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.

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).

HRA Medicaid Fax Cover Sheet to Fax medical bills to meet spend-down (2018)

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/

Contact info and locations for MAP Fair Hearing Conference Unit, Compliance and Aid Continuing Unit, Fair hearing Representation Unit, and Records Request Unit. INcludes updated info on how to request a Fair Hearing and a new FAX NUMBER to request case records for a conference or hearing.

NYC procedures to implement change in state law giving full Medicaid coverage to Undocumented Immigrants Age 65+ - but only through Medicaid managed care plans. See article on this change at http://health.wnylc.com/health/entry/251/ with state directives.

MICSA Alert 8-2-2024 Relocation of Brooklyn South (MAIN) Medicaid Office and Authorized Rep Window - adds new email address for AUthorized Representatives (approved by HRA) to email applications.

Applicants for Medicaid in New York City can use this "APPLICANT/RECIPIENT DECLARATION CONCERNING THE LEGALLY
RESPONSIBLE RELATIVE’S INCOME/RESOURCES" forms to indicate the refusal of their legally responsible relative to make available their income or resources for the cost of necessary medical care and services, i.e. "spousal/parental refusal." Since 2018, includes language to request accommodation of disability in reading notice. Instructions explain whi h form to use - MAP-2161 or 2161a - don't need both. Both attached in same PDF. Other languages availaable of MAP-2161 at https://www.nyc.gov/site/hra/help/health-assistance.page

HRA contacts for the New York City Home Care Services Program CASA offices (updated 12/2023)

Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2023. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.