of the MAP-3057 (Special Income Standard) form, if applicable (posted at http://www.wnylc.com/health/download/398/) and described in http://www.wnylc.com/health/entry/114/ - last link in Table of Contents

Changes in how Medicaid managed care recipients obtain transportation to doctor or other medical providers in non-emergencies

Initial timetable for NYS plan to coordinate all Medicare and Medicaid care for all dual eligibles in NYS beginning January 2014.