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MAP-259H Consumer Intent to Return/Not Return Home
MAP-259H Intent to Return Home 2008-06-20.pdf
This form is used when a client enters a residential facility and makes a determination that he/she will either return or not return home.
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13 Apr, 2015
236 kb
Downloads: 4948
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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: 3442
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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: 3152
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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: 3959
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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: 5370
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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: 7242
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Nursing Home Eligibility Division Expedited Renewal Protocol
2015-03-31 NHED EXPEDITED RENEWAL PROTOCOL.pdf
HRA's policy regarding automated renewal for certain institutionalized Medicaid recipients. This alert identifies which nursing home residents are being selected for automated Medicaid renewals.
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03 Apr, 2015
200 kb
Downloads: 8813
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Caregiver Fact Sheet FIDA--Informacion sobre FIDA Espanol Para Cuidadores
Caregiver Fact Sheet (Spanish) FINAL.pdf
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10 Mar, 2015
774 kb
Downloads: 4979
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Caregiver Fact Sheet FIDA--Chinese
Caregiver Fact Sheet (Chinese) FINAL.pdf
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09 Mar, 2015
369 kb
Downloads: 5695
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Directory of MICSA (NYC Medicaid) Contacts - August 2013
MICSA Directory (08-06-13).pdf
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.
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15 Aug, 2013
3.07 mb
Downloads: 206380
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