New York Health Access

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	Delivery System Reform Incentive Payment (DSRIP): What You Need to Know about New York’s Changes to Medicaid 17 Mar, 2016 DSRIP restructures the current Medicaid delivery system with the ultimate goal of reducing avoidable hospital admissions by 25%. This is accomplished by putting an emphasis on the use of primary care, and providers using a data sharing system so that all of a person’s providers can share...

	ALERT: Some Immigrants Who Were on Medicaid Lost Their Health Coverage January 1st 12 Jan, 2016 ALERT Some Immigrants Who Were on Medicaid Lost Their Health Coverage January 1st Some immigrant adults who had Medicaid through the Marketplace lost their Medicaid coverage on January 1, 2016 and now have no health insurance. Most of these individuals are eligible for the Essential...

	Coming July 1st: MLTC Members May Request Fair Hearing Without first Requesting Internal Appeal from Plan ("Exhaustion" Requirement ELIMINATED) 11 Jun, 2015 Managed Long Term Care Appeals System Change Exhaustion Requirement to be Eliminated Effective July 1, 2015 Since early June 2015, everyone in Managed Long Term Care (MLTC) plans have been receiving a notice from their MLTC plan that looks like this sample notice. This notice has caused a lot...

	NYS BUDGET for 2015-2016 Again Proposes End to Spousal Refusal and "Immediate Need" Medicaid 12 Feb, 2015 The Governor's proposed New York State budget for 2015-16 includes some good and some bad for health care for low-income New Yorkers. Click here to see the actual Health and Mental Hygiene (HMH) Bill and the Governor's Health and Mental Hygiene (HMH) Memorandum in Support. NYLAG is one of many...

	Mandatory Enrollment of Nursing Home residents into Managed Care & MLTC - scheduled to begin Feb. 1, 2015 27 Jan, 2015 Nursing Home Resident Transition to Managed Care February 1, 2015 marks the start date for the new requirement for nursing home residents who became "permanent" residents after that date to enroll in managed care or MLTC plans. CMS approved this expansion of MLTC and mainstream Medicaid managed...

	Consumer Advocates Call for Further Protections in Medicaid Managed Long Term Care 01 Sep, 2014 Consumer advocates have submitted several comments to the New York State Department of Health and the Centers for Medicare and Medicaid Services (CMS) that would protect the rights consumers as Managed Long Term Care is implemented. September 2014 - NYLAG, Empire Justice Center and other...

	Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services 03 Jul, 2014 Physicians and other healthcare providers are required to enroll with the NY State Medicaid program before Medicaid will pay for services that the providers prescribe, order, or refer. The rule applies to ordering, prescribing, referring and attending physicians and healthcare providers (“OPRA...

	NYS Budget Victories - "Spousal" and "Parental" Refusal Remain Intact, "Aid Continuing" Rights in Managed Care & MLTC, SCRIE Increase 31 Mar, 2014 The details of the 2014-15 NYS Budget is just being voted on today posted at A9205/6914 details are just being digested, but Medicaid recipients can celebrate at least two hard-won victories!! We owe a huge thank you to Assembly Health Committee Chair Richard Gottfried and the staff of the Assembly...

	State Announces new Procedures for Spousal Impoverishment Protections in MLTC & Other Waiver Programs 28 Mar, 2014 New York State has gradually expanded use of spousal impoverishment protections in various home care programs. Once available only in the Lombardi Long Term Home Health Care program, these protections have expanded to all Managed Long Term Care (MLTC) services, and other Home and Community Based...

	New contact list posted for Main NYC Medicaid Offices that moved to Brooklyn in May 2013 10 Mar, 2014 As of Monday, May 6, 2013 the NYC Medicaid Office (known as MICSA) moved from 330 W. 34th Street in Manhattan to 785 Atlantic Ave., Brooklyn, NY 11238. All MICSA-Medicaid operations, including TBI and NHTD waiver programs, have been relocated to this address. The Reception Unit which handled...

	HRA Corrects Illegal Practice of Denying "Spousal Impoverishment" Income Allowance to Some Spouses of Nursing Home Residents 04 Mar, 2014 A community spouse is entitled to the community spouse monthly income allowance (CSMIA) even if she does a spousal refusal to contribute resources. However, since mid-2012, the NYC HRA Medicaid program has violated this longstanding state rule and has denied the community spouse this income...

	Court Reverses Cuts in Medicaid Coverage for Compression Stockings and Orthopedic Footwear 20 Dec, 2013 On December 9, 2013, the Hon. Charles J. Siragusa granted a plaintiff class of Medicaid recipients' motion for summary judgment, ordering a permanent injunction against the State's limits on orthopedic footwear and compression stockings. Davis et al v. Shah (Case number: 12-CV-6134-CJS). Download...

	MLTC Updates - 2012 - 2013 25 Nov, 2013 NYLAG has been publishing a running news article with updates about the roll-out of Managed Long Term care. The most current news is posted here http://www.wnylc.com/health/news/41/. - includes updates since Jan. 1, 2014. Earlier postings from 2013 are in this article More information about...

	Health Exchange Navigators/In-Person Assistors Announced 10 Jul, 2013 The New York State Department of Health has released a map containing all the In-Person Assistors/Navigators for New York State. In-Person Assistors/Navigators will provide in-person enrollment assistance to individuals, families, small businesses and their employees who apply for Health...

	CMS suspends marketing and enrollment for SmartD RX Part D plans 25 Apr, 2013 Due to "significant compliance failures" which "create a serious threat to enrollee health and safety," CMS has issued an immediate sanction against SmartD Rx, a Medicare Part D contractor, and suspended all its marketing and enrollment activities effective April 23, 2013. SmartD RX (S0064) is...

	Evelyn Frank Legal Resources Program Moves from Selfhelp to New York Legal Assistance Group 09 Apr, 2013 Mergers don't only happen in the hospital world. Effective April 1, 2013, the Evelyn Frank Legal Resources Program (EFLRP) which was founded by and has been a division of Selfhelp Community Services, Inc. since the 1990's, has merged with the New York Legal Assistance Group (NYLAG). All...

	2013 Health Budget Restructures Medicaid Eligiblity 05 Feb, 2013 The Proposed 2013-2014 Health Budget contains sweeping changes to Medicaid eligibility and enrollment as required to implement the Affordable Care Act (ACA). The numerous existing population categories are consolidated into two groups - those whose eligibility will be determined according to the...

	Hurricane Sandy Resources on Health Benefits Access- Emergency Rules & Deadlines Extended 14 Nov, 2012 The Empire Justice Center has compiled links to Resources for Those Affected by Hurricane Sandy. Please see that link for information on Immediate/Emergency assistance, legal assistance, Food Stamps, Consumer, Social Security, Medicare, Medicaid, Housing, Immigration, and general information on...

	CDPAP Services Covered by Mainstream Medicaid Managed Care as of Nov. 1, 2012 for People Without Medicare 02 Nov, 2012 On November 1, 2012, Consumer-Directed Personal Assistance Program (CDPAP) services were added to the benefit package for "mainstream" Medicaid managed care (MMC) plans. Most Medicaid recipients in New York State who do not also have Medicare, are already enrolled in these plans,...

	State Clarifies 24-hour Split-Shift Medicaid Personal Care Eligibility, and Class Members have 21 Days to Request Reinstatement - Under Preliminary Injunction in Strouchler Class Action 05 Oct, 2012 There are 2 developments in implementation of the preliminary injunction in Strouchler v. Shah, which challenges across-the-board cuts by the NYC Medicaid program in 24-hour "split shift" Medicaid personal care services. 1. ...

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