Effective Nov. 1, 2012, Consumer-Directed Personal Assistance Program (CDPAP) is included in the benefit package for both Mainstream Medicaid Managed Care and Managed Long Term Care. This change affects both people who have Medicaid only and people who have both Medicaid and Medicare ("dual eligibles). See info on CDPAP at http://wnylc.com/health/entry/40/.

(1) Most people STATEWIDE with Medicaid Only (but no Medicare) are already required to enroll in a Mainstream Medicaid Managed Care (MMC) plan. Those plans will now approve, authorize and pay for CDPAP. See http://wnylc.com/health/news/22/

(2) Managed Long Term Care (MLTC)-- See info at http://wnylc.com/health/news/41/.

Since MLTC is now mandatory as of 9/1/2012 in NYC for "dual eligibles" needing personal care, CDPAP recipients in NYC will begin receiving letters giving them 60 days to select an MLTC plan, or they will be auto-assigned to a plan on a random basis. The MLTC plans must contract with CONCEPTS and Chinese-American Planning Council through 10/31/13 so consumers can keep their current aides. See more at http://wnylc.com/health/entry/40/

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.