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Sample NYC Stenson Notice (revised 2015) with Renewal form (revised 2013)
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)
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15 Jan, 2020
2.02 mb
Downloads: 10085
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MAPDR-21 - Medicaid Managed Care Exemptions and Exclusions
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
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03 Jan, 2020
71 kb
Downloads: 16126
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Consumer Directed Personal Assistance Application - NYC HRA Home Care Services Program
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.
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22 Oct, 2019
151 kb
Downloads: 6652
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NYC HRA Explanation of Medicaid Pay-In Program for Spend-down updated 2019-03-22 (Bengali)
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
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24 Aug, 2019
145 kb
Downloads: 2744
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MAP-931A Explanation of Medicaid Pay-In Program (English) (updated 2013-03-22)
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
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24 Aug, 2019
59 kb
Downloads: 12375
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MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Urdu) 2019-03-22
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.
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24 Aug, 2019
154 kb
Downloads: 2607
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MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (simplified Chinese) 2019-03-22
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
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24 Aug, 2019
304 kb
Downloads: 2601
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MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Polish) 2019-03-22
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
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24 Aug, 2019
119 kb
Downloads: 2547
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MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Haitian Creole) 2019-03-22
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.
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24 Aug, 2019
80 kb
Downloads: 2534
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MAP-931A Explanation of Medicaid Pay-In Program for Spend-down (Korean) 2019-03-22
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.
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24 Aug, 2019
169 kb
Downloads: 2629
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