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Medicaid Managed Care
Notice of Admission/Discharge for the Assisted Living Program Download
HCSP 3027 1-26-2015.pdf
This form is to be mailed to Home Care Services Program once a client is admitted or discharged from Assisted Living Programs
13 Apr, 2015 44 kb Downloads: 3587
15-INF-03 Informational Letter Personal Needs Allowance in Non-Medical & Medical Facilities Download
15-INF-03 Informational Letter Personal Needs Allowance in Non-Medical and Medical Facilities.pdf
This informational letter provides social services districts with updated charts that represent the monthly Personal Needs Allowance, PNAs, for residents of non-medical facilities the PNAs in medical facilities.
13 Apr, 2015 302 kb Downloads: 2959
MAP-259H Consumer Intent to Return/Not Return Home Download
MAP-259H Intent to Return Home 2008-06-20.pdf
This form is used when a client enters a residential facility and makes a determination that he/she will either return or not return home.
13 Apr, 2015 236 kb Downloads: 4621
Agreement to Participate in the Medicaid Pay-In Program Download
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: 3187
Optional Pay-In Program for Individuals with Excess Income Download
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: 2926
Notice of Acceptance of your Medical Assistance Application/Recertification Download
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: 3710
Notice of Permanent Placement Medicaid Managed Care Download
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: 6835
MAGI Consumers Long Term Eligibility Rules Download
2014-10-24 MAGI Consumers Long Term Eligibility Rules.pdf
long term eligibility rules for individuals who are eligible for Medicaid under a Modified Adjusted Gross Income (MAGI) eligibility group
09 Apr, 2015 74 kb Downloads: 5523
Transition of Long Term Nursing Home Benefit into Medicaid Managed Care Download
2015-04-03 Transition of Long Term Nursing Home Benefit into Medicaid Managed Care.pdf
Update on the transition of long term nursing home benefit into Medicaid Managed Care. : Eligible nursing home
consumers age 21 and over, unless otherwise exempt or excluded, who become permanent placed in a nursing facility are required to enroll in or remain enrolled in a managed care plan to receive this benefit, includes those who are Mainstream Managed Care, Managed Long Term Care Plans, and Fee for Service Plans.
03 Apr, 2015 690 kb Downloads: 16418
Fact Sheet on FIDA - by New York Legal Assistance Group Download
FIDA Fact Sheet NYC-Nassau (2015-4-1).pdf
Fact Sheet on FIDA with understanding of enrollment procedures as of Mar. 30, 2015. By NYLAG. Includes list of plans in Region 1 - NYC and Nassau. Revised to show enrollment postponed in Westchester and Suffolk
01 Apr, 2015 690 kb Downloads: 10982
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