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.

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/

Sample cover letter to local DSS/HRA accompany the documentation of a Medicaid recipient's enrollment in an SNT or pooled trust and request disability determination. Note that this does NOT give argument for why applicant is disabled, as that will be addressed to the NYS DOH Disability Review Unit once they request and you submit the disability forms. This letter serves as a checklist for what to submit.

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.

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).

Use this Excel spreadsheet to calculate the proper monthly contribution of excess income to an SNT in order to become eligible and maintain eligibility for Medicaid and/or Medicare Savings Program in New York. (updated 2022)

Eff. June 1, 2022, submissions to HRA to approve a Pooled Trust or MBI-WPD no longer need to include the disability forms (DOH-5141, DOH-5143, Authorization MAO-751e, AIDS report form MAP 252F. Instead, once the pooled trust is filed with HRA, HRA will route it to NYS DOH Disabilitiy Review Team, which will then request MAP 3177 Disability Determination Request from the consumer. Unclear if other documentation will be required but likely - stay tuned look for updates at http://www.wnylc.com/health/entry/44/ (This revises the Alert issued May 31, 2022

Traduccion enEspanol de "HOW TO USE A POOLED INCOME TRUST TO OBTAIN MEDICAID WITHOUT A
“EXCESS INCOME” OR SPEND-DOWN" (2022), by NYLAG Evelyn Frank Legal Resources Program, posted at http://www.wnylc.com/health/download/4/. Spanish translation courtesy of Centro de Harry y Jeanette Weinberg para la justicia de los ancianos en el Hogar Hebreo de Riverdale, en colaboración con la Asociación público-privada de servicios para la tercera edad de Westchester y el Centro de justicia para la mujer de Pace.

Mas informacion is at https://www.seniorlawday.info/derecho-para-la-tercera-edad/

English at https://www.seniorlawday.info/resources/ or http://www.seniorlawday.info/wp-content/uploads/2022/02/2021-Elder-Law-QA-222.pdf

Form to be signed by treating physician to certify disability as required for approval of Supplemental Needs Trusts, or for Medicaid based on disability where the Social Security Administration has not determined disability. Replaces Form 486T. See HRA MICSA Alert Dec. 20, 2021, available at http://www.wnylc.com/health/fdownload/799/

Announces a change in the form for treating physician to certify disability as needed to approve supplemental needs trusts including pooled trusts, and Medicaid based on disability, if not certified by the SSA. Replaces Form 486T, though 486T will be accepted until Feb. 1, 2022. New form posted at http://www.wnylc.com/health/download/798/