AIDS Drug Assistance Program - A prescription plan that pays for some of the medications needed by low-income people with HIV/AIDS.

Adult Day Health Care (aka "medical model" adult day care) - Medically-supervised services for individuals with physical or mental impairment.  Potentially includes nursing, transportation, leisure activities, physical therapy, speech pathology, nutrition assessment, occupational therapy, medical social services, psychosocial assessment, rehabilitation and socialization, nursing evaluation and treatment, coordination of referrals for outpatient health, and dental services.  It is covered by both fee-for-service Medicaid and Managed Long-Term Care (all flavors).

Administrative Directive - A type of official memo issued by the New York State Department of Health, instructing local districts how to implement the law and regulations.

Medicaid eligibility category for children and their caretaker relatives.

Aid Continuing is the right under the due process clause of the U.S. Constitution to have an administrative hearing (fair hearing) held and decided before benefits are reduced or terminated, where the benefits are an entitlement based on financial need.   This right was established by Goldberg v. Kelly, a US Supreme Court decision, and applies to Medicaid eligibility and services. 18 NYCRR Part 358, 360-2.9.  Notice of intent to reduce or terminate benefits must be given 10 days before the effective date of action.  18 NYCRR 358-2.23.  In order to obtain aid continuing, a hearing must be requested before the effective date on the notice.  18 NYCRR 358-2.5.  The recipient has a longer period -- 60 days from the date of the notice -- to request a hearing, but only receives the previous level of benefits unchanged pending the hearing if s/he requests the hearing within 10 days. 

Bureau of Fraud Investigation - A New York City agency that investigates claims of fraud against the HRA’s social service programs, including Medicaid and Family Health Plus.

Medicaid waiver programs that provide medical and related services to severely disabled children so that they do not need to remain institutionalized. This includes case management, respite care and home and vehicle modification services that would not otherwise be covered by Medicaid.

Community Alternative Systems Agency - Division of New York City's HRA that assesses and authorizes Medicaid personal care services for elderly and disabled individuals.

Community-Based Long-Term Care - A category of services covered under Medicaid consisting of:

• Personal Care Services (excluding those who need only housekeeping)
• Consumer-Directed Personal Assistance Services
• Certified Home Health Agency
• Adult Day Health Care (but not social-model adult day care)
• Private Duty Nursing
• Long-Term Home Health Care Program (Lombardi waiver)

An individual must require at least one of those services for at least 120 days per calendar year in order to be eligible to enroll in MLTC.  Furthermore, a dual eligible age 21+ who requires at least one of those services for at least 120 days per calendar year is required to enroll in MLTC.

Consumer Directed Personal Assistance Program - a type of Medicaid-covered Community-Based Long-Term Care in which the consumer can select, train, supervise, and schedule his/her own personal assistants, who are not required to be certified as PCA/HHAs and who are exempt from the restrictions of the Nurse Practice Act (i.e., they may administer medication and perform other skilled tasks, unlike PCA/HHAs).  18 NYCRR § 505.28.

Certified Home Health Agency - A private home care agency that provides part-time, intermittent health care and support services to individuals who need intermediate and skilled health care.  CHHAs can also provide long-term nursing and home health aide services, physical, occupational, and speech therapy, medical supplies and equipment, and social worker and nutrition services.  Services provided by CHHAs may be reimbursed by Medicare, Medicaid, private payment, and some health insurers.  CHHAs take referrals from physicians, discharge planners, and directly from patients.  There are many CHHAs in New York State, with at least one in each county.  To find CHHAs in your area, go to http://homecare.nyhealth.gov/ in NYS or nationally at http://www.medicare.gov/HHCompare.

Child Health Plus - A state-subsidized medical insurance program for low-income children up to age 19 who are not eligible for Medicaid.

A category of services covered under Medicaid consisting of:

• Personal Care Services (excluding those who need only housekeeping)
• Consumer-Directed Personal Assistance Services
• Certified Home Health Agency
• Adult Day Health Care (but not social-model adult day care)
• Private Duty Nursing
• Long-Term Home Health Care Program (Lombardi waiver)

An individual must require at least one of those services for at least 120 days per calendar year in order to be eligible to enroll in MLTC.  Furthermore, a dual eligible age 21+ who requires at least one of those services for at least 120 days per calendar year is required to enroll in MLTC.

For purposes of Medicaid eligibility, a community spouse is "[a] person who is the spouse of an institutionalized person [i.e., in a medical institution, nursing facility, or receiving HCBS waiver or PACE services], and who is residing in the community and not expected to receive home and community-based services provided pursuant to a waiver under Section 1915(c) of the Social Security Act for at least 30 consecutive days."  Medicaid Reference Guide, Glossary, at iii.

A category of Medicaid eligibility in New York State covering those who are aged (65 or over), blind, or disabled (as defined by the Social Security Administration).  Also known as SSI-related.  This is DIFFERENT than those who receive Medicaid because they receive Supplemental Security Income (SSI) benefits.  An individual does NOT need to receive SSI to be eligible for Medicaid under the SSI-related/DAB category.

New York State Department of Health - The state agency responsible for public health insurance programs and public health services.

For purposes of Medicaid eligibility, "[e]arned income is income received as a result of work activity.  This includes wages, salaries, tips, commissions and income received from self-employment."  Medicaid Reference Guide, Income, at 64.

Elderly Pharmaceutical Insurance Coverage - A program that pays part of the cost of prescription medicine for New York State residents over age 65 with annual income below $35,000 (or $50,000 for couples).  See EPIC website.

AKA surplus income or spend-down.  Some categories of Medicaid applicants can obtain Medicaid in spite of having income above the income limit.  Before Medicaid will cover the cost of services for these individuals, they must incur medical expenses that offset their excess income.  Medicaid Reference Guide, Income, at 239-242.

People or organizations that help complete Medicaid applications and answer questions about public health insurance programs.

A formal procedure provided by the Office of Administrative Hearings, upon request of a recipient, to determine whether a decision to deny, terminate or reduce services by a local district was correct.

A type of health insurance where doctors and other health care providers receive a fee for each service they perform such as tests or office visits.

Family Health Plus - A comprehensive New York State health insurance program for low-income adults ages 19 – 64 who have income above the current Medicaid levels, and who do not have other health insurance coverage.  See Family Health Plus website.

Federal Poverty Level.  This is a commonly-used income benchmark used to calculate income eligibility limits for various Federal and State public benefit programs.  The FPL is calculated and published by the U.S. Department of Health and Human Services each year.  In New York, most Medicaid categories are not based upon the FPL.  However, eligibility for many programs is based upon FPL, including the Medicare Savings Programs, Family Health Plus, Child Health Plus, Family Planning Benefit Program, and the Medicaid Buy-In for Working People with Disabilities.  FPL is also used as part of determining eligibility for SNAP (aka Food Stamps).  After the official FPL is determined by the Federal government, New York State must adopt them separately for use in the various State-administered programs.  Updated State program income limits can be found on the Department of Health website.

New York City Health and Hospitals Corporation - The public hospital system in New York City.  HHC serves New Yorkers regardless of immigration status or ability to pay, so it is a good option for many uninsured people.  "HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based clinics. HHC Health and Home Care also provides health services at home for New Yorkers."  See HHC website.

New York City Human Resources Administration - This is the City agency that administers the Medical Assistance Program (aka "Medicaid"), as well as Temporary Assistance, Food Stamps, HEAP, and other benefit programs.  Many of these benefits are administered through the Departments of Social Services (DSS) in each county of New York State.  HRA is the DSS for New York City.  See HRA website.

When a person or organization pays an expense on someone's behalf, rather than giving them cash, this is considered in-kind income.  For example, if a family member pays your phone bill, then it is in-kind income; but if they write you a check so that you can pay your phone bill, it is cash income.  In-kind income is usually not counted for purposes of Medicaid eligibility.  However, see Medicaid Reference Guide, Income, at 106-108.1.

The length of the period for which asset documentation is required when applying for Medicaid coverage of nursing home care.  For nursing home Medicaid applications between now and February 2011, the look-back period extends back to February 1, 2006.  From February 2011 onward, the look-back period will be 60 months long.  Medicaid will impose a transfer penalty based on the amount of uncompensated transfers identified within the look-back period.

Legally Responsible Relative - For purposes of Medicaid eligibility, "[a] relative who, by law, is responsible for the support and care of another person. In New York State, spouses are responsible for each other and parents are responsible for their children under 21."  See Medicaid Reference Guide, Glossary, at xi.

Long-Term Care - health-related services provided to a person with disabilities that assist that person in completing activities of daily living and/or maintaining maximum functioning.  Includes both community-based long-term care (see CBLTC) and facility-based (e.g., nursing home, assisted living residence).