New York Health Access - Recent Articles

Recent Articles

	Medicare Insurance Premium Payment Program (MIPP) Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $185 in 2025. MIPP is for some groups who are...


	Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes start Nov. 1, 2024 Enrollment in a Medicaid Managed Long Term Care (MLTC) plan is mandatory for most adult Dual Eligibles (people who have Medicare or Medicaid), who need Medicaid personal care (PCS) or Consumer Directed Personal Assistance Program (CDPAP) services, with some exceptions - See also DOH list of...


	Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services NOTE: This article is about consumer rights when a Medicaid recipient "transitions" to or from a Managed Care plan. For information about care related to gender transitions, see Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care. What is a Transition...


	2025 Medicaid Fair Hearing Compliance Plan In New York, there are over 10,000 Medicaid fair hearings pending past the 90-day deadline. The backlog grew significantly during the COVID-19 Public Health Emergency and is the largest in the nation. To address the backlog and avoid corrective action, the Department of Health (DOH) announced a...


	Medicaid Renewals/Recertifications in NYC- Medicaid can be DISCONTINUED if RENEWAL not returned - Starting April 2025 This article available as a fact sheet in ENGLISH and SPANISH This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration (HRA). If your Medicaid is handled by the New York State of Health â�� your renewal is not covered...


	Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility New York State Medicaid covers many immigrants not covered by federal law. Since 1996, federal Medicaid limits Medicaid eligibility to US citizens and “Qualified Aliens,” which include: Lawful Permanent Residents (LPR or “green card”) – under federal law, all but pregnant women...


	Immigrant Eligibility for Medicaid & other Public Benefits - 2024 Update for Undocumented Immigrants Age 65+ Updated Immigrant Eligibility for Public Benefits in NYS Chart by Empire Justice Center & NY Immigration Coalition - updated Jan. 2025 - SCROLL DOWN to DOWNLOAD CHART at the above link. PUBLIC CHARGE - See updates here. Jan. 1, 2024 Expansion: Undocumented Immigrants Age 65+...


	Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State - Big Changes Coming 2025! March 10, 2025 ALERT - Only 2 weeks left til March 28, 2025 Deadline for all CDPAP consumers and their Personal Assistants to be REGISTERED with PPL - the new NYS "Single Fiscal Intermediary" (FI). See here for links to information from State DOH, CDPAANYS, and PPL. See this article for latest...


	KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind This Fact Sheet (updated 03/05/2025 with 2025 figures) explains Medicaid eligibility for New Yorkers who are age 65+ or who have disabilities. It explains the basic financial rules on eligibility for Medicaid in the community for this category of people, and explains how to apply for Medicaid if...


	Income and Resource Limits for New York State Public Health Insurance Programs Big increases in income and asset limits for Age 65+, Blind & Disabled (ABD) took effect Jan. 1, 2023 - read about how these were rolled out here. Terminology note - The "Federal Poverty Levels" (FPL) are the same thing as the "Federal Poverty Guidelines." Sometimes you will see these terms...


	NEW YORK INDEPENDENT ASSESSOR PROGRAM (NYIAP) - How Medicaid Home Care Eligibility is Assessed IN THIS ARTICLE: What is the Independent Assessor? Click here for the basics. Two Official Websites about NYIA When does NYIA Start? Contacts - Where to Submit Complaints, How to Request an Evidence Packet, How to Submit a Power of Attorney NYIA CONSENT FORM - Where to...


	NYS Medicaid Application Form and "Supplement A" for Age 65+ or Disabled or Blind Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or Health Insurance Application or form DOH-4220 - available at this link. (As of 2-06-25 the form was last updated in January 2023.) See GIS 23 MA/17 - Revised DOH-4220: Access NY...


	Medicare Savings Programs (MSP) in New York Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries, qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs, and for those in QMB - pay Medicare coinsurance and deductibles. As of 2023, there are TWO separate...


	Medicaid Personal Care or Home Attendant Services The Medicaid program in New York State covers a type of home care services called Personal Care services (aka PCS or "home attendant"). This is a service under NYS's "State Medicaid Plan," which means that the rules described here apply whether the consumer receives it under fee-for service from...


	Medicaid Alerts & Other Protocols published by the NYC HRA Medicaid Program HRA Medicaid Alerts are periodic announcements of policy, staff and office changes published by the HRA Medicaid Progarm (formerly called the "Medical Insurance and Community Services Administration (MICSA)". The Medicaid Program is the part of New York City’s Human Resource Administration...


	List of Pooled SNTs in New York State This is an unofficial list of non-profit organizations in New York State that offer pooled Supplemental Needs Trusts (or similar services) to people with disabilities. We do not claim that this is an exhaustive list; there may be other pooled trusts in the state of which we are unaware. In...


	Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...


	Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections Medicaid rules are different for people living in the "community" than people living in institutions. For this article, the word "institution" means nursing home care. If you live in your home, someone else's home, or an Assisted Living Program, you are considered to live in the "community." ...


	Medicaid Spend-down: NYC Medicaid Now Accepts FAXED Medical Bills In May 2009, the NYC Medicaid Program announced a pilot program that allows consumers who must "spend down" to qualify for Medicaid to fax their medical bills each month to the Medicaid Centralized Surplus Unit. See announcement. You can download the official Spend-down fax cover sheet with the...


	Medicaid Managed Care IN THIS ARTICLE * Complaints - Where to File *Law & Regulations & Model Contracts, CMS Special Terms & Conditions 1 - What is Managed Care? 2 - Mandatory Enrollment for Most People with Medicaid - and LOCK-IN 3 - Who is Exempt or Excluded from Enroling in Managed Care 4 -...


	Medicaid Assisted Living Programs (ALP) in NYS INTRODUCTION The Assisted Living Program provides supportive housing and home care services to individuals who are medically eligible for placement in a nursing facility but, whose needs can be met in a less restrictive and lower cost residential setting. he operator of the assisted living...


	Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income" Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting used for people age 65+, Disabled, or...


	Medicaid Fair Hearings in NYS - Common Links and Changes Medicaid recipients have the right to request a Fair Hearing to appeal an adverse action. This includes decisions made by a managed care or Managed Long Term Care plan, by the local Dept. of Social Services, or by NYS's contractor, NY Medicaid Choice or the NY Independent Assessor. This is not...


	Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA) August 5, 2024 - address for main NYC Medicaid Office - called the Brooklyn South Medicaid office - has been changed to 495 Clermont Avenue, Brooklyn, NY 11238. This is around the corner from the previous address on Atlantic Avenue since 2013 see 2024-08-02 Change of address for Brooklyn_South...


	New York Medicaid Expansion - 2023 Know Your Rights: What You Need to Know About NYS Medicaid Expansion in 2023 This year’s Health Budget makes significant changes to New York’s Medicaid program – expanding eligibility to 138% of the federal poverty law (FPL) and changing budgeting rules and enrollment processes for...