A Medicaid Recipient who submits medical bills from a Provider to meet the spenddown will receive an OHIP-3183 “Provider/Recipient Letter” indicating which medical expenses are the responsibility of the Recipient (and which the Provider should not bill to Medicaid). When the Recipient is enrolled with a Managed Long Term Care Plan (MLTC), the Recipient and the MLTC will receive an OHIP-0128 “MLTC/Recipient Letter” indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). These forms replace the LDSS-3183 form.

PowerPoint describes the changes in Medicaid Home Care that started being rolled out Nov. 8, 2021. This PowerPoint developed before DOH launched website about Independent Assessor that starts March 1, 2022, so does not include that info posted at https://www.health.ny.gov/health_care/medicaid/redesign/nyia/. Check for more updates at http://www.wnylc.com/health/news/85/. Webinar recording will also be posted. Proposed expansion of financial eligibility for age 65+, disabled, and blind is also discussed.

12/15/22 letter sent to DOH jointly from Medicaid Matters NY and NYLAG with concerns about implementation of the Independent Assessor changes on March 1, 2022 - with no guidance or procedures yet issued let alone tested and ready, and with a lack of capacity for NY Medicaid Choice to handle the huge demand of approximately 300,000 nurse assessments and 300,000 physician/practitioner assessments a year.

Fact Sheet includes key forms (updated 12-2021)

Powerpoint with latest info - as of Oct. 20, 2021 -- on implementation of changes enacted in the NYS FY 2020-2021 budget, including the restrictions on eligibility for Personal Care services (PCS) and CDPAP services (reqiring 2-3 ADLs), the Independent Assessor procedures, and the loosened standards allowing plans to more easily reduce hours of home care after a "transition period" for certain members.

Notice sent by MLTC plans to members of intent to disenroll because of a Long Term Nursing Home Stay - a stay of more than 3 months, where the member has been approved for Nursing Home Medicaid. Notice sent 30 days prior to disenrolllment. A second notice is sent by NY Medicaid Choice 10 days prior to disenrollment, posted with more info in this article http://www.wnylc.com/health/entry/199/

List of 2022 Medicare Special Needs Plans (SNP's)in NYS. Indicates whether plan is also a Medicaid Advantage Plus (MAP) plan (includes MLTC plan in same plan), and whether the plan is subject to Default Enrollment. See more about that at http://www.wnylc.com/health/entry/226/. Notes which plans participate in Senior Savings Program for which copay for insulin is never more than $35/mo. (That insulin program is irrelevant to those with Extra Help).

Fact Sheet about the Class Action Injunction in the Varshavsky v Perales case, which gives special rights for people appealing adverse denials of increases of Medicaid home care services. In some cases, the consumer has the right to a temporary increase in home care hours 45 days after requesting the hearing, while the hearing takes its course. If a phone hearing cannot be favorably decided, the consumer has the right to a home hearing. Learn advocacy tips in this fact sheet, also posted as an article at http://www.wnylc.com/health/entry/228/ (with updated OTDA contact info 9-24-21)

Letter sent by NYLAG, Medicaid Matters NY, Legal Aid Society, Empire Justice Center and other NYS advocacy organizations to CMS dated Aug. 5, 2021. Expresses concerns about the NYS plan for spending billions of enhanced federal Medicaid dollars available under the American Rescue Plan Act of 2021 (ARPA) that must be used for enhancing access to Home & Community Based Services (HCBS). NYS Spending Plan and other info about this funding is at https://www.health.ny.gov/health_care/medicaid/redesign/hcbs/enhanced_funding/.

This Alert is to advise Medicaid Providers, Hospitals, Client Representatives, Community Based Organizations and Advocates that the Medical Assistance Program's Undercare Division can now receive case action update requests via email at undercareproviderrelations@hra.nyc.gov. This email is NOT FOR NEW APPLICATIONS. MAP 751k or 751w form attached to this alert is required. This alert revises the July 2021 alert