NY Health Access About Us   |   Contact Us Empire Justice Center Legal Aid Society NYLAG WNYLC
New York City Government
MICSA Alert 8-2-2024 Relocation of Brooklyn South (MAIN) Medicaid Office and Authorized Rep Window Download
2024-08-02 Change address for C-Rep and brooklyn_south.pdf
MICSA Alert 8-2-2024 Relocation of Brooklyn South (MAIN) Medicaid Office and Authorized Rep Window - adds new email address for AUthorized Representatives (approved by HRA) to email applications.
17 Sep, 2024 134 kb Downloads: 653
MAP-2161 and MAP 2161a Spousal / Parental Refusal Form (2023) (ENGLISH) Download
MAP-2161 (2023-03) + MAP-2161a (2023-11) Combined ENGLISH.pdf
Applicants for Medicaid in New York City can use this "APPLICANT/RECIPIENT DECLARATION CONCERNING THE LEGALLY
RESPONSIBLE RELATIVE’S INCOME/RESOURCES" forms to indicate the refusal of their legally responsible relative to make available their income or resources for the cost of necessary medical care and services, i.e. "spousal/parental refusal." Since 2018, includes language to request accommodation of disability in reading notice. Instructions explain whi h form to use - MAP-2161 or 2161a - don't need both. Both attached in same PDF. Other languages availaable of MAP-2161 at https://www.nyc.gov/site/hra/help/health-assistance.page
20 Mar, 2024 329 kb Downloads: 68553
CASA Contact List Download
CASA List (HCSP-3037 English) 12-4-2023.pdf
HRA contacts for the New York City Home Care Services Program CASA offices (updated 12/2023)
18 Mar, 2024 74 kb Downloads: 71802
HRA MICSA Alert 2015-03-10 Download
2015-03-10 CORRECTED UPDATE Transition coverage from NYSOH to WMS with copy of 2014-06 Original Alert + Transmittal form.pdf
Consumers who have their Medicaid coverage through the New York State of Health (the Marketplace) and who require certain services, must have their case transitioned to WMS (and administered by HRA) in order to receive those services. Amends and references an earlier Alert of June 2014, which is attached to this copy along with the Transmittal form annexted to the June 2014 Alert.
31 Oct, 2023 505 kb Downloads: 6127
NYC HRA Medicaid Alert NY Independent Assessor & Changes to Personal Care (PCS) Assessment Process (5/31/23) Download
2023-05-31 NYIA and Changes to Personal Care Assessment Process.pdf
Explains what consumers seeking Medicaid CDPAP or personal care (PCS) should do in 2 situations: (1) Those who contacted NYIA directly, rather than applying for Immediate Need services and who are not in a Mainstream Medicaid managed care plan (known as "Fee for service (FFS) consumers") - If the NYIA notice says they are not eligible to enroll in MLTC and refers them to the LDSS - they should fax a copy of their NYIA decision notice to the CASA Central Intake unit (718) 636-7784. Case will be assigned to a CASA to use the notice to retrieve the NYIA assessments and then proceed to assess whether eligible for PCS or CDPAPt. But.. if they are a dual eligible and not in a hospice program, or in OPWDD, TBI or NHTD waiver - they are probably only eligible for 8 hours/WEEK of Housekeeping services from CASA. T

(2) If you applied to HRA for Immediate Need services - PCS or CDPAP via eFax (917) 639-0665 - you should not have to contact the HRA Home Care Services Program/CASA after the NYIA assessessments -- because NYIA should notify CASA of the outcome of the assessments directly and they should contact you about next steps to decide if you are eligible for services and if so - what is your plan of care.
03 Jun, 2023 132 kb Downloads: 1673
MAPDR-05 (08/04/2022) List of Managed Care & Managed Long Term Care Plans in NYC Download
2022-08-04 MAPDR-05 Medicaid Managed Care Plans NYC.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care
* Health and Recovery Plan Managed Care Plans (HARP)
* Managed Long Term Care (MLTC)
* Medicaid Advantage Plus (for dual eligibles, includes MLTC)
* HIV Special Needs Plans (SNP)
* Programs of All-inclusive Care for the Elderly (PACE)
* Fully Integrated Dual Advantage (FIDA) IDD

Updated August 4, 2022 (current on HRA site as of 5/31/23)
31 May, 2023 129 kb Downloads: 62496
Stenson - Sample Notice of Discontinuance for Failure to Return Stenson Renewal Download
Disco notice after Stenson packet not received - 2023 Redacted.pdf
Sample notice of intent to discontinue Medicaid, where former SSI recipient failed to return a renewal package to renew Medicaid as a separate stand-alone benefit from SSI. Redacted.
27 Mar, 2023 2.25 mb Downloads: 1282
MAP-648 P SUBMISSION OF REQUEST FROM RESIDENTIAL HEALTH CARE FACILITIES (RHCF)(05/05/2022) Download
MAP-648p Submission of request from RHCF-NH 2022-05-05.pdf
Transmittal form for Nursing Home to submit to HRA: new Medicaid application, request to convert coverage from community Medicaid, upgrade coverage, or notify HRA that transfer penalty period expired. (updated 5/5/2022)
25 Mar, 2023 69 kb Downloads: 11410
12-22-22 HRA Medicaid Alert - Eligibility increases starting Jan. 2023 & REVISED MAP-3190 Form to Request Re-budgeting Download
2022-12-27 Non-MAGI Eligibility Increases 2023- with REVISED map-3190 (1-10-23).pdf
HRA Medicaid Alert announcing the increases in income and asset eligibility for Age 65+, Disabled & Blind recipients starting Jan. 2023. NYLAG has swapped in HRA's iupdated form MAP-3190 form (rev. 1-10-23) that will be mailed to everyone with a spend-down starting Jan. 30, 2023. The form can be completed and returned to HRA to request a decreease in the spend-down. See more at http://www.wnylc.com/health/news/90/#II.%20Timing
28 Jan, 2023 827 kb Downloads: 4748
NYC Medicaid Alert 6-30-2022 - Change in Submissions to HRA for Disability Determination for Pooled Trusts & MBI-WPD (revises 5/31/22 Alert) Download
2022-6-30 MA Alert Disability Determination by New York State Medicaid.pdf
Eff. June 1, 2022, submissions to HRA to approve a Pooled Trust or MBI-WPD no longer need to include the disability forms (DOH-5141, DOH-5143, Authorization MAO-751e, AIDS report form MAP 252F. Instead, once the pooled trust is filed with HRA, HRA will route it to NYS DOH Disabilitiy Review Team, which will then request MAP 3177 Disability Determination Request from the consumer. Unclear if other documentation will be required but likely - stay tuned look for updates at http://www.wnylc.com/health/entry/44/ (This revises the Alert issued May 31, 2022
01 Jul, 2022 148 kb Downloads: 3301
Prev Next
1 2 3 4 5 6 7 8 9 10


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.