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NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2024
2001_to_2024_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2024. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
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07 Mar, 2025
3.77 mb
Downloads: 301923
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Basic Eligibility for Medicaid and Home Care in NYS - Age 65+, Disabled, Blind
Medicaid Basic - 2025 final.pdf
This is basic information about Medicaid eligibility for the Disabled, Aged 65+, and Blind (DAB) category and about applying for Community Medicaid in order to receive home care (personal care or consumer-directed personal assistance) through Managed Long Term Care or based on Immediate Need through the local Medicaid program. (updated March 5, 2025 with final 2025 Income and Asset limits released by DOH)
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07 Mar, 2025
279 kb
Downloads: 194085
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Excel Template for Medicaid Non-MAGI Budgeting -2025 FPL:
Medicaid Budgeting worksheet 2025.xls
Excel template to calculate Medicaid non-MAGI eligibility under the increased 2025 levels - see http://health.wnylc.com/health/news/90/. Can be used as a tool to estimate spend-down and pooled trust contributions. Template has different tabs for different types of budgeting schemes. -- See list of these at http://health.wnylc.com/health/entry/222/.
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07 Mar, 2025
131 kb
Downloads: 7416
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Currency Conversion Worksheet for Holocaust Reparations
Reparation worksheet.xls (2-2025).xlsx
Use this worksheet to convert lifetime total amount received in Holocaust reparations / restitution from foreign currencies (Deutschmarks and Euros) into U.S. Dollars. This is for purposes of taking advantage of the exemption of saved reparations payments from the resource test for Federally-funded means-tested benefits, like Medicaid and Supplemental Security Income. Updated monthly.
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01 Mar, 2025
148 kb
Downloads: 9098
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Medicaid income and resource levels - 2025 (2-14-2025)
MAPDR-01 Feb 26 2025.pdf
NYC HRA MAPDR-01 (updated 02-14-2025) -- Although this was issued in Feb. 2025, almost all the figures are in yellow which means that they are still the 2024 figures. The 2025 figures can only be calculated after NYS Dept. of Health issues the 2025 Federal Poverty Levels (FPL) later in February or March (even though the FPLs were announced by the federal govt).
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26 Feb, 2025
2.13 mb
Downloads: 450654
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MAP-751W Consumer/Provider Request to Change Information on File (11-25-2024)(fill-able)
MAP-751W Request to Change Information (Doc required) (11-25-2024).pdf
NYC HRA Form to notify HRA of corrections or changes, e.g. close case, combine case, add/remove individual, notify of death, change in immigration status, upgrade eligibility, request MSP evaluation, budgeting changes, pooled trust budgeting and add/remove third party health insurance. may be faxed to Fax 1-917-646-0837 per August 2024 Medicaid Alert http://www.wnylc.com/health/download/738/. Note that a change in demographic information (such as name, address, phone number) should be reported in a different form: MAP-751K. The 2018 version of the MAP-751W is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages - but has not yet been updated to the 2024 version as of 1/23/25.
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20 Feb, 2025
186 kb
Downloads: 9931
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MAP-751K Consumer Request to Change Information on File (12-14-2023)(fill-able)
MAP-751k consumer-provider request to change info on file (English) (2023-12-14).pdf
NYC HRA Form to use to notify HRA of change in name, address, mailing address, date of birth, SSN, and to request mail in different languages or formats for disability (Updated 12-14-2023). The MAP-751K is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages. Fax to HRA MAP Undercare 1-917-646-0837 per Medicaid Alert 8/2024 http://www.wnylc.com/health/download/738/. NOTE: The 751k is no longer used to request a change in budgeting. For that, use new form MAP-751W posted at the same webpage as above for the 751K (but updated form not posted there - use http://health.wnylc.com/download/770/
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24 Jan, 2025
111 kb
Downloads: 9863
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MICSA Alert 8-2-2024 Relocation of Brooklyn South (MAIN) Medicaid Office and Authorized Rep Window
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.
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17 Sep, 2024
134 kb
Downloads: 502
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HRA MICSA Alert 2015-03-10
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.
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31 Oct, 2023
505 kb
Downloads: 6005
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MAP-909E DAB Renewal Form Redacted (2022-01-04)
MAP-909e DAB Renewal (2022-01-04) Redacted Sample with 2023 ACT NOW insert.pdf
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)
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31 May, 2023
2.17 mb
Downloads: 15760
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