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Medicaid Managed Care
Healthfirst MAP Plan Letter to Member Affected by Mistake in Failing to Schedule Hearing - March 2021 Download
Redacted IAHO healthfirst letter 3-23-21.pdf
Redacted sample of a letter sent in late March 2021 to 789 members of the Healthfirst Medicaid Advantage Plus plan explaining the plan's mistake in failing to forward their case for a hearing, as required in the new Integrated Appeal process for MAP plans that began 2020. Read about this new appeal process and more about this letter at http://www.wnylc.com/health/entry/225/
30 Mar, 2021 139 kb Downloads: 1874
NYLAG & Other Advocates Call For NYS Budget to Ensure Access to Community Based Long Term Care Services Download
Consumer Advocate Letter re Community based LTC NYS 21-22 Budget.2.pdf
Letter to Governor Cuomo and leaders of the legislature calling for NYS Budget initiatives that will ensure access to home care to prevent unnecessary institutionalization -- COVID-19 has been a wake-up call for the need to avoid nursing home placement when ever possible.
26 Mar, 2021 638 kb Downloads: 1565
NYLAG COMMENTS on Proposed Home Care Regulation Changes - Eligibility and Assessment Procedures Download
NYLAG Comments 505.14 - 505.28 3-13-21 with NYSBA copy.pdf
NYLAG's comments submitted on the 2nd round of proposed State regulations implementing 2020 changes in State law restricting eligibility for personal care, CDPAP and MLTC enrollment, and changing the procedures for how Medicaid home care services are assessed. The proposed State reg can be found at https://health.ny.gov/health_care/medicaid/redesign/mrt2/express_terms_summary.htm. The NYSBA Elder Law & Special Needs Section comments are also attached to and referenced in the NYLAG comments.
19 Mar, 2021 1.28 mb Downloads: 2577
NYLAG Comments on Proposed Changes in 1115 Waiver - ADL Limits for MLTC and Staying in Medicaid Managed Care when Enroll in Medicare Download
NYLAG CMS comments 1115 Waiver NYS 12-24-20.pdf
NYS DOH has requested that CMS change the 1115 waiver that governs MLTC and managed care in 2 ways. (1) Restrict enrollment in MLTC to those meeting new 2- or 3- ADL requirement enacted in State budget in April 2020; (2) Keep people in mainstream Medicaid managed care plans when they start getting Medicare, if they are enrolled in a Dual-Special Needs Plan. They could opt out but otherwise would automatically stay in managed care. See waiver request at https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/2aea7cd. NYLAG comments posted here
24 Dec, 2020 1012 kb Downloads: 1504
NYLAG Comments on Medicaid State Plan Amendment to Implement the ADL Restrictions on Eligibility for Personal Care & CDPAP Download
Comments filed by NYLAG dated Oct. 29, 2020 on the proposed Medicaid State Plan Amendment (SPA) that would restrict elgibility for personal care and CDPAP services to require 2 or 3 ADL needs. The proposed SPA No. 20-41 was posted September 29, 2020 and is available at https://www.health.ny.gov/regulations/state_plans/status/ltcare/original/docs/os_2020-09-29_spa_20-41.pdf.
24 Dec, 2020 841 kb Downloads: 1436
Sample Notice to MLTC Members Explaining new Lock-In Rule that Starts Dec. 1, 2020 Download
Lock in notice 2020-10 redacted.pdf
Sample Notice sent to MLTC Members in October 2020 Explaining new Lock-In Rule that Starts Dec. 1, 2020. This notice is from VNS Choice, but each plan would be sending their own versiono n their letterhead, using State-approved language.
29 Oct, 2020 1.95 mb Downloads: 2139
MLTC Member Handbook Amendment - New "Lock-in" Download
MLTC Partial Lock In Member Handbook.pdf
Language that Plans must add to their MLTC Member Handbooks to explain the new Lock-in that begins Dec 1, 2020 for people enrolling in a plan after that date, whether a first-time enrollee or changing plans on or after that date
29 Oct, 2020 18 kb Downloads: 2163
NYLAG Comments on Proposed Changes to State Regulations for Medicaid Managed Care Appeals and Fair Hearings Download
Final Comments to Proposed Regulations Managed Care Fair Hearing 09.8.2020.pdf
NYLAG Comments filed on Sept. 8, 2020 on Proposed Changes to State Regulations for Medicaid Managed Care Appeals and Fair Hearings. The proposed amendments implement the "exhaustion" requirements implemented in NYS in 2018, implementing federal changes adopted in 2016.
23 Sep, 2020 511 kb Downloads: 1906
NYLAG COMMENTS on Proposed Home Care Changes - Eligibility and Assessment Procedures Download
NYLAG COMMENTS on Proposed Regulations implementing the Medicaid Home Care Changes - Eligibility and Assessment Procedures enacted in the 2020-21 NYS Budget. The proposed regulations are posted here - https://regs.health.ny.gov/sites/default/files/proposed-regulations/Personal%20Care%20Services%20and%20Consumer%20Directed%20Personal%20Assistance%20Program.pdf
09 Sep, 2020 1.07 mb Downloads: 2111
PowerPoint on NYS Medicaid Changes Coming in 2020-21 - Lookback, Restricted Home Care Eligibility & New Assessment Procedures Download
NYLAG Presentation - NYS Budget Changes - Medicaid FY 2020-21.pdf
Webinar presentation by Valerie Bogart, EFLRP, NYLAG, presented on Sept. 9, 2020 on upcoming changes in Medicaid - a new lookback for community based long term care services, new ADL requirements on eligibiliity for personal care and CDPAP, and new assessments for all home care in MLTC, managed care and local Medicaid offices
09 Sep, 2020 534 kb Downloads: 3893
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