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30,000 NYS Residents Age 65+ May Lose Medicaid If They Do Not Apply to Enroll in Medicare - 2,204 in NYC Who Lost Medicaid Restored Temporarily

14 Mar, 2018

March 14, 2018 UPDATE:  After ​​​advocacy by Legal Services NYC, including a threat of litigation, the State DOH has agreed  to restore Medicaid coverage to all 2,204 NYC Medicaid recipients who had coverage terminated on March 6th.  They had all received notices that they must provide proof by Feb. 7th  that they applied for Medicare.   Five individuals threatened with termination of Medicaid sought legal assistance from Legal Services-NYC Bronx --some should have been exempt from the requirement to enroll in Medicare and should not have been included in the mailing.  All had attempted to comply with the requirement by contacting the SSA to enroll in Medicare but had been unable to obtain documentation to verify this to HRA.    Many experienced difficulties obtaining assistance and extensions from HRA.

Affected  NYC individuals can contact the LSNYC Access Line at 917-661-4500 if their Medicaid coverage is inactive.  


DOH estimates that more than 12,000 NYC Medicaid recipients still need to be notified to comply with the Medicare application requirement.  DOH has agreed to continue working collectively with legal services advocates to improve this process in the future so this vulnerable group of Medicaid recipients—the elderly, disabled, and limited English proficient—can maintain Medicaid coverage while also complying with the Medicare application requirement.  Those individuals whose Medicaid was restored through LS-NYC intervention or who receive these mailings in the future must take immediate steps to apply for Medicare by calling the Social Security Administration at 1-800-772-1213.  They will be given an appointment to complete their Medicare application by phone or in person at a local SSA office. They should be advised to state to SSA, “I am calling because I need to apply for Medicare because HRA/Medicaid is requiring me to.”  


January 2018 UPDATE:  4,000 Upstate Medicaid Recipients age 65 have already had Medicaid discontinued effective Jan. 1, 2018 under this new requirement!  In NYC, a corrected  letter was sent on Jan. 6, 2018 to  5,500 recipients, extending their deadline to submit proof that they applied for Medicare to Feb. 7, 2018.  See the  CORRECTED Jan. 10, 2018 Medicaid Alert   Be alert for these cases and more to come - see advocacy tips including fair hearing rights  here.

30,000 Medicaid Recipients Age 65+ Threatened with Discontinuance of Medicaid if they do not Enroll in Medicare A or B

From November 2017 - February 2018,  letters have been or will be mailed out to 30,000 NYS Medicaid recipients age 65+ who do not have either Medicare Parts A or B, telling them that they must go to the Social Security Administration (SSA) and try to enroll in Medicare, in order to keep Medicaid coverage.   They will need to provide their local Medicaid program with proof that they tried to enroll in Medicare in order to prevent discontinuance of their Medicaid.  Notices are being sent solely to those  who:  

  1. Are age 65+ and have neither Medicare Part A or Part B.  If they are on SSI, they should NOT be receiving these notices because the State should automatically enroll them in Medicare through the "Buy-In."   But they need to contact HRA to explain this and prevent discontinuance of their Medicaid. 

  2. Are US Citizens or have been Permanent Resident Aliens for 5+ years, but who are not "PRUCOL" - as they are definitely not eligible for Medicare.

  3. Have incomes below the Medicare Savings Program SLIMB level  (120% Federal Poverty Level)

See more about this State initiative in this article, including links to NY State and NYC guidance and samples of the notices.  The Medicare Rights Center created a Tip Sheet about this issue. 

Going forward, those applying for Medicaid who meet the criteria above will be required to show that they have applied to enroll in Medicare if they are not already enrolled in Part A or Part B. 

See more here about this requirement to enroll in Medicare. 

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