HRA Medicaid Renewal Form for Disabled, Aged, & Blind (DAB) recipients - 12/6/2023 version
(1) a 2-page Renewal Notification letter with the deadline to return the renewal, which is always the 10th of the 2nd month after the notification,
(2) "STOP ACT NOW" alert intended to alert consumers that this renewal MUST be returned, unlike those sent during the Public Health Emergency (MAP-3185 - 2025-01-09),
(3) Renewal form has a new section in Part 6 RESOURCES requiring authorization for HRA to verify resources using data matching - must be signeded by recipient and spouse(page 7, 12-13 of the PDF);
(4) Renewal form must be signed by both applicant and spouse (p. 15 of PDF)
(5) Financial Maintenance form - not new - only required if housing costs are more than 70% gross monthly income (p. 10 of PDF);
(6) Renewal instructions (pp. 15-17 of PDF)
(7) Bar coded return envelope - LAST PAGE of PDF. If you don't have this, mail it to the address on this copy CERTIFIED.

This alert reiterates the previous Alert dated April 18, 2024 and one earlier in 2022. When requesting a Disability Determination, submit only MAP-3177 Disability Determination request. HRA will forward this to the NYS Disability REview Unit, which will then request the rest of the documents listed in this article - http://health.wnylc.com/health/entry/134/.

NEW Fax numbers for Home Care Services Program at NYC HRA Medicaid CENTRAL INTAKE, Use for
submission of NYIA decision "OUTCOME" otfices for adult applicants if NYIA denied MLTC enrollment and refers back to local district to request HOUSEKEEPING services (limited to 8 hours/week), and to submit M11Qs for applicants under 18,  and to submit change requests on active cases, and reauthorizations of CASA cases. 

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.

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).

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.

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.