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Spousal Refusal Form - Suffolk County
Spousal Refusal Form - suffolk county.doc
This is the spousal refusal form for Suffolk County residents
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13 Apr, 2015
25 kb
Downloads: 12195
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Agreement to Participate in the Medicaid Pay-In Program
MAP-931B Agreement to Participate in Pay-In Program searchable pdf.pdf
This is the form in both English & Spanish agreeing to participate in the Medicaid Pay-In Program
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13 Apr, 2015
86 kb
Downloads: 3100
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Optional Pay-In Program for Individuals with Excess Income
MAP-931A Optional Pay-In Program searchable pdf.pdf
This explains the Excess Income Program for clients whose incomes exceeds the Medical Assistance income limits
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13 Apr, 2015
142 kb
Downloads: 2843
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Notice of Acceptance of your Medical Assistance Application/Recertification
MAP-259p_redacted.pdf
This is a redacted MAP-259p form to act as a guide for purposes of Medical Assistance application/recertification
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13 Apr, 2015
334 kb
Downloads: 3616
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Notice of Renewal of your Public Health Insurance Coverage
MAP 2088v_redacted.pdf
This is a redacted notice of renewal of public health insurance coverage to act as a guide to help clients fill out their renewals.
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13 Apr, 2015
882 kb
Downloads: 4810
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Formerly Incarcerated Individuals Reactivation Transmittal
map-3103 Formerly Incarcerated Individuals Reactivation Transmittal.pdf
This form was uploaded by NYC HRA on 2/20/15 to help formerly incarcerated individuals reactivate their medicaid account once they have been released.
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13 Apr, 2015
111 kb
Downloads: 2949
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MAGI Consumers Long Term Eligibility Rules
2014-10-24 MAGI Consumers Long Term Eligibility Rules.pdf
long term eligibility rules for individuals who are eligible for Medicaid under a Modified Adjusted Gross Income (MAGI) eligibility group
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09 Apr, 2015
74 kb
Downloads: 5421
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Reinstatement of Suspended Medicaid Coverage for Formerly Incarcerated Individuals
2015-02-20 Reinstatement of Suspended Medicaid Coverage for Formerly Incarcerated Individuals.pdf
Medicaid coverage for individuals who have been been released from 30+ days of incarceration.
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03 Apr, 2015
457 kb
Downloads: 6863
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Training Announcement: FIDA & MLTC Update - April 20, 2015 - CLE credit available
CLE Flyer.pdf
CLE/training seminar on MLTC and FIDA conducted by NYLAG Evelyn Frank Legal Resources Program -
April 20, 2015 - 2 - 5 PM
7 Hanover Square, 15th floor, NY NY 10007. Registration form attached to announcement.
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24 Mar, 2015
400 kb
Downloads: 5798
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NYC HRA MICSA ALERT 02 03-2015 Medicaid Recipients Transferred at Renewal from NYS of Health to Local Dept. of Soc. Services
2015-02-03 Medicaid Recipients Transferred at Renewal from the New York State of Health to the Local Department of Social Services.pdf
Procedure for transitioning people from expanded "MAGI" Medicaid generally for people under 65 who do not have Medicare -- when they turn 65 or become enrolled in Medicare, they must transfer to Non-MAGI Medicaid, using a stricter income and resource test. The procedure provides some coverage to fill the gap during the transition. It implements State DOH 14-LCM-02 posted at https://www.health.ny.gov/health_care/medicaid/publications/lcm/14lcm-2.htm (Dec. 2014)
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23 Feb, 2015
143 kb
Downloads: 6098
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