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.

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.

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)

HRA Medicaid Renewal Form being sent in 2023 to Disabled, Aged, & Blind (DAB) recipients in the "unwinding" of the Public Health Emergency. Note that the packet contains
(1) a 2-page Renewal Notification letter with the deadline to return the renewal, which is always the 10th of the 2nd month after the notification,
(2) "ACT NOW" alert intended to alert consumers that this renewal MUST be returned, unlike those sent during the Public Health Emergency (MAP-3185 - 2023-01-19),
(3) Renewal form has a new section in Part 6 RESOURCES requiring authorization for HRA to verify resources using data matching (page 6 of the PDF);
(4) Renewal form must be signed by both applicant and spouse (p. 9 of PDF)
(5) Financial Maintenance form - not new - only required if housing costs are more than 70% gross monthly income (p. 10 of PDF);
(6) NEW: Authorization for Verification of Resources - Recipient and Spouse each must sign this and send back with renewal!
(MAP-3179 and 3179a) (pp. 11-13 of PDF)
(7) Renewal instructions (pp. 14-16 of 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.

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)

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

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

Beginning May 16, 2022, any adult 18 and older seeking fee for service (FFS) Personal Care Services (PCS) and/or Consumer Directed Personal Care Services (CDPAS) for the first time or seeking initial MLTC plan eligibility must be referred to the New York Independent Assessor (NYIA) for their Community Health Assessment (CHA) and Clinical Appointment (CA). This change does not include the Immediate Needs process at this time. NYIA will conduct independent assessments, provide independent practitioner orders, and perform independent reviews of high needs cases for PCS and CDPAS. The NYIA will also take over the work currently done by the Conflict Free Evaluation and Enrollment Center (CFEEC) to assess individuals for MLTC plan eligibility.

Per MICSA Alert dated 03-24-2022, if an older version than the revised DOH 4220 form - Access NY Health Care Application (updated as of 9-2021) is submitted, DOH 5130 (and OHIP-0112) has to be submitted.