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.

This is the statewide DOH-4220 Medicaid Application form used to apply for non-MAGI Medicaid (updated 8/2021 but HRA just announced this change in an Alert dated 03-24-2022).

The statewide DOH-4220 Medicaid Application form used to apply for non-MAGI Medicaid has been updated (dated 8/2021 but HRA just announced this change in this alert). If an applicant submits an older version of the form, the agency will continue to accept it and not require the applicant to complete the newer application form. However, copies of the OHIP-0112 and DOH-5130 would need to be sent with the older application. It has reminder that as of March 1, 2022, the DOH-5178A will be the only Supplement A accepted with the DOH-4220 application.

A Medicaid Recipient who submits medical bills from a Provider to meet the spenddown will receive an OHIP-3183 “Provider/Recipient Letter” indicating which medical expenses are the responsibility of the Recipient (and which the Provider should not bill to Medicaid). When the Recipient is enrolled with a Managed Long Term Care Plan (MLTC), the Recipient and the MLTC will receive an OHIP-0128 “MLTC/Recipient Letter” indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). These forms replace the LDSS-3183 form.

Contact List - Medicaid Managed Care Organizations in NYC (updated 12-30-2021)

HRA did a mass mailing to all recipients requesting them to update their residential or mailing address (as well as alternative format and language preferences). The alert includes Form 751k for recipients to report changes.

2021-12-28 Usage of DOH 5178A Medicaid Application Supplement and DOH 4495A – New Medicaid Applications in NYC must be accompanied by DOH 5178A Supplement A form, even if the applicant is attesting the amount of their resources. The old form (DOH 4495A) will be accepted provided it is accompanied by DOH 5148 or DOH 5149. As of March 1, 2022, only the DOH-5178A will be accepted.

Announces mass mailing to all NYC Medicaid recipients asking them to report any address changes and certain other changes that occurred during the pandemic with Form 751K. Updating addresses is important because once the pandemic is declared over, all recipients will receive Renewal notices by mail. Without an updated address, they will not receive these renewals, and Medicaid could be discontinued. Form 751-k can be downloaded at http://www.wnylc.com/health/download/638/ (fillable) or in varioius languages at https://www1.nyc.gov/site/hra/help/health-assistance.page.

Announces a change in the form for treating physician to certify disability as needed to approve supplemental needs trusts including pooled trusts, and Medicaid based on disability, if not certified by the SSA. Replaces Form 486T, though 486T will be accepted until Feb. 1, 2022. New form posted at http://www.wnylc.com/health/download/798/