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Medicare Savings Program
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2024 Download
2001_to_2024_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2024. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
07 Mar, 2025 3.77 mb Downloads: 301923
Medicaid income and resource levels - 2025 (2-14-2025) Download
MAPDR-01 Feb 26 2025.pdf
NYC HRA MAPDR-01 (updated 02-14-2025) -- Although this was issued in Feb. 2025, almost all the figures are in yellow which means that they are still the 2024 figures. The 2025 figures can only be calculated after NYS Dept. of Health issues the 2025 Federal Poverty Levels (FPL) later in February or March (even though the FPLs were announced by the federal govt).
26 Feb, 2025 2.13 mb Downloads: 450654
MAP-751W Consumer/Provider Request to Change Information on File (11-25-2024)(fill-able) Download
MAP-751W Request to Change Information (Doc required) (11-25-2024).pdf
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.
20 Feb, 2025 186 kb Downloads: 9931
MAP-751K Consumer Request to Change Information on File (12-14-2023)(fill-able) Download
MAP-751k consumer-provider request to change info on file (English) (2023-12-14).pdf
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/
24 Jan, 2025 111 kb Downloads: 9863
SNT Excess Income Contribution Worksheet Download
Pooled Income Trust Contribution Worksheet.xls
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)
04 Jul, 2022 42 kb Downloads: 38642
NYLAG Memo in Support of Medicare Savings Program Expansion in NYS FY 2023 Budget - Assembly Proposal Download
NYLAG memo in support MSP one house FINAL .pdf
NYLAG Memo in Support of Medicare Savings Program Expansion in NYS FY 2023 Budget - as proposed in the Assembly one-house bill n A. 9007B Part SS and in S8228/A924 (May/Gottfried)
15 Mar, 2022 420 kb Downloads: 1492
HIPP/MIPP DOH Training-- Health Insurance Training Center Download
Excerpt HIPP Notebook - 2017 9.1.16 for Print v2 (1).pdf
Excerpt of training "notebook" on HIPP/MIPP eligibility. Full document can be found: http://www.caiglobal.co/caiglobal.co/tchip/Community%20TAs%20-%207_2018/HIPP-MIPP%20-%202_2017/Notebook%20CHANGE%20ORDER%20OF%20QRGs/1%20tab%20-%20hipp%20notebook%20pages/HIPP%20Notebook%20-%209.1.16%20for%20Print%20v2.pdf
22 Feb, 2021 1.06 mb Downloads: 3671
MIPP Authority-- MAP Office of Procedures Download
Part B reimbursement - MBI WPD.pdf
MAP Office of Procedures Journal 2015-- information on Medicare Insurance Premium Payment (MIPP) eligibility. Accessed via FOIL request
22 Feb, 2021 36 kb Downloads: 2461
Medicare Insurance Premium Payment (MIPP) Check SAMPLE Download
MIPP Check Example.pdf
Some consumers are eligible for a program called MIPP, which reimburses them for their Part B premium on a monthly basis. This is a sample of the document that accompanies the check.
22 Feb, 2021 2.23 mb Downloads: 3463
2020-12-17 MSP Applications Fax Download
2020-12-17 MSP fax.pdf
Number to fax MSP applications
18 Dec, 2020 134 kb Downloads: 2174
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