July 12, 2012
The purpose of this ALERT is to inform Community Based Organizations, Client Representatives, Certified Home Health Agencies and other providers that the Medical Assistance Program is changing the way it processes Medicaid applications for excess income eligible consumers seeking enrollment into a Managed Long Term Care (MLTC) plan. Consumers seeking MLTC enrollment who are found to only be eligible for the Medicaid Excess Income (Surplus) Program will now have their cases accepted and authorized with “06” (provisional) coverage. This will occur even if their applications are received without bills that cover their excess or surplus.

This new process will allow MLTCplans to see the provisional coverage on ePaces/eMedNY and will facilitate receipt of services for these consumers. Submitters are requested, when appropriate, to prominently indicate on the cover sheet of submitted applications that the consumer intends to enroll into an MLTC plan

Current policy will remain unchanged for all other consumers found eligible for the Excess Income Program.

Obtained through freedom of information request by Urban Justice Center, Feb. 2014

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.