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Sample NYC Stenson Notice (revised 2015) with Renewal form (revised 2013) Download
MAP-909 (English) Stenson Notice (1-15-2015) with 3074 form (10-16-2013).pdf
Notice used in NYC to advise a former SSI recipient of the procedure to have continuing Medicaid eligibility determined, with Renewal form to be completed and returned (MAP 909 and MAP 3074)
15 Jan, 2020 2.02 mb Downloads: 10171
MAPDR-21 - Medicaid Managed Care Exemptions and Exclusions Download
MAPDR-21 Medicaid Managed Care Exemptions and Exclusions 9-28-2015.pdf
This documents lists which categories of beneficiaries are exempt or excluded from the requirement of joining a mainstream medicaid managed care plan. Rev'd 9/28/15
03 Jan, 2020 71 kb Downloads: 16203
Consumer Directed Personal Assistance Application - NYC HRA Home Care Services Program Download
M-13d - CDPAP Application (2018-04) Fill-able.pdf
From M13d, rev. 4/2018, which a NYC consumer or person directing his/her care must complete and have approved by the CASA in order to enroll in the Consumer Directed Personal Assistance Program (CDPAP). Made fill-in-able by NYLAG EFLRP.
22 Oct, 2019 151 kb Downloads: 6700
NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (Bengali) Download
MAP-931a (Bengali) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (Bengali) to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear. Other languages now posted on this site
24 Aug, 2019 145 kb Downloads: 2784
MAP-931A Explanation of Medicaid Pay-In Program (English) (updated 2013-03-22) Download
MAP-931a (English) 2019-03-22.pdf
NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (English) to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear. Other languages now posted on this site
24 Aug, 2019 59 kb Downloads: 12424
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Urdu) 2019-03-22 Download
MAP-931a (Urdu) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down ( Urdu) 2019-03-22 updated to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear.
24 Aug, 2019 154 kb Downloads: 2642
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (simplified Chinese) 2019-03-22 Download
MAP-931a (Simplified Chinese) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Simplified Chinese) 2019-03-22 updated to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear
24 Aug, 2019 304 kb Downloads: 2657
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Polish) 2019-03-22 Download
MAP-931a (Polish) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Polish) 2019-03-22 updated to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear
24 Aug, 2019 119 kb Downloads: 2582
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Haitian Creole) 2019-03-22 Download
MAP-931a (Haitian Creole) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Haitian Creole) 2019-03-22 updated to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear.
24 Aug, 2019 80 kb Downloads: 2571
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Korean) 2019-03-22 Download
MAP-931a (Korean) Optional Pay-in Program for Individuals with Surplus Income 2019-03-22.pdf
MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Korean) 2019-03-22 updated to include State fact sheet on pooled trusts also available at http//health.ny.gov/health_care/Medicaid/index.htm#trusts. Note that the NYS Bar Association Elder Law Section has asked DOH to revise the pooled trust fact sheet to make it more clear.
24 Aug, 2019 169 kb Downloads: 2666
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