Medicaid alert describing situations in which a Medicaid case must be transitioned from the NYSOH Exchange to HRA/WMS, and procedures for that transition.

Presentation to NASW Suffolk Chapter by David Silva at NYLAG

July 12, 2012
The purpose of this ALERT is to inform Community Based Organizations, Client Representatives, Certified Home Health Agencies and other providers that the Medical Assistance Program is changing the way it processes Medicaid applications for excess income eligible consumers seeking enrollment into a Managed Long Term Care (MLTC) plan. Consumers seeking MLTC enrollment who are found to only be eligible for the Medicaid Excess Income (Surplus) Program will now have their cases accepted and authorized with “06” (provisional) coverage. This will occur even if their applications are received without bills that cover their excess or surplus.

This new process will allow MLTCplans to see the provisional coverage on ePaces/eMedNY and will facilitate receipt of services for these consumers. Submitters are requested, when appropriate, to prominently indicate on the cover sheet of submitted applications that the consumer intends to enroll into an MLTC plan

Current policy will remain unchanged for all other consumers found eligible for the Excess Income Program.

Supplemental form to be submitted with a MBI-WPD application.

Document to be submitted to HRA accompanying a MBI-WPD application.

PowerPoint was presented for certified Client Representatives who have completed a certification to be authorized submitters of Medicaid applications to HRA. However, information in this may be generally applicable.

FAQ clarifying issues that pose barriers to enrollment into MLTC plans. Many of these problems stem from "coding" problems - eligibility codes in the Medicaid "eMedNy" system. This FAQ explains that some codes may appear to say the individual is not eligible for Medicaid or for MLTC -- but THEY DO NOT MEAN THAT! And plan should submit "conversion package" to HRA to activate Medicaid and allow enrollment.

NYC Medicaid office moved from 330 West 34th Street to 785 Atlantic Avenue, Brooklyn NY 11238 in May 2013. Contact numbers at that office listed in this document.

HRA Alert announcing mandatory enrollment of LTHHCP consumers in managed care and managed long term care plans. The first letters are expected to be sent in early May. Eligible consumers have the option of enrolling in other waiver programs.