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Applying For and Keeping Medicaid
Training Powerpoint on 2023 Medicaid Increases in NYS Download
PPT NYLAG CLE Medicaid Increases 2023-01.pdf
PowerPoint presented in CLE Webinar on Jan. 18, 2023 by NYLAG Evelyn Frank Legal Resources program on how NYS is rolling out the increases in Medicaid eligibility for the Aged 65+, Blind, & Disabled category (ABD or DAB or NOn-MAGI). Includes how this rollout intersects with "unwinding the Public Health Emergency" starting in March 2023. See updates at http://health.wnylc.com/health/news/90/
25 Jan, 2023 696 kb Downloads: 2498
NYS Dept. of Health Memo Jan. 13, 2023 with Timeline of Unwinding of Public Health Emergency Download
2023-01-13 DOH Unwind Timeline guidance.pdf
NYS Dept. of Health Memo Jan. 13, 2023 with Timeline of Unwinding of Public Health Emergency - when renewals and discontinuances will start, and when the "easements" that loosen documentation requirements for applications will cease and full documentation will be required
20 Jan, 2023 357 kb Downloads: 1351
MAP-751W Consumer/Provider Request to Change Information on File (3-25-21)(fill-able) Download
MAP-751W Request to Change Information (3-25-21) (fill-able)(with 3-4-22 memo where to submit).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. Per attached 3/2022 memo may be faxed to (917) 639-0837 or mailed. Note that a change in demographic information (such as name, address, phone number) should be reported in a different form: MAP-751K. The MAP-751W is also posted at https://www1.nyc.gov/site/hra/help/health-assistance.page in other languages.
24 Oct, 2022 376 kb Downloads: 8256
2022-0-5-13 New York Independent Assessor Download
2022-05-13 New York Independent Assessor.pdf
Beginning May 16, 2022, any adult 18 and older seeking fee for service (FFS) Personal Care Services (PCS) and/or Consumer Directed Personal Care Services (CDPAS) for the first time or seeking initial MLTC plan eligibility must be referred to the New York Independent Assessor (NYIA) for their Community Health Assessment (CHA) and Clinical Appointment (CA). This change does not include the Immediate Needs process at this time. NYIA will conduct independent assessments, provide independent practitioner orders, and perform independent reviews of high needs cases for PCS and CDPAS. The NYIA will also take over the work currently done by the Conflict Free Evaluation and Enrollment Center (CFEEC) to assess individuals for MLTC plan eligibility.
23 May, 2022 93 kb Downloads: 1499
DOH-5130 Form Download
DOH form 5130_updated 9-2021.pdf
Per MICSA Alert dated 03-24-2022, if an older version than the revised DOH 4220 form - Access NY Health Care Application (updated as of 9-2021) is submitted, DOH 5130 (and OHIP-0112) has to be submitted.
31 Mar, 2022 23 kb Downloads: 1180
Revised DOH-4220, Access NY Health Care Application (updated 8-2021) Download
DOH form 4220_updated 8-2021.pdf
This is the statewide DOH-4220 Medicaid Application form used to apply for non-MAGI Medicaid (updated 8/2021 but HRA just announced this change in an Alert dated 03-24-2022).
31 Mar, 2022 619 kb Downloads: 1144
MICSA Alert re Revised DOH-4220, Access NY Health Care Application Download
2022-03-24 Revised DOH-4220 Access NY Health Care Application.pdf
The statewide DOH-4220 Medicaid Application form used to apply for non-MAGI Medicaid has been updated (dated 8/2021 but HRA just announced this change in this alert). If an applicant submits an older version of the form, the agency will continue to accept it and not require the applicant to complete the newer application form. However, copies of the OHIP-0112 and DOH-5130 would need to be sent with the older application. It has reminder that as of March 1, 2022, the DOH-5178A will be the only Supplement A accepted with the DOH-4220 application.
31 Mar, 2022 136 kb Downloads: 1181
2022-02-04 Changes to the LDSS-3183 Provider or MLTC Plan and Recipient Letter Download
2022-02-04 Changes to LDSS-3183 Provider or MLTC Plan & Recipient Letter.pdf
A Medicaid Recipient who submits medical bills from a Provider to meet the spenddown will receive an OHIP-3183 “Provider/Recipient Letter” indicating which medical expenses are the responsibility of the Recipient (and which the Provider should not bill to Medicaid). When the Recipient is enrolled with a Managed Long Term Care Plan (MLTC), the Recipient and the MLTC will receive an OHIP-0128 “MLTC/Recipient Letter” indicating the amount that the Recipient owes to the MLTC (after deducting the medical expenses/bills from the spenddown). These forms replace the LDSS-3183 form.
17 Feb, 2022 810 kb Downloads: 1805
2021-12-16 Medical Assistance Program Request for Information form MAP-751v Download
2021-12-16 MAP Request for Information form 751v + 751k.pdf
HRA did a mass mailing to all recipients requesting them to update their residential or mailing address (as well as alternative format and language preferences). The alert includes Form 751k for recipients to report changes.
18 Jan, 2022 1.46 mb Downloads: 1160
2021-12-28 Usage of DOH 5178A Medicaid Application Supplement and DOH 4495A Download
2021-12-28 Usage of DOH5178A Medicaid App Suppl & DOH 4495A.pdf
2021-12-28 Usage of DOH 5178A Medicaid Application Supplement and DOH 4495A – New Medicaid Applications in NYC must be accompanied by DOH 5178A Supplement A form, even if the applicant is attesting the amount of their resources. The old form (DOH 4495A) will be accepted provided it is accompanied by DOH 5148 or DOH 5149. As of March 1, 2022, only the DOH-5178A will be accepted.
11 Jan, 2022 77 kb Downloads: 1621
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