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Applying For and Keeping Medicaid
Spousal Refusal Form - Suffolk County Download
Spousal Refusal Form - suffolk county.doc
This is the spousal refusal form for Suffolk County residents
13 Apr, 2015 25 kb Downloads: 12635
Agreement to Participate in the Medicaid Pay-In Program Download
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
13 Apr, 2015 86 kb Downloads: 3186
Optional Pay-In Program for Individuals with Excess Income Download
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
13 Apr, 2015 142 kb Downloads: 2925
Notice of Acceptance of your Medical Assistance Application/Recertification Download
MAP-259p_redacted.pdf
This is a redacted MAP-259p form to act as a guide for purposes of Medical Assistance application/recertification
13 Apr, 2015 334 kb Downloads: 3709
Notice of Renewal of your Public Health Insurance Coverage Download
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.
13 Apr, 2015 882 kb Downloads: 5040
Formerly Incarcerated Individuals Reactivation Transmittal Download
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.
13 Apr, 2015 111 kb Downloads: 3033
MAGI Consumers Long Term Eligibility Rules Download
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
09 Apr, 2015 74 kb Downloads: 5522
Reinstatement of Suspended Medicaid Coverage for Formerly Incarcerated Individuals Download
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.
03 Apr, 2015 457 kb Downloads: 6954
Training Announcement: FIDA & MLTC Update - April 20, 2015 - CLE credit available Download
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.
24 Mar, 2015 400 kb Downloads: 5885
NYC HRA MICSA ALERT 02 03-2015 Medicaid Recipients Transferred at Renewal from NYS of Health to Local Dept. of Soc. Services Download
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)
23 Feb, 2015 143 kb Downloads: 6188
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