|
HCSP-3047a MLTC/PRU
HCSP-3047a MLTC-PRU 1-26-15.pdf
This is the MLTC Provider Relations Unit cover sheet to be used
|
|
13 Apr, 2015
47 kb
Downloads: 3541
|
|
|
HCSP 3026 ALP Medicaid Cover Sheet
HCSP-3026 HCSP Cover Sheet for ALP-MLTC 1-26-2015.pdf
This is the cover sheet for HRA-ALP Medicaid Cover Sheet
|
|
13 Apr, 2015
44 kb
Downloads: 3626
|
|
|
MAP-58u List of Medicaid Offices
MAP-58u Where To Apply.pdf
This is a list of Medicaid Offices throughout NYC's 5 boroughs, along with a list of MICSA/MAP sites with certified application counselotrs
|
|
13 Apr, 2015
377 kb
Downloads: 4377
|
|
|
Spousal Refusal Form - Suffolk County
Spousal Refusal Form - suffolk county.doc
This is the spousal refusal form for Suffolk County residents
|
|
13 Apr, 2015
25 kb
Downloads: 13607
|
|
|
Agreement to Participate in the Medicaid Pay-In Program
MAP-931B Agreement to Participate in Pay-In Program searchable pdf.pdf
This is the form in both English & Spanish agreeing to participate in the Medicaid Pay-In Program
|
|
13 Apr, 2015
86 kb
Downloads: 3442
|
|
|
Optional Pay-In Program for Individuals with Excess Income
MAP-931A Optional Pay-In Program searchable pdf.pdf
This explains the Excess Income Program for clients whose incomes exceeds the Medical Assistance income limits
|
|
13 Apr, 2015
142 kb
Downloads: 3152
|
|
|
Notice of Acceptance of your Medical Assistance Application/Recertification
MAP-259p_redacted.pdf
This is a redacted MAP-259p form to act as a guide for purposes of Medical Assistance application/recertification
|
|
13 Apr, 2015
334 kb
Downloads: 3959
|
|
|
Notice of Renewal of your Public Health Insurance Coverage
MAP 2088v_redacted.pdf
This is a redacted notice of renewal of public health insurance coverage to act as a guide to help clients fill out their renewals.
|
|
13 Apr, 2015
882 kb
Downloads: 5370
|
|
|
Formerly Incarcerated Individuals Reactivation Transmittal
map-3103 Formerly Incarcerated Individuals Reactivation Transmittal.pdf
This form was uploaded by NYC HRA on 2/20/15 to help formerly incarcerated individuals reactivate their medicaid account once they have been released.
|
|
13 Apr, 2015
111 kb
Downloads: 3296
|
|
|
Notice of Permanent Placement Medicaid Managed Care
MAP-2159i Notice of Permanent Placement Medicaid Managed Care.pdf
NYC HRA uploaded this form on 4/3/15 to be used for clients requiring permanent placement under Medicaid's managed care plan.
|
|
13 Apr, 2015
36 kb
Downloads: 7316
|
|
