Published in March 2014

A community spouse is entitled to the community spouse monthly income allowance (CSMIA) even if she does a spousal refusal to contribute resources. See NYS ADM 91-ADM-33 and NYS DOH Medicaid Reference Guide at page 396. However, since mid-2012, the NYC HRA Medicaid program has violated this longstanding state rule and has denied the community spouse this income allowance if she executed a spousal refusal. Many fair hearing decisions reversed these determinations, see, e.g. FH 6208131N (3/1/2013), FH 6318971R (9/5/2013). In December 2013, the Elder Law Section of the NYS Bar Association asked HRA to cease this unlawful practice of denying this impoverishment allowance. Through a Freedom of Information request, the Bar identified some internal HRA procedures that were wrong and asked that HRA correct them. On Dec. 24, 2013, HRA issued 2013 MAP-INF 04 which correctly states that the community spouse is entitled to the CSMIA even if she does a spousal refusal, if she provides complete information regarding income and resources.

Supplemental form to be submitted with a MBI-WPD application.

Document to be submitted to HRA accompanying a MBI-WPD application.

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

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

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.

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.

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.

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