NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC
New York City Government
MAP-628C MBI-WPD documentation checklist Download
MAP-628C MBI-WPD documentation checklist.pdf
Supplemental form to be submitted with a MBI-WPD application.
18 Feb, 2014 143 kb Downloads: 7875
MAP-101 MBI-WPD prescreening document Download
MAP-101 MBI-WPD prescreening document.pdf
Document to be submitted to HRA accompanying a MBI-WPD application.
18 Feb, 2014 76 kb Downloads: 8590
State Dept of Health and NYC HRA Medicaid program contacts Download
Medicaid phone list.pdf
NYC Medical Insurance & Community Services Administration (MICSA) CONTACT LIST
with some NYS Dept. of Health contact information
Compiled by NYLAG Evelyn Frank Legal Resources Program
14 Jan, 2014 224 kb Downloads: 63595
Letter Dec. 23, 2013 from Roy Esnard, General Counsel NYC HRA re Community Spouse Monthly Income Allowance in Spousal Refusal cases Download
Esnard Letter 2013-12-23 CSMIA.pdf
Letter in response to 12/18/2013 letter sent by NYS Bar Association Elder Law Section demanding that HRA cease illegal practice of denying Community Spouse Monthly Income Allowance to community spouses who did a Spousal Refusal
02 Jan, 2014 79 kb Downloads: 6707
NYC HRA PowePoint on New Medicaid application procedures for 2014 under Affordable Care Act Download
EIS Overview of Upcoming Changes - ACA implementation.pdf
PowerPoint was presented for certified Client Representatives who have completed a certification to be authorized submitters of Medicaid applications to HRA. However, information in this may be generally applicable.
20 Dec, 2013 3.28 mb Downloads: 3811
HRA MICSA Medicaid Alert - Waiver Look-Alikes May become Exempt from Managed Care for 6 Months Download
Alert 2012-9-19 Managed Care Waiver Lookalikes Exemption.pdf
Alert 9/19/2012 The purpose of this Alert is to inform Community Based Organizations, Client
Representatives, Certified Home Health Agencies and other providers that the waiver
“look-alikes” exemption for managed care ended September 1st.

This exemption had been available for consumers who have the same characteristics and needs as
consumers enrolled in Medicaid waiver programs such as Traumatic Brain Injury,
Care at Home, Home and Community Based Services for the Developmentally
Disabled, and the Nursing Home Transition Waiver, but are not enrolled in a waiver
program.

Such consumers may decide they now want to apply for a waiver program or
designation as developmentally disabled. Because this process may take more than
30 days, SDOH has decided to allow an exemption for up to six months for non -
dually eligible consumers who are in the process of applying for a waiver program or
designation as developmentally disabled. To qualify for this exemption, consumers
must call NY Medicaid Choice at 800-505-5678, to inform staff that they are applying
for waiver services.
09 Dec, 2013 51 kb Downloads: 8072
NYC HRA: MLTC Frequently Asked Questions (HCSP Quick-Reference-03 revised 11/13/2013) Download
MLTC Frequently Asked Questions HCSP Quick Reference- REVISED 11-13-2013.pdf
FAQ clarifying issues that pose barriers to enrollment into MLTC plans. Many of these problems stem from "coding" problems - eligibility codes in the Medicaid "eMedNy" system. This FAQ explains that some codes may appear to say the individual is not eligible for Medicaid or for MLTC -- but THEY DO NOT MEAN THAT! And plan should submit "conversion package" to HRA to activate Medicaid and allow enrollment.
15 Nov, 2013 178 kb Downloads: 6837
NYC HRA MICSA Alert - MLTC Submissions of Nursing Home Enrollments - Feb.14, 2013 Download
Medicaid Alert 2-2013 NH to MLTC.pdf
Special procedure for MLTC plans to submit "conversion" package to NYC HRA Medicaid program, to enroll residents of nursing homes who want to enroll in an MLTC plan in order to return to the community.

In all MLTC enrollments, the conversion package is a set of forms that HRA needs in order to make the necessary entries into the Medicaid eligibility and billing system, so that the enrollment takes effect on the 1st of the following month, and so the MLTC Plan is paid its capitation rate. Once in MLTC, the member will not be able to access Medicaid services in the MLTC service package outside the MLTC Plan's network.

For nursing home residents, the "conversion" is more complicated. HRA not only has to enter the codes described above but also has to remove the codes that applied because of the residence in the nursing home. For many years, nursing home residents have encountered delays in lifting the nursing home "code" from their eligibility, so that they could now access community-based home care and other medical services. The conversion package must include:

(1) The HCSP-3022 (Medicaid Cover Sheet) - This is the conversion form.. A copy is or will be posted on this website.
(2) Completed Nursing Home discharge Alert (MAP-259D)(posted at http://www.wnylc.com/health/download/132) and see article at http://www.wnylc.com/health/entry/117/ )
(3) A copy of the signed enrollment form
(4) A copy of the MAP-3057 (Special Income Standard) form, if applicable (posted at http://www.wnylc.com/health/download/398/) and described in http://www.wnylc.com/health/entry/114/ - last link in Table of Contents
05 Sep, 2013 284 kb Downloads: 3585
Directory of MICSA (NYC Medicaid) Contacts - August 2013 Download
MICSA Directory (08-06-13).pdf
NYC Medicaid office moved from 330 West 34th Street to 785 Atlantic Avenue, Brooklyn NY 11238 in May 2013. Contact numbers at that office listed in this document.
15 Aug, 2013 3.07 mb Downloads: 206230
Disenrolled Housekeeping Case Consumers (MLTC) 8-13-13 Download
Disenrolled Housekeeping Case Consumers (MLTC) 8-13-13.pdf
8-13-13 MICSA Alert detailing the housekeeping conversion process to facilitate consumer disenrollment from MLTC plans to HRA.
15 Aug, 2013 65 kb Downloads: 10474
Prev Next


This site provides general information only. This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelpny.org. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law. However, we do not guarantee the accuracy of this information. To report a dead link or other website-related problem, please e-mail us.